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I had a fascinating conversation with Dr. Ryan Van Patten, board-certified neuropsychologist, podcaster, and researcher, about the increasingly recognized but still misunderstood condition known as Functional Cognitive Disorder (FCD). We unpacked its place within the broader Functional Neurological Disorder (FND) umbrella, explored the core concept of “internal inconsistency” as a positive diagnostic sign, and discussed how clinicians can compassionately assess, diagnose, and treat FCD. We also delved into mechanisms like metacognition, abnormal Bayesian priors, and the nocebo effect. Ryan shared incredibly practical insights for assessment and feedback sessions, along with an honest look at what research and clinical resources are still missing.

Topics Covered

• Why FCD represents the “quintessential neuropsychiatric disorder”
• The biopsychosocial model and the “Four P’s” of formulation
• FND vs. malingering: clinical and neurological distinctions
• Internal inconsistency as a diagnostic hallmark of FCD
• How to assess FCD using interviews, behavioral observations, and testing
• Differentiating FCD from MCI and dementia
• Metacognition, memory perfectionism, and nocebo effects
• Providing compassionate, validating feedback to clients with FCD
• Treatment strategies clinicians can use today
• Research gaps and future directions for the field

Resources Mentioned

• Harriet Ball et al. (2020) – Diagnostic criteria for FCD
• Navigating Neuropsychology Podcast:
  • FCD w/ Dr. Laura McWhirter – Episode 128
  • FND w/ Dr. Mark Hallett – Episode 108
  • Functional Seizures w/ Dr. Curt LaFrance – Episode 112
  • Persistent Post-Concussive Symptoms w/ Dr. Noah Silverberg – Episode 147
• FND Society Education Hub – www.fndsociety.org/fnd-education
• FND Hope (patient education and advocacy) – www.fndhope.org
• Functional Neurological Disorder education portal – www.neurosymptoms.org
• KnowNeuropsych: Functional Neurological Disorders page
• Reuber et al. (2009) – Biopsychosocial model of FND
• Teodoro et al. (2023) – Mechanisms of FCD: Metacognition & Expectancy
• Cabreira et al. (2023) – Systematic review on FCD vs. dementia

Cool Things Mentioned

• The Testing Psychologist mastermind groups and business consulting

Featured Resources

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About Dr. Ryan Van Patten

Ryan Van Patten, PhD is an Assistant Professor at Brown University and a Board Certified Clinical Neuropsychologist at the Providence VA Medical Center in Providence, RI. Ryan is an active researcher, clinician, and educator. As an early career clinical scientist, he has over 60 peer reviewed publications (more than 30 first authored), as well as VA grants, book chapters, and editorial service. His research program focuses on functional neurological disorder, digital neuropsychology, traumatic brain injury, and cognitive rehabilitation.

Get in Touch & Resources:

• E-mail: ryan_van_patten@brown.edu
• Website: www.navneuro.com

About Dr. Jeremy Sharp

I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

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