How dismissed symptoms can push patients to breaking point

University of East Anglia

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Peer reviewed - survey - humans

Patients have been left feeling suicidal after feeling like their doctor was saying their symptoms were ‘all in their head’ – according to research from the University of East Anglia and the University of Cambridge.

A new study uncovers concerns about misdiagnosis, stigma and inconsistent care for people with autoimmune diseases who are also diagnosed with functional neurological disorder (FND).

It also reveals deep disagreements between clinicians over FND diagnoses.

The research team say better communication, multidisciplinary working and more holistic care are needed to improve patient outcomes.

Lead author Dr Melanie Sloan, from UEA’s Norwich Medical School and the Department of Public Health at the University of Cambridge, said: “FND is a recognised neurological condition that can cause symptoms such as weakness, shaking, changes in movement or feeling, and non-epileptic seizures.

“These symptoms are real and are not made up or under a person's control.

“We wanted to better understand the challenges of diagnosing complex neurological symptoms in autoimmune diseases, and why patients and clinicians can sometimes see things very differently.

“Ultimately, our aim was to identify practical ways to improve communication, reduce distress and help ensure patients receive the most appropriate care and support.”

How the research happened

The research team explored how FND diagnoses are used and understood in people with autoimmune diseases, and where disagreements arise between patients and clinicians.

Researchers analysed responses from international surveys involving 1,853 patients, 400 clinicians and 463 members of the public, as well as conducting in-depth interviews with patients and doctors.

They examined how complex neurological symptoms in autoimmune diseases are diagnosed, interpreted and communicated in real-world healthcare settings.

They found that while 86 per cent of patients agreed that a diagnosis of depression was correct, only 53 per cent agreed with a diagnosis of fibromyalgia and 30 per cent agreed with a diagnosis of FND.

Deep divide

Only seven per cent agreed with being told that their symptoms were “psychosomatic”.

Doctors taking part in the study described how difficult it can be to work out what is causing symptoms. Many said they had little training in FND and others had very strong opinions either for or against FND diagnoses.

Patients and doctors reported examples of symptoms being put down to the wrong cause, with misdiagnoses reported in both directions.

Dr Sloan said: “We still do not know enough about some of the ways autoimmune diseases affect the brain and nervous system to always be certain what is causing a particular symptom.

“FND is a real condition and people with FND need the right treatment. But we need to be careful about assuming we know the cause of every symptom and coming to quick conclusions. There may be many different causes of neurological symptoms in autoimmune diseases which are very hard to untangle.

“Clearer explanations of diagnoses could help patients understand and accept them, while doctors need to be cautious when the cause of symptoms is not clear.”

How a diagnosis is explained matters

The study found that the way a diagnosis was explained could make a big difference to how patients felt about it and that stigma played a role.

Doctors (72 per cent) were much more likely than patients (50 per cent) or the general public (48 per cent) to say that mental-health symptoms were seen as more acceptable or less stigmatised when they were thought to be caused directly by the person's physical disease.

Patients left feeling suicidal

Some patients described feeling distressed when an FND diagnosis seemed to suggest that their symptoms were psychological or something they could control. Poor explanations could lead to feelings of guilt, shame, loss of trust with some expressing suicidal thoughts.

The problem of stigma was also highlighted by Prof Guy Leischziner, neurology consultant at Guys’ and St Thomas’ hospital. He said: “FND used to be known by a variety of outdated and offensive terms like ‘hysteria’, and some of the old ideas behind that term have unfortunately carried over into how people still think about FND today.

“It used to be thought that FND almost invariably had a psychological trigger, but we now know that this is not the case. There is also growing interest in how physical illnesses, including autoimmune diseases, may play a role in FND.”

Why listening is key

The study found that patients were more likely to accept a diagnosis when doctors listened to them, explained why they thought a symptom had a particular cause, and explained how symptoms linked to FND differed from those caused by their autoimmune disease.

The researchers say better teamwork between rheumatology, neurology, psychiatry, patients and other specialists is needed, and listening - not just to a patient’s symptoms but also what they feel may be the cause or causes.

When patients feel dismissed

Michael Bosley, a patient and one of the study's authors, said: “How doctors explain this uncertainty really matters. People need to know that their symptoms are being taken seriously, understand why doctors think a particular diagnosis fits, and feel able to come back if things change.

"The damage done by an explanation that's unclear, rushed, or doesn't acknowledge the patient's experience was clear, with several patients in our study reporting feeling suicidal after a unempathetic diagnostic consultation."

Patient and co-author Lucy Calderwood added: “I think one of the most concerning findings from our study is that getting one of these diagnoses may be more about the doctor's views and pre-judgements than about the patient’s symptoms.

"So the same patient with the same symptoms could go to different doctors and one would say it was the autoimmune disease and another would say it is functional. And they’d get completely different treatment."

The findings come shortly after research from the same programme found that females were more likely than males to report that their symptoms had previously been put down to psychiatric or “psychosomatic” causes.

Together, the studies highlight the importance of listening to patients, being open about what we do not yet know, explaining diagnoses clearly and sensitively, and being more aware of gender and other biases in medicine.

Senior study psychiatrist Prof James Bourgeois, from the University of California, said: “The brain and the body are closely connected. Symptoms experienced by the brain such as depressed or anxious mood, confusion, or irritability go along with pain, weakness, and other symptoms of illness experienced in other parts of the body.

“Brain-related symptoms can be the first sign of illness, so doctors need to consider brain-related symptoms along with body-related symptoms. Brain-related symptoms are part of the illness and are not under the patient's direct control. Comprehensive care requires managing brain and body symptoms together in an integrated way, and doctors being honest about what we do not yet know.”

This research was led by UEA in collaboration with the University of Cambridge, Guy's and St Thomas' Hospitals NHS Foundation Trust, King's College London, South London and Maudsley NHS Foundation Trust, Swansea University, St George's University Hospitals NHS Foundation Trust, Barts Health NHS Trust, the University of Ferrara and Azienda (Italy) and the University of California (US).

It was funded by The Lupus Trust.

‘“False dichotomies” and “FND fundamentalists”: an international mixed methods exploration of clinician and rheumatology patients’ views and experiences of functional neurological disorder (FND) co-diagnoses’ is published in the journal Rheumatology International.

ENDS
 

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Journal

Rheumatology International

Method of Research

Survey

Subject of Research

People

Article Title

“False dichotomies” and “FND fundamentalists”: an international mixed methods exploration of clinician and rheumatology patients’ views and experiences of functional neurolgical disorder (FND) co-diagnoses’

Article Publication Date

27-Oct-2026

 

The mathematics of growing a shell

California Institute of Technology

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Caltech engineers have figured out a mathematical way to explain the puzzling reproducibility of molluscan shells—the animals' ability to make roughly the same shell, regardless of the challenges that an individual mollusk might face.

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Credit: Huan Liu/Caltech

Kaushik Bhattacharya is an engineer and materials scientist, but he has always been fascinated by seashells. Part of the draw is the "beautiful" idea that even simple organisms like mollusks can construct wonderfully complex structures over and again, even in differing environments. He marvels at nature's engineering capabilities.

""Manufacturing materials is a nasty, difficult process," Bhattacharya says. "How does nature do it so nicely in such simple organisms?"

Bhattacharya, Caltech's Howell N. Tyson, Sr., Professor of Mechanics and Materials Science, and postdoctoral scholar Huan Liu have now figured out a mathematical way to explain the puzzling reproducibility of mollusk shells—the animals' ability to make roughly the same shell, regardless of the challenges that an individual mollusk might face.

This mathematical method can reliably reproduce the characteristic shells of almost any class of mollusk—from the coiled shell of a nautilus to the fanlike shell of a scallop—beginning with nothing more than three elements: the shape at the leading edge of a developing shell (what the researchers call the "curve" element); a scaling factor that reflects how fast a shell expands; and the angle of the shell's rotation, whether it is making the tight spirals of a tower snail or the wide swooping whorls of a nautilus, for example.

The mollusk-shell growth process is both passive, meaning it happens without additional control, and energy efficient—and the scientists now hope to emulate this ability to make other materials with complex shapes, such as specialized manifolds for jet engines.

Bhattacharya and Liu, a Cecil and Sally Drinkward Postdoctoral Fellow at Caltech, describe their findings in a paper published in the journal Proceedings of the National Academy of Sciences on October 23.

About a year ago, Bhattacharya mentioned his interest in molluscan shells to Liu, noting that shell growth had to be governed by ""some simple rule which is done repeatedly," he recalls. "It can't be that the mollusk is sensing the whole shape and then adding to it in a clever way.""

By studying a variety of real seashells, including the conelike shells of some sea snails and the hinged two-part shells of bivalves, Liu saw that the growth lines of each shell had the same shape as the one before it. Like tree rings, these growth lines are laid down sequentially over time. As a mollusk grows, its mantle secretes material that the organism then makes into its shell, creating ridges or bands with each new growth.

Liu and Bhattacharya quickly realized that the growing edge of the first shell that forms in the mollusk's embryo—what is known as a protoconch—repeated one set of actions over and over. The growth lines only differed by a scaling factor, or scalar, and a turn, or rotation.

This suggested that a concept from mathematics called a Lie group (pronounced "lee") would be a natural way of describing seashell growth. (In this context, "group" is a collection of actions that can be combined or undone.) In a Lie group, those actions change smoothly rather than in fixed steps, and this characteristic makes them ideal for describing a process in which the same small operation is executed repeatedly. By treating the shell's growth as a Lie group that acts on the shell's growing edge, the researchers could work out a growth law—a mathematical formula that explains how the growing edge transforms as the shell grows. Using the law, they were able to accurately build up the full spiral shape of a shell by repeating the process over time.

"We found that the wide variety of molluscan shells can be described by a simple family of Lie groups that only contain three elements—one curve, one scalar, and one rotation," Liu says.

Changing the values of two of the three elements in the growth law produces markedly different shells. The starting curve at the growing edge of the shell sets the shape of the shell's opening, while the scaling factor, which the researchers call lambda (λ) determines how fast the shell expands. By changing those two factors in the model, Bhattacharya and Liu were able to generate the shape of nearly all known molluscan shells.

"What is remarkable about all of this is it's very robust," Bhattacharya says. "You can change things around, like the growth rate, or you can add a little defect, and still the overall shape of the shell remains very repeatable."

The scientists also showed that this whole-shell description is also mathematically equivalent to a local growth law at the growing edge. New material is added only along that curve, and the relative rate of material addition depends on the local geometry at that curve, such as how sharply it curves on the shell surface. From the beginning of development, once the protoconch is established, each step of growth determines the next, which means the continued expansion of the shell is a passive process. The mollusk does not need additional energy or activity to direct the construction of the shell; it simply builds upon itself.

The value of lambda—the scaling factor—also turned out to be biologically meaningful. Shells of mollusks within the same class on the phylogenetic tree—even some that look quite different from one another—have nearly the same lambda. And each of the five shell-bearing classes of mollusks (Gastropoda, Bivalvia, Cephalopoda, Monoplacophora, and Scaphopoda) occupies its own narrow range of lambda values.

Bhattacharya, who is interested in engineering materials in more efficient ways, says the results suggest the possibility of gentler and less energy-hungry methods of manufacturing complex parts.

The paper is titled "Local growth laws determine global shape of molluscan shells." The work was supported by the Drinkward Postdoctoral Fellowship and the Howell N. Tyson, Sr., Professorship at Caltech.

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Journal

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2614478123

Article Title

Local growth laws determine global shape of molluscan shells

Article Publication Date

23-Oct-2026

Shells of species within the same class (grouped here by color) have nearly the same value of λ, a scaling factor that the researchers found determines how quickly a molluscan shell expands.

The protoconch, the embryonic shell of the mollusk, is indicated here by the lowest arrow. Shells grow through repeated material accretion at the growing edge through a continuous sequence of transformations. Notice the repeated growth lines (purple dotted lines).

Credit

Huan Liu/Caltech

New UK dinosaur discovered using Natural History Museum’s fossil collections named after devoted dad and husband

Taylor & Francis Group

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A reconstruction of the iguanodontian dinosaur Paludohadros proudlovii walking through mud along the edge of a shallow body of water. In the distance, the large predatory dinosaur Baryonyx can be seen.

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Credit: © Guilherme Gehr

• A new relative of Iguanodon from southern England has been discovered in the Natural History Museum’s collections.
• The new species has been named in honour of Will Proudlove, the former manager of wienerberger’s Ewhurst brick and roof tile works where the dinosaur was discovered, who died shortly before its excavation.
• Paludohadros was uncovered not far from where Baryonyx, an iconic Cretaceous carnivore that ate young iguanodontians as well as fish, was first found.

More than 25 years after it was first discovered, a new species and genus of dinosaur has been named from the fossil collections cared for by the Natural History Museum.

Paludohadros proudlovii was discovered at wienerberger’s Ewhurst brick and roof tile works (Ewhurst Works) in Surrey in 2001 and subsequently donated to the Natural History Museum. It was a member of the iguanodontians – a group of dinosaurs known for their charismatic thumbspikes.

Historically, iguanodontians found in southern England were considered to be either Iguanodon or its smaller relative Mantellisaurus. However, a detailed redescription of the latter by Natural History Museum scientists, published in 2023, has allowed key differences to be identified.

This has led to a flurry of newly named iguanodontians in the past few years, including Brighstoneus, Comptonatus, the sail-backed Istiorachis and now Paludohadros.

The four-legged herbivore lived around 125 million years ago during the Early Cretaceous Period, when iguanodontians were becoming widespread across the world. At the time, southern England would have been covered in muddy wetlands. This environment helped to give the dinosaur its name, as ‘palus’ means ‘swamp’ in Latin.

Meanwhile, the name of the species – proudlovii – honours Will Proudlove, a former employee of the Ewhurst Works who had worked his way up through the ranks to become manager. Sadly, Will died at the age of just 35 shortly before Paludohadros was excavated, leaving behind his wife Rachael as well as their young children Ellie and Matt.

Rachael Proudlove says, “Will always had an interest in dinosaur fossils and was fascinated about what, if anything, would be uncovered each time a layer of clay was removed from the quarry. Sadly, this dinosaur was only discovered the year after he died, but its story has become a part of our lives since then.”

“We were invited to go and look at it being excavated back in 2001, so it’s amazing to hear all this time later that it’s not just a new species of dinosaur, but a new genus too. We’re absolutely overjoyed and honoured that Will’s name and legacy will live on in this dinosaur.”

At around five metres long and around 1.5 to two tonnes in weight, Paludohadros proudlovii would have been a similar size to a rhino when it died. However, as its bones don’t appear to have been fully developed, it’s likely that this individual was still a juvenile – and could potentially have grown twice as large as an adult.

Paludohadros would have lived alongside a variety of other dinosaurs, including Baryonyx walkeri. This fearsome two-legged carnivore has frequently hit the headlines since being discovered at the Ewhurst Works in 1983, and the two dinosaurs might have had a close connection.

Senior author Professor Susannah Maidment of the Natural History Museum, London, and the University of Birmingham, says, “Paludohadros was found just 100 metres away from Baryonyx, whose fossils we also look after at the Natural History Museum. While Baryonyx is best known for eating fish, this dinosaur’s last meal also included a baby iguanodontian.”

“We can’t tell for certain which species this came from, so it’s possible that Baryonyx could have been scavenging on the remains of young Paludohadros or even hunting them when it had the opportunity.”

The naming of Paludohadros and other iguanodontians in recent years has led to palaeontologists re-examining fossils in the Natural History Museum’s care, with several other Paludohadros specimens identified among specimens first collected in the 1950s. This reanalysis is set to continue over the coming years, with the potential for more species to be discovered.

Ricardo Sacamoto, a PhD student at the Natural History Museum, London and the University of São Paulo who led the research, says, “Paludohadros is the first species I’ve ever named and I’m honoured to have been able to work on it. I still remember the incredible moment when I realised that this was a new species that no one had ever identified before.”

“I’m now going to go through the Natural History Museum’s iguanodontian collections to identify what’s there as part of my PhD. This could lead to the discovery of more new dinosaur species that haven’t yet been recognised.”

The paper ‘A new iguanodontian dinosaur from the Weald Clay Formation (Lower Cretaceous) of Smokejacks Brickworks, southern England’ was published in the Journal of Systematic Palaeontology.

In situ skull bones

Credit

Credit Tim Burgess (Wienerberger Ltd)

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Journal

Journal of Systematic Palaeontology

DOI

10.1080/14772019.2026.2726221

Article Title

‘A new iguanodontian dinosaur from the Weald Clay Formation (Lower Cretaceous) of Smokejacks Brickworks, southern England’

Article Publication Date

27-Oct-2026

 

A low-cost tool can help people plan successful evacuation routes during a tsunami

Seismological Society of America

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Dynamic evacuation visualization for departure 8 minutes after the earthquake origin. The video shows the recorded GPS trajectories together with the advancing simulated tsunami inundation over the first 45 minutes after earthquake origin. Participants are shown as semi-transparent black dots moving along their recorded trajectories. When the simulated inundation reaches a participant, the dot turns red and remains fixed at that location.

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Credit: Courtesy of Alejandra Gubler

People living in coastal communities sometimes have only minutes to reach a safe spot after an earthquake-triggered tsunami. But will the evacuation route that they’ve chosen lead them to safety?

In a new study published in Seismological Research Letters, researchers Alejandra Gubler and Matías Carvajal demonstrate that the safety of these routes strongly depends on how soon after an earthquake people begin to evacuate.

The Pontificia Universidad Católica de Valparaíso and Pontificia Universidad Católica de Chile researchers built a low-cost tool that combines data from GPS tracks, collected from participants in community evacuation drills in Chile’s Viña del Mar, with models of inundation from the type of tsunami expected in this central region of the country.

In their analysis of 119 GPS trajectories collected from drill participants, they discovered that successful evacuation depends strongly on when people begin moving. If people began to evacuate immediately after the start of the earthquake, 100 of the 119 trajectories studied would have allowed people to reach safety before being inundated.

But if they waited eight minutes after the earthquake’s origin before evacuating—roughly when a tsunami warning would be issued—only 49 of the trajectories would have led to safety.

And if people were to evacuate twelve minutes after the earthquake origin, only three of the trajectories would reach higher ground before rising waters caught up to them.

“In near-field settings like central Chile, where the tsunami can reach the coast within minutes of the earthquake, that margin is very small, so every minute really counts,” said Gubler.

Gubler and Carvajal created simple but dramatic video animations of their findings, to help residents, authorities and decision-makers understand the critical consequences of delayed evacuation.

“What really surprised us was what happened when we showed the videos to the drill participants. As they watched their own trajectories being reached by the simulated tsunami, you could hear a general ‘oooohhh’ across the room,” said Gubler.

“That reaction showed us how much the videos captured their attention, in a way that a graph or a curve rarely does,” she added.

The researchers collected personal GPS data from participants, mostly university students, in tsunami evacuation drills conducted between 2022 and 2026. The participants were instructed to follow an evacuation route shown on the official evacuation map. Some of the recorded trajectories followed local evacuation signage, however, which does not always match the official map.

Gubler and Carvajal compared the trajectories with a simulated time-dependent tsunami inundation field for a plausible subduction earthquake scenario in the region.

“Most of the tools communities rely on, such as evacuation maps, are static. They show where to go, but not how much time you actually have to get there,” Gubler noted. “We wanted to put that time dimension front and center, and today it is much more feasible to do so, because we can combine GPS tracks recorded during real drills with time-dependent inundation modeling.”

The researchers also grouped the 119 trajectories into 13 main corridors, finding that the number of feasible corridors—paths that would lead to safety before being overtaken by the tsunami—decreased substantially as people delayed their evacuation.

There were also strong differences in some cases between neighboring corridors. In one corridor, 91% of participants would have completed their evacuation when leaving eight minutes after the earthquake origin.

In a corridor only 200 meters away, however, only 13% of participants would have safely evacuated under the same start time. The differences reflect both the local inundation pattern and the recorded movement of the people, the researchers said.

“We have actually gathered a lot of information on the difficulties participants encounter during the drills, such as problems with particular routes or infrastructure,” Gubler said. “Analyzing it properly is something we would like to do in future work.”

Gubler said the researchers also have plans to work with local authorities and the institutions that supported the study to share the animations more widely.

“That said, although we believe it is valuable to show these videos to the whole community, we think the awareness effect is much greater when people have recorded their own route during a drill and then see themselves being reached by the tsunami,” she said. “Watching someone else’s trajectory is informative; watching your own is what really makes an impression.”

The paper was published as part of an upcoming SRL Focus Section on Advances in Operational Response.

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Journal

Seismological Research Letters

DOI

10.1785/0220260245

Method of Research

Observational study

Subject of Research

Not applicable

Article Title

A Low‐Cost Tool for Communicating the Time‐Critical Feasibility of Near‐Field Tsunami Evacuation: A Proof of Concept in Viña del Mar, Chile

Article Publication Date

26-Oct-2026

Animation of Evacuation from Simulated Chilean Tsunami (Spanish) [VIDEO] 

Dynamic evacuation visualization for departure 8 minutes after the earthquake origin. The video shows the recorded GPS trajectories together with the advancing simulated tsunami inundation over the first 45 minutes after earthquake origin. Participants are shown as semi-transparent black dots moving along their recorded trajectories. When the simulated inundation reaches a participant, the dot turns red and remains fixed at that location.

Credit

Courtesy of Alejandra Gubler