Functional Neurological Disorder (FND) is a condition that affects how the brain and body send and receive signals. Unlike other neurological disorders where structural damage can typically be identified, FND does not show any detectable abnormalities on standard medical scans or tests. Yet, individuals with FND experience very real and often debilitating symptoms that can mimic those of other neurological illnesses, such as seizures, limb weakness, movement disorders, or problems with speech and coordination. These symptoms are thought to arise from a disconnect in how the brain processes and interprets information, rather than damage to the brain itself.
Despite the lack of identifiable physical damage, FND is a genuine and serious condition. It is increasingly recognised in both neurology and psychiatry as lying at the intersection of physical and emotional health. The symptoms are involuntary and not consciously produced by the patient, often causing significant distress and disability. Research suggests that stress and adverse life events, particularly those related to mental health or emotional trauma, may act as triggers for symptom onset or worsening. However, not all cases are linked to a specific psychological factor, making diagnosis and understanding of the disorder complex.
FND was historically referred to by names such as “conversion disorder” or “hysteria,” terms which carried a lot of stigma. Today, health professionals aim to approach the condition with a more empathetic and evidence-based understanding, recognising that symptoms are not “all in the patient’s head,” but rather rooted in disruptions in the functioning of the nervous system. Importantly, FND is considered treatable, especially with early intervention and multidisciplinary support, which can include physiotherapy, psychotherapy, and targeted strategies for managing stress.
A better understanding of FND is key to improving outcomes for patients, particularly since the condition often overlaps with anxiety, depression, or past trauma. As more research emerges, it is clear that a collaborative approach, combining neurological insight with mental health support, is essential in helping individuals navigate their symptoms and regain control over their lives.
How stress impacts brain function
Stress has a profound effect on how the brain functions, particularly in individuals vulnerable to conditions like Functional Neurological Disorder (FND). When a person experiences stress—whether acute or chronic—it triggers a cascade of physiological responses designed to help the body cope with perceived threats. This process involves the activation of the hypothalamic-pituitary-adrenal (HPA) axis, which leads to the release of stress hormones such as cortisol and adrenaline. While these responses are helpful in short bursts, prolonged exposure to stress hormones can disrupt normal brain activity, especially in regions responsible for emotional regulation, movement control, and sensory processing.
In the context of FND, stress can amplify existing vulnerabilities in how the brain communicates with the body. Functional imaging studies have shown that people with FND often display altered connectivity between areas of the brain involved in self-agency, emotional processing, and motor control. Sustained stress appears to exacerbate this dysfunction—essentially overwhelming the brain’s capacity to regulate physical and emotional information correctly. This can result in the onset or intensification of neurological symptoms, such as tremors, non-epileptic seizures, or limb weakness, even though no structural brain damage is present.
Furthermore, cumulative stress, particularly from adverse life events such as childhood trauma, grief, or ongoing relational conflict, can sensitize neural pathways and prime the brain to react intensely to relatively minor stressors. This heightened reactivity may contribute to the frequent observation that emotional health is deeply intertwined with FND symptom flare-ups. For individuals with FND, seemingly everyday pressures—such as a stressful work environment or lack of social support—can become powerful triggers, not only impacting mental health but also manifesting through physical symptoms.
It’s also notable that stress can impair the brain’s executive functioning, making processes like decision-making, attention, and memory more difficult. This can further complicate the day-to-day management of FND and potentially lead to a cycle where worry and overthinking about symptoms themselves become additional sources of stress. As such, understanding and addressing the ways in which stress affects the brain is critical for devising effective treatment strategies and supporting individuals living with functional neurological symptoms.
Psychological triggers and FND symptoms
Many individuals with Functional Neurological Disorder (FND) report that their symptoms are most closely linked to psychological and emotional stressors. These factors, often termed psychological triggers, can influence the appearance, intensity, and unpredictability of FND symptoms. Common examples include traumatic life events, interpersonal conflicts, chronic stress, or significant changes in life circumstances. However, the triggering factors need not always be extreme; for some people, seemingly minor stressors like a busy day at work or an argument with a loved one can precipitate symptoms such as tremors, speech difficulties, or episodes resembling seizures.
The relationship between emotional health and FND is increasingly recognised in both clinical and research settings. Emotional stress does not cause FND in a straightforward manner, but it can disrupt the normal functioning of the brain-body connection, particularly in individuals who may already be predisposed to the condition. This disruption can result in the brain misinterpreting or misdirecting signals, leading to physical symptoms that lack an identifiable organic cause. For example, overwhelming anxiety might trigger non-epileptic seizures, or repressed emotional distress may be associated with sudden limb weakness or gait disturbances.
Clinical observations suggest that people living with FND often have a history of heightened emotional sensitivity or have experienced periods of compromised mental health. Depression, anxiety, and post-traumatic stress are frequently found in FND patients, not necessarily as causes, but as co-occurring conditions that can act as triggers or complicating factors. These overlapping issues can obscure the clinical picture, making it harder to identify the root cause of symptoms and posing challenges for both diagnosis and treatment.
Symptoms of FND are often variable, episodic, and may emerge in response to internal psychological conflict or external environmental demands. For example, some patients report that their symptoms worsen during moments of pressure or after recalling distressing memories. Conversely, periods of emotional stability or supportive surroundings can sometimes result in symptom relief or periods of remission. This pattern highlights the close interplay between psychological triggers and the nervous system’s functioning in FND.
It is important to note that these symptoms are not consciously produced or under voluntary control. People with FND are not faking their experiences, and the distress they face is genuine. Increased awareness of how emotional health interacts with physical symptoms can help both patients and healthcare providers better understand the role of psychological triggers. Therapies that focus on identifying and managing these triggers—such as cognitive behavioural therapy or trauma-informed counselling—are proving valuable in many cases, offering patients tools to reduce the impact of emotional factors on their condition.
Diagnosis and patient experiences
Receiving a diagnosis of Functional Neurological Disorder (FND) can be a complex and often emotional experience, both for patients and healthcare providers. The diagnostic process usually begins when individuals present symptoms resembling neurological conditions—ranging from seizures and weakness to speech difficulties or problems with coordination—but results from standard tests such as MRIs and EEGs come back normal. This absence of structural abnormalities can lead to significant delays in diagnosis, with patients often referred between specialists without clear answers. These delays can impact emotional health, as individuals feel misunderstood or dismissed, further compounding existing distress.
A correct diagnosis of FND typically involves a neurologist who is familiar with the condition recognising specific clinical features that are characteristic of functional symptoms. Positive signs—those which suggest FND rather than rule out other conditions—are key to diagnosis. For instance, Hoover’s sign can help identify functional leg weakness, and changes in symptoms depending on the patient’s focus or distraction can provide clues. Importantly, FND should not be viewed as a diagnosis of exclusion, but rather one that is positively identified through well-established clinical criteria.
Once diagnosed, patients often experience a mix of relief and uncertainty. For many, putting a name to their symptoms validates their experiences, especially after periods of medical scepticism or overly protracted testing. However, the term “functional” can be confusing or unsettling, particularly if not explained clearly. Some patients fear that their symptoms are being labelled as psychological or “not real”, which can negatively affect their mental health and trust in the medical profession. Clear, empathetic communication about the nature of FND—emphasising the legitimacy of symptoms and the potential for recovery—is crucial at this stage.
Patient experiences vary widely, but a common theme is the significant impact of FND on daily functioning and self-image. Many report that their symptoms interfere with work, relationships, or basic activities, leading to social isolation or low mood. The unpredictability of symptoms can be especially distressing; individuals may go through periods of apparent stability, only to experience sudden flare-ups triggered by stress or exhaustion. Understanding and managing emotional triggers becomes an essential part of coping with the condition, and patients frequently express the need for support that addresses both physical and psychological aspects of their health.
The path to diagnosis can also influence how patients engage with treatment. Those who feel believed and supported early on are more likely to engage in therapies addressing stress and emotional health. Conversely, individuals who have faced repeated dismissals or conflicting information may be sceptical of recommendations, particularly if they associate psychological interventions with stigma. Peer support and hearing from others with lived experience of FND can be powerful tools in this context, helping to normalise the condition and restore confidence in the recovery process.
Ultimately, diagnosis is not just a clinical moment but part of an ongoing journey. Recognition of FND as a legitimate, brain-based condition influenced by interactions between stress, emotion, and neurobiology is helping to reshape patient experiences. Increased awareness and education among healthcare providers, along with collaborative approaches to care, are critical in improving both diagnostic experiences and health outcomes for those living with FND.
Treatment approaches and stress management
Treatment for Functional Neurological Disorder (FND) typically involves a multidisciplinary approach aimed not only at addressing physical symptoms but also at managing the psychological and emotional health aspects that often accompany the condition. Because FND sits at the intersection of neurology and psychiatry, treatment plans need to consider brain function, behavioural patterns, and individual life experiences, including how patients respond to stress and potential emotional triggers.
One of the most effective forms of therapy for FND is specialised physiotherapy tailored to functional symptoms. Unlike conventional physical rehabilitation, FND-focused physiotherapy concentrates on retraining the brain-body connection through active movement therapy and techniques that encourage normal patterning of movement. Physiotherapists may use distraction techniques or focus exercises to reduce abnormal movements or regain strength in a limb. Treatment success often hinges on early intervention and patient engagement, particularly when there is a good understanding and explanation of how FND works.
Psychological interventions also play a crucial role in treatment. Cognitive Behavioural Therapy (CBT) is frequently recommended, as it helps patients identify and manage stress, unhelpful thought patterns, and behavioural responses that influence symptom severity. In addition to CBT, other approaches including trauma-informed therapy, acceptance and commitment therapy (ACT), and mindfulness-based stress reduction may be beneficial, especially for those whose FND symptoms appear linked with emotional trauma or chronic stress. These interventions aim to improve emotional regulation and resilience, which can reduce the frequency or intensity of FND episodes.
Stress management techniques are often integrated into both physical and psychological treatment plans. Because stress can act as a significant trigger for FND symptoms, patients are encouraged to develop practical coping strategies. These might include relaxation exercises, paced breathing, guided imagery, or even structured routines designed to reduce anxiety and improve self-efficacy. For some, engaging in creative activities or gentle movement-based practices such as yoga or tai chi can support a sense of calm and bodily control.
The role of patient education cannot be overstated. When individuals understand that their symptoms are real but reversible, and rooted in altered nervous system function rather than structural damage, motivation and outcomes often improve. Learning to identify personal stressors and emotional triggers helps patients to feel more in control and less overwhelmed by unpredictable symptoms. In this way, managing emotional health becomes a core component of living with and recovering from FND.
Support from mental health professionals is particularly important for those navigating co-existing conditions such as anxiety, depression, or post-traumatic stress. Addressing these concerns within the broader FND treatment framework can enhance the effectiveness of other therapies and improve overall well-being. Group therapy and peer-led support groups may also provide valuable space for patients to share coping techniques and reduce feelings of isolation.
Medical professionals play a critical role in shaping treatment outcomes. A collaborative healthcare team that includes neurologists, psychologists, physiotherapists, and occupational therapists tends to offer the most comprehensive care. Crucially, the therapeutic relationship between patient and clinician should be founded on trust, clear communication, and mutual respect. Where possible, treatment should be individualised, taking into account the person’s psychological profile, lifestyle, and specific symptom presentation.
While recovery from FND can be gradual, many individuals achieve significant improvements in symptoms and daily functioning through a combination of physical rehabilitation and stress-oriented psychological support. By acknowledging the complex interplay between mental health and functional symptoms, and by teaching strategies to navigate both stress and emotional challenges, treatment can offer a tangible path forward for those living with FND.
