What Is Functional Neurological Disorder? A Psychiatrist Explains
Functional Neurological Disorder (FND) is a condition that is widely misunderstood — and too often dismissed.
Many people with FND arrive in my consulting room after months or years of frightening symptoms, repeated investigations, and profound uncertainty. They have been told that their scans are normal, that nothing is “wrong”, or that stress is the cause — without any clear explanation of what is actually happening.
Functional Neurological Disorder is real, common, and treatable. Understanding it properly is the first and most important step.
What Is Functional Neurological Disorder?
Functional Neurological Disorder (FND) is a condition in which there is a problem with how the brain sends and receives signals, rather than with the structure of the brain or nervous system.
In simple terms:
The hardware (brain structure) is intact
The software (brain functioning and communication) is disrupted
This disruption leads to genuine neurological symptoms — even though scans and tests may appear normal.
Common Symptoms of FND
FND can affect many different neurological functions. Symptoms may include:
Weakness or paralysis
Tremors or abnormal movements
Seizure-like episodes (functional seizures)
Gait difficulties
Speech or swallowing problems
Sensory symptoms such as numbness or altered sensation
Cognitive difficulties (“brain fog”)
Symptoms are not imagined, exaggerated, or voluntary. They occur outside of conscious control.
Why Are Tests Often Normal?
One of the most confusing aspects of FND is that investigations such as MRI scans, CT scans, EEGs, and blood tests are often normal.
This does not mean that nothing is wrong.
FND is diagnosed based on positive clinical signs — patterns of symptoms and examination findings that are characteristic of functional disorders — rather than by exclusion alone.
Modern neurology recognises FND as a diagnosable condition, not a diagnosis of uncertainty.
Is FND Psychological or Neurological?
This is one of the most common questions people ask — and it reflects a false divide.
FND is both neurological and psychological, because brain function is shaped by biology, experience, learning, and the nervous system’s threat response.
Stress, trauma, illness, injury, or pain may act as triggers — but not everyone with FND has a history of trauma, and symptoms are not “caused by stress” in a simplistic way.
FND involves changes in how the brain predicts, controls, and experiences movement and sensation.
Why Validation Matters
Many people with FND have experienced:
Feeling dismissed or not believed
Being told symptoms are “just anxiety”
Conflicting explanations from different clinicians
This can be deeply distressing and can worsen symptoms by keeping the nervous system in a state of threat.
Clear explanation and validation are not optional extras in FND care — they are therapeutic interventions in their own right.
Is Functional Neurological Disorder Treatable?
Yes.
FND is potentially reversible, particularly when it is recognised early and treated with an appropriate, multidisciplinary approach.
Treatment may include:
Neurology input for diagnosis
Psychological therapy to address nervous system regulation and symptom patterns
Physiotherapy or occupational therapy for movement and function
Education about the condition and symptom management
The goal is not to convince someone their symptoms are psychological, but to help the brain relearn safer, more adaptive patterns of functioning.
A Different Way of Understanding Symptoms
One of the most helpful shifts for people with FND is moving from the question:
“What is wrong with me?”
to
“What is my nervous system doing — and how can it learn something different?”
This reframing opens the door to recovery.
You Are Not Imagining This
If you have been diagnosed with Functional Neurological Disorder — or suspect that it may explain your symptoms — it is important to know this:
Your symptoms are real.
You are not weak.
You are not “making it up”.
With the right explanation and support, improvement is possible.
I offer assessment and treatment for Functional Neurological Disorder as part of a comprehensive, multidisciplinary approach. If you would like to explore whether this may be helpful for you, you are welcome to get in touch.
By Dr Michelle Beukes-King
