P3.208: Functional Neurological Disorder in an Adolescent - The Impact of Culture and Stress

Introduction: Functional neurological disorder can have a poor prognosis, particularly when it affects gait, and is especially debilitating in adolescents with acute onset and no specific trigger. Psychogenic gait usually requires extensive physical therapy, making quick recovery unlikely. Additionally, functional neurological disorder is often linked to prior psychiatric diagnoses. This case explores the impact of minority culture and how poor coping skills in adolescents may contribute to functional neurological disorder (FND).

Case Description: A 16-year-old Asian American male in 12th grade with no known psychiatric or medical history presented with syncopal, seizure-like episodes and inability to ambulate for two days. Upon arrival at the Emergency Room (ER), he received lorazepam intramuscularly for shaking, which resolved, but he remained unable to walk. Symptoms spontaneously resolved within 48 hours, returning to baseline. He was discharged with outpatient follow-up.

The patient reported his primary stressor was the end of a recent relationship. Other stressors included academic responsibilities—president of Junior Reserve Officers' Training Corps (JROTC), applying for universities, maintaining high grades, and volunteering at a medical clinic. He denied depressive, manic, or psychotic symptoms, substance use, trauma history, or other recent changes. He also denied suicidality history, except for brief non-suicidal self-injury 6 months ago due to academic stress.

These symptoms did not recur until a few months later when his former partner falsely spread rumors about an incestuous relationship with his sister and involuntarily signed him up for the Marines. During this time, the patient lost consciousness for 1-2 minutes, with severe pain and tremors in his arms and legs. He could not ambulate until arriving at the ER, where he was medically cleared and returned to baseline within 30 minutes.

The symptoms recurred mildly a month later during emotional distress from bullying by JROTC members, causing dizziness and leg shaking that resolved in minutes. He now uses coping skills like running and weekly therapy. He is future-oriented, insightful about his stressors, and consistently attends appointments. He declined medications, preferring therapy.

Discussion: Adolescents' coping skills, or lack thereof, can contribute to gait difficulties, with emotional distress manifesting physically as FND. Cultural stigma surrounding mental health prevents open discussion, leading to underreporting and reluctance to seek help. Minority groups, particularly in Asian cultures, discourage emotional expression and emphasize obedience, exacerbating stress. As adolescents navigate cultural differences, internalized stress may contribute to FND.

Conclusion: The relationship between cultural stigma, emotional distress, and physical symptoms like gait difficulties highlights the need for improved mental health awareness and support. Addressing cultural barriers, promoting emotional expression, and providing timely intervention can help prevent the development of physical manifestations of stress. By improving healthcare access and mental health education, we can support adolescents in navigating stress in a healthier way.