Understanding Functional Neurological Disorder
Neuropsychological assessment and evidence-based treatment for FND, working alongside your neurologist.
Functional Neurological Disorder (FND) causes real, involuntary neurological symptoms—weakness, tremor, seizures, difficulty walking, numbness, or cognitive difficulties—that arise from a problem with how the brain sends and receives signals rather than from damage to the brain or nerves themselves.
A useful way to think about it: the hardware is intact, but the software is not running as it should. The nervous system is structurally healthy, yet the messages travelling through it are disrupted. This is why scans and standard tests often come back normal even though the symptoms are severe and disabling.
Your Symptoms Are Real
FND symptoms are genuine, involuntary, and outside your conscious control. You are not producing them on purpose, and you are not exaggerating. FND is one of the most common reasons people see a neurologist, and it is a recognized medical diagnosis with a growing evidence base and effective treatments.
How FND Presents
FND affects people differently, and symptoms can fluctuate in intensity or change over time. Persistent fatigue, chronic pain, dizziness, and dissociation—a sense of detachment from your body or surroundings—commonly accompany the symptoms below.
Movement
- Tremor and jerking movements
- Muscle spasms or dystonia
- Difficulty walking
- Unsteadiness and poor coordination
Weakness and Sensation
- Limb weakness or paralysis
- Numbness and tingling
- Altered or absent sensation
Functional Seizures
- Episodes of shaking
- Unresponsiveness
- Loss of awareness
- Sometimes called dissociative seizures
Cognitive Symptoms
- Brain fog
- Memory lapses
- Word-finding difficulty
- Trouble concentrating
How FND Is Diagnosed
FND is diagnosed by a neurologist, and it is diagnosed by what is present rather than by what is absent. Neurologists look for specific positive clinical signs—patterns showing that the nervous system can perform a movement in one context but not another, which points to a functional rather than structural cause. FND is no longer a diagnosis made simply because everything else was ruled out. It is a diagnosis made on its own evidence.
Our Role
Because of this, a neurologist's diagnosis is the starting point for our work. We do not diagnose FND ourselves. What we contribute is the psychological and cognitive side of the picture—and, where cognitive symptoms are prominent, neuropsychological assessment that can help distinguish functional cognitive difficulties from other causes of cognitive change.
What Contributes to FND
FND does not have a single cause. Current understanding points to a combination of factors that make the nervous system vulnerable, trigger the onset of symptoms, and then keep them going.
Predisposing Factors
Previous illness or injury, chronic pain, migraine, or a history of significant stress or adversity can all increase vulnerability.
Triggering Events
Symptoms often begin after a physical injury, an illness, a panic attack, a surgical procedure, or a period of intense stress. Sometimes there is no identifiable trigger at all.
Perpetuating Factors
This is frequently where the greatest opportunity for change lies: attention becoming locked onto symptoms, fear of triggering an episode, avoidance of activity, deconditioning, disrupted sleep, low mood, and the exhausting cycle of pushing through and then crashing.
An important clarification: past trauma is a risk factor for some people with FND, but it is not present in everyone, and it is not required for the diagnosis. Older models overstated this link. You do not need to have a trauma history to have FND, and you will not be treated as though you must be hiding one.
How We Help
Effective FND care is multidisciplinary. Psychological treatment is one component of it, and it works best alongside the other professionals involved in your care.
Neuropsychological Assessment
Objective evaluation of attention, memory, and executive function to characterize cognitive symptoms, distinguish functional cognitive difficulties from other causes, and guide realistic planning for work, study, and daily life.
Psychological Treatment
Evidence-based therapy adapted for FND, focused on understanding what maintains your symptoms and changing it—working with attention and symptom monitoring, reducing the fear and avoidance that shrink your life, managing dissociation, and rebuilding activity at a pace your nervous system can tolerate.
Treating What Travels Alongside
Anxiety, panic, depression, PTSD, insomnia, and chronic pain are common in FND, and each one can amplify symptoms. Treating them directly often improves the FND itself.
Support for Families
Education for partners and family members about what FND is, what it is not, and how to respond during episodes in a way that helps rather than reinforces symptoms.
Collaboration
We work alongside your neurologist, family physician, and any physiotherapists or occupational therapists involved in your care. FND-informed physiotherapy is a central part of treatment for motor symptoms, and coordinated care produces better outcomes than any single discipline working alone.
Recovery Is Possible
FND is treatable, and improvement is genuinely possible—including full recovery for some people. Outcomes tend to be better when the diagnosis is understood and accepted, when treatment begins sooner, and when the people involved in your care are working from the same understanding of what is happening and why. Understanding your diagnosis is not a side note to treatment. For many people with FND, it is the beginning of it.
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