FNDS 2026 Conference

This episode is a lively discussion with various conferences moderators and presenters at the FNDS 2026 Annual Conference in Baltimore, MD, USA

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SPEAKER_02 0:02

Thank you for listening to the FD Society podcast. I'm your host, Erica Cotton, coming to you from Chicago. I have an excellent team, including Michael Romeo, our sound and production engineer, coming to us from Australia, and our content curators, Ingrid Huritzauer from the UK, and Chris Ma Pretorius from South Africa. We also thank Megan and Robert for all their administrative support. So this episode is an on-site FNDS conference discussion. Guests are Ingrid Hurritzauer from the University of Edinburgh, Chadrick Lane from the University of UT Southwestern, Alex Lynn, Princess Alexandra Hospital, Christma Victorius from Stalinbosch University, Gabrielle Gilmore, University of Calgary. And what my listeners can't see is that all of these wonderful guests are enjoying themselves by giving very enthusiastic hand gestures for every single one of us. With that, I will turn it over to Alex and Chrisma to discuss day one and the initial training for our uh listeners.

SPEAKER_00 1:06

Thank you. Well, you should ask us what our our highlights are, I think. Yeah. Day one was my highlights of five to say. Um I'm very much a clinician at heart. I think this is something we need to foster and drive in a society. I think this is a really nice tradition. We have already started with those um day one training courses. I have forgotten already what first stands for. What was first? Fundational But it sounded a good editorial. I have forgotten, admittedly, what first stands for, but really enjoy the day. I I think this is something that needs to be done at every um meeting. This is a really great opportunity to get junior doctors, junior adult health, um, and other interested people on boards, create a common level of understanding about that and really drive good clinical care. So I think this is totally to be done further and hopefully even build up on further with more practical courses that we can do.

SPEAKER_02 2:04

As a society, I think this is just a really cool thing. I haven't seen this at many other meetings where there's such an opportunity for such immediate learning before people even start the context. You just don't see that. I think it's great that FNDS is doing anything. It's really allowing a lot of growth and training.

SPEAKER_00 2:20

And I don't have easy answers for it because it's probably you have the same, like with the different tracks that we have. Oh, yeah. Amazing as it is, but then you kind of always I always have FOMO, isn't it? Should have gone to the other one.

SPEAKER_03 2:31

That's a great time. Like I love the opportunity to go to different uh tracks as the years come by.

SPEAKER_02 2:37

Yeah, yeah.

SPEAKER_00 2:38

Yeah.

SPEAKER_02 2:38

Yeah, we could cycle through the years. Yeah, thank you.

SPEAKER_00 2:41

And Chris, my you enjoyed the afternoon session.

SPEAKER_01 2:44

Yeah, and um, another important and uh memorable session focused on self-care and burnout prevention for uh clinicians working with F and D. So while FD work can be um deeply rewarding, it also carries unique challenges, as we all know. And uh, Prof. Stern highlighted the emotional intensity of this work and the sense of responsibility clinicians often feel um for the patient outcomes. And a key message was that it's normal to struggle at times. And um, patients are not to blame for their conditions, and uh clinicians are not solely responsible for their recovery. That was quite quite cool to be reminded of that. Um, sustainable practice requires realistic expectations, clear boundaries, and um support from colleagues and multidisciplinary teams. Um, this session also addressed practical strategies for managing workload. I think we all struggle with that now, um, including the value of structure effective communication and recognizing that meaningful progress is often incremental rather than dramatic. Um, importantly, many patients are not seeking a quick fix. Um, they want to be taken seriously, understood, and given reassurance about these symptoms. And a recurring theme was the importance of connection. Um the session concluded with a reminder that FD care is a team support and that clinicians should make use of the wealth of expertise and support available within the wider F and DS community. I think that's so valuable for people who work in isolation of uh to reach out to colleagues from the F and D S T. So I really, really enjoyed that session.

SPEAKER_05 4:23

So glad that you mentioned that. I've been doing FD work for about four uses now, and there's something quite validating and helpful to see your heroes standing on stage, like Alan Carson and John Stone, and telling us we have these challenges too, we face the same struggles, we have the same needs. It allows us not to feel in isolation when we hit those roadblocks.

SPEAKER_00 4:46

You know, when John Stone gave that quote of that junior doctor who said it in his in his clinic, who said, Oh, the most positive most helpful thing was symptom struggle. I totally see where it's coming from. I can totally think it was time as well.

SPEAKER_04 5:00

I think clinics are always running.

SPEAKER_00 5:02

I was like, You too, oh my god, okay, lovely.

SPEAKER_03 5:07

I think a theme for me that day was definitely team. I exactly as you said. And you know, the whole talks, all the talks, my nurse and I were texting each other, planning our next team building activities and all the things we wanted to do together to really emphasize that.

SPEAKER_04 5:21

And I I love as well that there are like nurses here, you know. Obviously, we've such a wealth of sort of psychological experience and also neurology and psychiatry, but also like more nurses, more speech and language pathologists and therapists, and like um, you know, and kind of an obviously amazing OTs. And you know what I mean? It really's starting to feel like we're actually getting the whole team sort of to come. So I've been texting my people being like, You all need to come these years to figure out how to get people's study budget.

SPEAKER_00 5:50

So we did see for a lot of teams, the whole team actually turned up or certainly various team members. It was really nice to see, isn't it?

SPEAKER_03 5:57

And in our in our neurology track, um, we asked sort of the audience who was there, and we had a paramedic there, we had a family doctor. Like that's that was like very, very wonderful.

SPEAKER_00 6:07

I sat on a table with a guest phonologist for public.

SPEAKER_02 6:12

No, this is a future.

SPEAKER_05 6:15

It was also really nice to hear that moment when uh Professor Stone mentioned in a perfect world you'd have this huge multidisciplinary team, but that one person can make a difference. If you don't have the resources, if you're not in the location and the setting where you have a big multidisciplinary team, you can make a difference.

SPEAKER_04 6:33

Yeah, yeah, because I didn't he say though that you can just sort of just even some of the best things he's done is just think phoning somebody, having that conversation with a different with a therapist who maybe doesn't feel so useful or doesn't feel like they have skills. And I think as well, like the I mean FNTS, you know, the the training and the rehab 101, like that is again another thing I'm gonna take away because there are people sort of again that I work with at more the district general hospitals that feel very much like they don't know what to do. And I'm like, oh, I'm going to go to that resource we already have. And you know, again, do that anyway. Sorry, we're talking too much about day one.

SPEAKER_02 7:10

Yeah, I think everyone's comments about day one is just a testament to the importance of foundational training and entry-level access for people for where F and D as a diagnosis and as a profession is. And so I think it's just so important that we highlight that that is you don't need to be an all-star in FND to come to FNDS and learn something and participate. So I think that's excellent. With that said, um, let's continue uh discussing um comorbidities with Gabrielle and some of our first talks that we that we heard from.

SPEAKER_03 7:43

Yeah, so I think we've had a really nice selection of talks that really highlight the comorbidities that we see with FNT. So we've had some talks about, you know, the GI system and the gut brain axis. We've talked about um POTS, uh, pain, ailers, download. So lots of different things. And that's something actually that we're really looking forward to as well in the next day with autism and brain. Yeah. I think something that really stuck out for me was the POTS talk. I really loved the um the description of POTS as being a functional autonomic disorder, and there are also structural autonomic disorders, and we can really think about the condition in a very similar way. Um, and I loved the future of POTS treatment with using or borrowing from pain reprocessing therapy to POTS reprocessing therapy and starting to think about these novel treatment options. Very exciting.

SPEAKER_04 8:37

Yeah, that feels very hopeful as well. I think because I think and again that sort of hope was similarly, I think, taken forward in the Aller San Loss lecture as well, which again felt really hopeful and very much like, okay, so you know, we know that sort of one in ten people will will be asymptomatic, but we'll kind of have these sort of these positive findings and the bite score.

SPEAKER_02 8:56

And I think uh we actually have to tell say the audience we had everybody to be quite everybody was so busy checking to see what you can't see, but all the guests right now are doing the the the EES different tips of hyperflexibility with all of them more than 10 degrees is pretty good, but that's way better. Okay, so the whole entire room of 600 people looking at their elbows and their thumbs, it is quite quite a spectacle.

SPEAKER_04 9:28

Be quiet like twice because everybody can because the talk I think was so engaging. And I think it's been so nice to be in a room, I think, for those other people that are really enthused by all this stuff. Because again, the conversations at the tables, you know, we've had to be like, shh, let's stop it, and everybody, we need to just focus. I thought the prize up here. But that I thought that was really good and really hopeful. And again, um, and and again, you know, I think I think some of the narrative about ADS is it can be sort of very like, oh, you know, people are broken and their autonomic system is broken and they're gonna end up with all these kind of awful things that are happening to them. And I again, I thought like somebody who's just so clinically focused and to have that talk and to have that sort of those positive outcomes and to talk as well about like again treatment. I think it's the kind of thing I am gonna say to you, like, everybody listening, go go look at that talk. It was really good. I think the pot's talk and that one were just like my real highlights.

SPEAKER_05 10:25

Ingrid, I know you you had firsthand experience having moderated a session. You mentioned how engaged everyone is. The other way that's been reflected is the number of amazing questions. And there's just not enough time to get through all the questions, but uh certainly points to how interested the audience is.

SPEAKER_02 10:47

Yeah, they're exceptionally thoughtful. Obviously.

SPEAKER_04 10:49

Very point, great, yeah, yeah. And I think it's been really nice as well, again, so to have different kinds of thoughts in the room as well. So we were talking about like at the beginning, you have to sort of when you um sign into the app and things like that, you have to agree that you're gonna be comfortable with other people saying things you might not necessarily agree with. Because the, you know, the thing about FND is is that you know, they're there, I think particularly because it's been sort of something that's been so stigmatized and underrecognized, you know, we you you have a real sort of fellowship with people. Um, and and what that sometimes means as well is that you have to make sure that we are own, we're not just seeing what we want to see, that our predictions aren't becoming, you know, too big a trajectory. So I think it was really helpful to hear a different sort of viewpoint with the pain talk. And I think that allowed us to sort of have a look at this. And and and you know, again, I think that it was um so we were so again, it was really, but again, I thought that that was really well handled where it were people again, where we had that challenging but helpful discussion about again, what is nosoplastic pain, you know, what is neuroplastic, what is um nosoceptive pain, you know, what are the differences between those? And I think again, it started a lot of conversations about some of these really important comorbidities. And as Gabrielle said, you know, we're looking at migraine, we're looking at autism, you know, we're looking at these other kind of things that again we see over and over again in our patients, and it's just trying again, um, what what is the rest of the world saying about this? So that we're not just in our little bubble where we're like, everyone thinks this, you know what I mean? And then again, if if we disagree, we can do that in a really lovely, respectful way. And then we can also again recognize that you know other people have thought sensitively about these things. So how do we then again sort of assist in sort of maybe shifting conversations forward? So it was a really I thought it was a really positive thing. Again, do you want all the voices in the room and then everybody moves things forward? And I we had a we had a really interesting conversation about the the sort of the functional gut disorder stuff, and I don't know if anyone else wants to say anything about that.

SPEAKER_05 12:52

Well, I I think that I think that does tie in pretty well into some of the upstream mechanisms that we've been learning about today. This idea of the embodied mind. So when we think about functional neurological disorder, the concept of our brain is trying to make its best guess about what's happening in the body, how to interpret and perceive the signals it receives from our body. And sometimes its best guess might not be exactly accurate. And it could even feel extremely confident, it could feel quite certain that it's accurate even when it's not. And we we have applied this model, this predictive processing model in F and D. But as we start to learn about these conditions like disorders of gut-brain interaction, like POTS, like chronic pain, we see that this is a common story that runs across disciplines. We've been talking about some of the same things, just using specialty-specific language. So, one of the nice things about F and D society, and as I heard my colleagues say that there was a family medicine doctor, a paramedic, a gastroenterologist, that's exactly what we need to shed light on how these conditions might have a common cause, a thread that's upstream happening in the nervous system that could explain uh symptoms across different organ systems. So it's uh it's been really, really impressive to see that play out. But there's a lot of uh science that's happening in intersection and predictive processing. There's a lot more that's coming down the pipeline. And then, of course, the pursuit of knowledge is great on its own, fantastic, wonderful discovery. Two thumbs up. What's really wonderful is when you can apply the pursuit of knowledge to ease the suffering of another community, and that is the intersection of the F and D society. I want to put a plug-in for uh on that note. We have this is the first year that we're launching our cultural ambassador program, and we are over the moon excited about this because it has brought together over 20 ambassadors from around the world to come together to understand how culture informs the diagnosis, the treatment of people living with F and D, and how do we continue to share knowledge across languages, across regions throughout the world? So it's it's really beautiful to see that coming to fruition.

SPEAKER_04 15:07

I think so positive, and actually, and I know Chrisma will keep me pointing at her, which I'm currently doing it, but um, but but Chrisma's talk was also about about our explanations how that how they have to be sort of cultural specific. And again, I think that's you know, even the language that we use, the analogies that we have, they are going to be different depending on where we are and what our you know, and and so again, as you said, like I'm I'm so delighted as well about the cultural ambassador. I saw the role and I was immediately like, go everybody, go because because we we need to have an understanding and we need to be able to to speak in with local parlance about about what this is, because it is a universal thing, you know, this is what happens when the brain predicts wrong, isn't it? Um yeah, so I really like that. And I also liked in the functional gut disorder a bit where where the speaker talked about how um overlap is the rule, not the exception. She was like, Look, if you've got IBS, you're probably also gonna have these other things. And I think, you know, again, like looking at all that stuff. Um, you if you look way back at one of my hair, Dandon Claw, who Erica did a lovely podcast with, um, you know, again, he was talking about that way back when. And again, I think it's just so nice to sort of see these things replicated and again in a really scientific way. Um, yeah, and the interception talk was such a scientific exploration of that. So I don't know if that is, I mean, that was amazing.

SPEAKER_02 16:32

That that segue into just how um there is no simplicity in F and D. It's it's always complexity. I think that's a great segue in into discussing the upcoming talks and the rest of the conference where we have discussions considering autism, migraines, autoimmune, and classification. Speaking of how we're even attempting to classify all these different overlaps and conditions. Does anyone want to share any hopes, expectations, and comments about our classification?

SPEAKER_04 17:03

Why I'd just say that um Sonia did the first talk I've ever heard about classifications that wasn't boring. That is an odd limited for I was not asleep for any of that. And that is really difficult. So I think, but it's so exciting, isn't it?

SPEAKER_03 17:22

And I think something that I'm so excited for about it is really, you know, as we're thinking about all these different conditions that probably have similar upstream mechanisms, we're starting to define a little bit more what is FND and how is FND different, but also related to these comorbidities and these other things. And I think that that is very exciting for me in terms of what that can mean for a future research for our patients.

SPEAKER_00 17:45

And it makes clinical sense. Like DSM by all means has come a long way. Um, but it's very much historically grown and has some historical baggage as well. Uh, and seeing with on the basis of the new understanding, we have those very sensible classifications, I think, will do a lot of good to the society and for patients.

SPEAKER_02 18:03

And for those um listeners not aware or not following along with the conference, um, the as an F and DS initiative, um, there is a classification uh committee and discussion. Um, and uh Sonia presented those preliminary um steps or components and requested um membership feedback, which again, yeah, just just the edge. Raise your voice, everybody. Like raise your voice. We will try to include a QR code um in the show notes that may or may not be possible. Um, but if if you are a member, we would encourage um, we will also send it out and highlight that in the upcoming newsletter, et cetera. So please do um comment and um make sure that your views are represented so that we have a well thought out um diagnostic classification system.

SPEAKER_05 18:49

Shout out to Krisna, who was on the working group for I believe the functional dissociative seizure subject.

SPEAKER_04 18:54

Yes, yeah. Yeah, and the hopefulness of the conference has been a big thing, hasn't it? We were at we had the functional um cognitive disorder sessions this morning, which were again about diagnosis and all of that work. And again, you know, you know, that thing about is you know, I think again, this uh there's been several um, you know, kind of commonalities. So everybody's had biological, psychological, social, great. Everybody's had don't be weird, and but then also, but then also people have really again embraced other literature and brought that in. So again, a lot of like no Silverberg's work about kind of um post-mild in brain injury stuff in the functional cognitive disorder stuff, and then also all this hopeful kind of rehab stuff that I know that you're leading on, Erica. And again, she's already gone red because she doesn't like fabulous, but it I'm sorry, you give a great talk, we need to talk about it. But it was it was really, really positive, and again, I think just um, and it's something is that maybe if you don't mind, we could also share your QR code too, in terms of her access to the functional cognitive resources, yeah, yeah.

SPEAKER_02 19:58

Of course, I'd be very happy to share that. Yeah, thank you. Assuming we can include it, we I don't know if we've included a QR code in the show notes, but um or a link. Yeah, or a link we we can do that as well.

SPEAKER_01 20:08

Um I think one other thing I'm looking forward to is the patient session including the perspectives of our patients and to just keep us reminding that they are at the center of our work and also to learn from them.

SPEAKER_04 20:26

Oh that's it, I think it makes it much more poignant, doesn't it, to have because you know, we've got patients in the audience and it just you know it's that thing, isn't it? About when you have people that are involved in in in the care that you provide in the audience, you you that's exactly what you want because you want to know what are the questions that they have that we are currently not answering, you know, what are the things that are coming up for them whenever they're listening to us present, you know, and that is And how how nice to connect to them.

SPEAKER_00 21:01

Are several patients grabbing it between sessions and having a chat and connecting, and it's yeah, we did where else, what other society do you imagine that's something very special.

SPEAKER_02 21:11

But it's perfect, isn't it? I think it is it offers that different layer because we're all here because we're clinicians, but the opportunity we have with patients is one-to-one, and there's not really a forum for the broad patient to talk to the broad clinician about the state of the field, which is just the the level of at which that can impact change or guidance or growth and shared growth and learning, I think is is really powerful and very impactful.

SPEAKER_04 21:38

I know we're probably running almost out of time. Oh, we have tops to get to, tops to get to my model. Um so I'm gonna give you my top talk. Okay, right. Um, so I really liked when bodily self is no longer functional. So I'm not I'm a normal person, I'm a just a just a boring clinician that sees patients, but like that was my favorite one. Like, oh how interception works and how oh, it's lovely. Anyway, that was my favorite. Okay, what about anybody else? I'm up on the spot.

SPEAKER_02 22:14

I give a plug for the driving talk. Alex will not not say it himself, but just patient safety with driving. I can't think of a more critical clinical intersection than that. And I think they've done great work. That was one of my favorites.

SPEAKER_03 22:26

I think my favorite was Ingrid's talk um about women and hormones. And you know, when I was moderating the session this morning, seeing the number of questions coming through about mencies, about uh menopause, I I think it it struck some uh got some people thinking, shall we have?

SPEAKER_00 22:44

And she could totally have a second career as a stand-up.

SPEAKER_04 22:49

I would like to point out that I gave everybody $20 before we came in here.

SPEAKER_05 22:58

I'm just waiting for Ingrid's Netflix special.

SPEAKER_04 23:03

No, you know what it is? I had Hulk Hogan in that, and I was like, no doubt, nothing to have an art here.

SPEAKER_02 23:09

Anyway, you've heard it. Just it's FNDS is Hulk Hogan. No, it is a wonderful place, I think, for providers to connect um and have each other as a resource, as support, to learn from each other, to hear from patients, and to try and progress the field at all different stages across people just starting to great research to clinicians just trying to learn and improve and practice. And it's just I can't say I don't know about you guys, but I just think it's always such a pleasure to be so inspiring to see so many wonderful people and just good for the soul to see other people who are as crazy about as they are. A little crazy and nerdy. Um, so with that, I want to be sure to thank everyone and please enjoy the rest of the conference and thanks to all of our all of our listeners. And listen, frog and yeah, frog. Okay, bye everyone.