#7201 How stigma unfolds for patients with functional neurological disorder (FND); clinical interactions matter, but it’s not the whole story

<h3>Objective</h3> The aim of this study is to investigate experiences of stigma in FND from the perspective of the patient as it unfolds from symptom onset through diagnosis and thereafter, viewed through the lens of known stigma frameworks. <h3>Background</h3> Quantitative studies have identified that stigma is a problem for patients with FND, and several qualitative studies have examined patient perspectives and experiences of FND, from which stigma themes naturally emerged. The majority of these studies relate to functional seizures – there are few studies covering the fuller spectrum of FND symptoms. Additionally, few studies have focussed on how a patient’s stigma experience unfolds over time, keeping in mind recognised stigma frameworks. <h3>Methods</h3> We performed a qualitative interview study with patients who were diagnosed with FND, using data based on semi-structured interviews. Our topic guide comprised open-ended questions that were informed by the stigma in healthcare literature. Participants were recruited consecutively via outpatient clinics. The audio-recorded interviews were transcribed verbatim and analysed using the software program MaxQDA 2022. We followed six iterative steps of analysis: familiarisation; coding; generating initial themes; reviewing and developing themes; refining, defining and naming themes; and writing up. We used a reflexive thematic analytic approach, discussing any differences in coding until consensus was reached. We selected illustrative quotes which we considered depicted a theme/subtheme well. <h3>Results</h3> We interviewed 15 patients, 11 who identified as women, one as non-binary and three men, aged between 19 to 68 years. We identified six themes and 16 subthemes relevant to their stigma trajectory. We found that stigma unfolds through four main areas: 1) through their <i>symptom experience</i>; 2) through <i>‘othering’ by the healthcare system</i>; 3) through <i>everyday interactions</i> with friends, family and online; and 4) from w<i>ithin the self.</i> Underpinning these four domains was a central theme of 5) <i>stages of knowledge</i>, and lastly, 6) <i>validation</i> emerged as a ‘counter-stigma’ theme. <h3>Conclusions</h3> Stigma did not unfold as a linear process; it came from multiple sources that interacted with each other in a dynamic way. Stigma was fuelled by lack of knowledge – from public misperception to clinical confusion, and was countered by increasing knowledge, and validating the patient experience. The point of diagnosis emerged as an important moment from which knowledge could be imparted in a helpful way, and there were many other areas that could be useful targets for counter-stigma interventions for FND.