Myths and Facts about Functional Neurological Disorder (FND)

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Key Takeaways

• Functional Neurological Disorder (FND) is a very real disorder caused by physical structures in the brain
• The disorder has a complicated history, with many downplaying it as a mental health issue or entirely psychosomatic
• Proper diagnosis of symptoms is critical to proper treatment, which often involves a personalized combination of neurology, psychological care, and physical rehabilitation
• Supporting FND patients struggling with their symptoms can make significant difference in their well-being

The Invisible Struggle of FND

Imagine waking up and suddenly having trouble walking, problems with your vision, or experiencing seizure-like episodes, only to be told that all your labs and scans appear normal.

Many living with Functional Neurological Disorder (FND) have had this experience. FND is a disorder in which the nervous system does not function properly, even though routine structural scans (like MRIs and x-rays) may not show visible injury.

These symptoms are genuine – sometimes disabling – and can disrupt one’s independence, work, and relationships. Although the condition is historically misunderstood, current research suggests that FND reflects changes in the way the nervous system functions, with growing evidence of altered communication across brain networks involved in movement, attention, self-agency, and emotion.

The History of Functional Neurological Disorder

FND has a long and complicated history. In the 19th century, these symptoms were studied by neurologists such as Jean-Martin Charcot and later shaped by the psychoanalytic work of Josef Breuer and Sigmund Freud. In 1895, Breuer and Freud helped popularize the idea that unconscious emotional conflict could be “converted” from the psyche into physical neurological symptoms, a process Freud later described as “conversion.”

Because of this, the condition was previously known as “conversion disorder”. Prior to that, it was largely referred to as “hysteria.”

Today, diagnostic frameworks for FND no longer require a clear psychological stressor for diagnosis. Functional neurological disorder is now the accepted term because it better reflects current understanding of the condition as a disorder of nervous system functioning, rather than one defined solely as a reaction to psychological conflict.

Symptoms and Potential Causes

FND can take many forms, including:

• Weakness
• Paralysis
• Tremors
• Sensory changes
• Visual symptoms
• Speech symptoms
• Seizure-like episodes

One of the most harmful misconceptions about FND is that if patients have a normal MRI or CT scan, it means “nothing is actually wrong.” That assumption can leave patients feeling dismissed and disbelieved, even though they are struggling with very real and very frightening symptoms.

Research-based imaging methods, such as functional MRI, suggest that FND involves differences in how brain systems related to emotion, attention, self-agency, and movement communicate. Some studies have also identified altered interactions between emotion-related regions (such as the amygdala) and movement-related regions (such as the supplementary motor area). Together, this research supports the idea that FND symptoms may involve disrupted integration among emotion, attention, body signaling, and movement systems.

Co-occurring mental health difficulties – especially anxiety, panic, and depression – are also common, affecting over 50% of people with FND. These challenges may be intensified by the distress and disability the disorder can cause.

Despite this overlap, FND is not “all in your  head.” Instead, a whole-person understanding of the disorder is necessary due to the complex interplay between psychological and physical symptoms.

Functional Neurological Disorder Diagnosis

Because FND symptoms can resemble other neurological or psychiatric conditions, distinguishing it from related diagnoses is especially important.

FND is not the same as factitious disorder (also known as malingering), in which symptoms are intentionally produced or exaggerated. It also differs from somatic symptom disorder, which is defined by a significant focus on physical symptoms along with excessive thoughts, feelings, or behaviors related to them. People with FND experience neurological symptoms, such as movement, sensory, speech, or seizure-like symptoms, rather than the broader pattern of symptom-related distress that defines somatic symptom disorder.

It can also occur alongside other medical or neurological conditions, which makes clinical evaluation especially important. Because of this complexity, it often takes patients with FND a long time to receive a clear diagnosis, and they may need to be evaluated for numerous conditions and by numerous healthcare providers before the explanation for their symptoms is found.

Treating FND

Research suggests that FND treatment often works best when it involves a multidisciplinary approach, including neurology, psychological care, and rehabilitation (such as physical therapy). Current treatment recommendations emphasize education, movement retraining, and self-management, recognizing that patients often need support for both their neurological symptoms and the emotional burden that can come with them.

Through rehabilitation, patients may work with physical, occupational, and/or speech therapists, depending on their symptoms. These therapies can help patients gradually retrain affected movements, practice daily activities, improve speech or swallowing symptoms when present, reduce fear around symptoms, and build confidence in using their bodies again.

For people living with FND, one of the greatest harms is not only the symptoms themselves, but the misunderstanding that surrounds them. When those symptoms are recognized as genuine, and their treatment needs are taken seriously, patients are better able to access the neurological, psychological, and rehabilitative care that supports recovery. For many people with FND, being believed can be the first step in moving from confusion and isolation to meaningful treatment and support.

Resources to learn more:

• General overview of FND
• Patient-friendly explanation of FND
• FND Hope patient guide
• Brain imaging research in FND
• Emotion and brain-processing research in FND
• History of FND, hysteria, and conversion disorder
• Rehabilitation and movement retraining in FND
• SBM Integrated care article

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