Is Functional Neurological Disorder Psychological or Neurological?
This is one of the most common questions people ask after being diagnosed with Functional Neurological Disorder (FND):
“Is this psychological, or is it neurological?”
Behind this question is often something deeper:
Am I being taken seriously?
Is this real?
Is this my fault?
The short answer is that this question rests on a false divide.
The longer — and more helpful — answer requires us to rethink how we understand the brain.
The Problem With the Psychological vs Neurological Divide
In medicine, we have traditionally separated conditions into “physical” and “psychological”. This distinction may be convenient, but it does not reflect how the brain actually works.
The brain does not separate:
thoughts from movement
emotion from sensation
psychology from neurology
Every experience — pain, movement, fear, weakness, seizures — is generated through brain networks that integrate biology, learning, attention, and context.
Functional Neurological Disorder sits exactly at this intersection.
What “Functional” Actually Means
The term functional does not mean imaginary or less serious.
In FND, the problem lies in how the brain functions, not in damage to its structure.
Brain scans are typically normal
Nerves and muscles are intact
But the brain’s control and prediction systems are not operating as they should
This leads to genuine neurological symptoms that occur outside of conscious control.
Why Psychological Factors Sometimes Matter — and Sometimes Don’t
For some people, FND symptoms are triggered or exacerbated by:
stress
trauma
illness or injury
chronic pain
periods of high nervous system load
For others, there is no clear psychological trigger at all.
This variability is important.
Psychological factors may influence how the nervous system learns and responds to threat — but they are not the sole cause, and their absence does not invalidate the diagnosis.
FND is not “caused by stress” in a simplistic way.
The Role of the Nervous System
A more accurate way to understand FND is through the lens of nervous system regulation.
In FND:
the brain becomes overly focused on threat or prediction
automatic control of movement or sensation is disrupted
attention and expectation shape symptoms
This is why symptoms may fluctuate, worsen with fatigue or stress, or improve with distraction — not because they are voluntary, but because the nervous system is state-dependent.
Why Labels Matter
When FND is framed as “psychological”, many people hear:
This isn’t real
This is your fault
You just need to try harder
These interpretations are not only inaccurate — they are harmful. They increase shame, self-doubt, and nervous system threat, all of which can worsen symptoms.
Clear, accurate explanation reduces fear and creates the conditions for recovery.
A More Helpful Question
Rather than asking:
“Is this psychological or neurological?”
A more helpful question is:
“How is my brain functioning — and what does it need to relearn?”
This reframing moves the focus from blame to understanding, and from confusion to possibility.
Treatment Works Best When the Divide Is Dropped
Effective treatment for Functional Neurological Disorder does not choose sides.
It brings together:
neurological diagnosis and validation
psychological therapy focused on nervous system regulation
physical rehabilitation where appropriate
education and explanation
This integrated approach recognises the complexity of the brain — and the person.
You Are Not Failing Your Nervous System
If you have been told your condition is “psychological” and felt dismissed or blamed, it is important to know this:
Your symptoms are real.
They are not deliberate.
And they are not a sign of weakness.
Functional Neurological Disorder is best understood as a disorder of brain functioning, not of character or motivation.
I offer assessment and treatment for Functional Neurological Disorder as part of a multidisciplinary, evidence-based approach. If this perspective resonates, you are welcome to get in touch to explore whether this may be helpful for you.
By Dr Michelle Beukes-King
