Functional Neurological Disorder (FND), formerly known as conversion disorder, is a condition where patients experience neurological symptoms—such as tremors, seizures, and sensory disturbances—that are not explained by traditional medical tests. This article explores the causes, symptoms, diagnosis, and treatment of FND, including my personal experience with this complex condition.
Sources say there is not a structural cause for FND symptoms, but as a sufferer of FND after looking at my own brain scans, I disagree. My personal opinion is that the spots shown on my brain are actual damage. I have also read about the possible link to neuroinflammation, and I think that is a very real possibility. I often find comfort in a modified child's pose during an FND episode. this position pushes blood toward my frontal lobe. I think this could be evidence of neuroinflammation and or other structural changes.
Is FND Real?
FND symptoms are very real and often debilitating for those who suffer from them. FND has gained increased attention in recent years as research has shed more light on its causes, treatments, and the importance of a multidisciplinary approach in managing this condition.
What is Functional Neurological Disorder?
According to sources, FND, also known as conversion disorder, involves a disruption in the way the brain sends and receives signals to different parts of the body. Rather than being caused by damage to the brain or nerves (again, I disagree), FND is believed to result from a functional issue—how the brain processes information—leading to real physical symptoms. These symptoms can mimic various neurological conditions, such as stroke, multiple sclerosis, or epilepsy, making diagnosis challenging.
Functional Neurological Disorder Symptoms
The symptoms of FND are diverse and can affect movement, sensation, or cognition. Common symptoms include:
Motor symptoms: Tremors, spasms, or sudden weakness, often affecting a single limb or side of the body. I have noticed a group of us that specifically had tremors in the right hand/forearm. This observation deserves more research. I also had trouble speaking and would stutter.
Non-epileptic seizures (NES): Seizure-like episodes that resemble epilepsy but do not have the same electrical abnormalities in the brain. I used to call them pseudo seizures.
Sensory symptoms: Numbness, tingling, or loss of sensation in certain body parts. I didn't have so much of these, other than some intermittent neuropathy in one foot. I did have noise and visual sensitivity.
Cognitive symptoms: Difficulty concentrating, memory issues, or cognitive "fog."
These symptoms can fluctuate and are often triggered or worsened by stress, fatigue, or emotional distress.
What FND symptoms have you had?
Motor Symptoms
Non-epileptic Seizures (NES)
Sensory Symptoms
Cognitive Symptoms
Causes and Risk Factors for FND
FND has a multifactorial origin, with various physical, psychological, and social factors contributing to its development. Some individuals may develop FND following physical injury, illness, or a period of high emotional stress, while others may have a history of trauma or adverse life events. Sources say though no single cause has been identified, the disorder is thought to result from a combination of predisposing factors (such as genetics or temperament), precipitating factors (such as stress or physical illness), and perpetuating factors (like avoidance behaviors or ongoing stress).
I say that the body endures the cumulative affects of what it is exposed to and hasn't had the chance to heal from fully. Think of your body as separate from yourself. Then list the things that would stress out your body and make it work harder to compensate. Infection, injury, abuse, phycological stress, being too busy, feeling pressured, etc. If you are like me, I used to try to do too much in life at the same time. I really pushed myself. The problem with pushing yourself to the limit like I did is that sometimes life events happen that you can't control. Sometimes more than one thing in quick succession. And you don't have the metaphorical extra fuel in your tank to deal with it. After begging for rest for years and being ignored for years your body reaches the tipping point. You've let too much stuff accumulate that needs to be healed. It doesn't have the capacity to keep functioning without rest. It will force you to rest. In my case it would shut down my body. My legs would give out and I would fall on the floor. FND forced me to cut unnecessary things out of my life and quit doing more than I could handle.
FND Diagnosis
Diagnosing FND involves ruling out other neurological conditions and recognizing positive signs that are specific to FND. For instance, Hoover's sign—a test used during a physical examination—can help differentiate functional weakness from organic weakness. Additionally, neuroimaging and EEG tests are often performed to exclude other disorders, but a diagnosis of FND is based on clinical observations rather than laboratory findings.
FND Treatment Options
Effective treatment of FND requires a multidisciplinary approach, incorporating neurological, psychological, and physical rehabilitation interventions. Treatment plans are highly individualized but may include:
Cognitive-behavioral therapy (CBT): CBT helps patients understand and manage the thoughts and behaviors that may contribute to their symptoms.
Physical therapy: Targeted exercises aim to restore normal movement patterns and function.
Psychotherapy: Addressing underlying emotional or psychological issues, such as trauma, can play a critical role in symptom improvement.
Medications: While there is no specific drug for FND, medications for anxiety, depression, or heart rate may be prescribed depending on the patient’s symptoms.
Early intervention and a strong therapeutic alliance between the patient and healthcare providers are essential for improving outcomes.
In my humble opinion, the medical industry lacks understanding about FND. Therefore treatment is lacking. I got helpful tools. But it sort of felt like I was expected to pull myself up by my bootstraps if I wanted to get better. But healing is a matter of rest, not of pushing yourself. Your body has literally run out of energy to push itself. It needs HELP when it has FND, maybe more than ever. And sadly, for many of us, treatment is lacking. For example, I was not well and I asked for more help. I was told that I could do another round of CBT. But I had already done that. So I basically felt stone walled. Like the medical industry was saying we've done everything we are going to do. And there I was still sick. Thankfully in my case my dad eventually visited and saw how sick I was, and he started researching to help me get well naturopathically. And eventually my parents took me in and gave me a safe place to regenerate. Again, rest is critical for healing.
Living with FND
FND is a long-term condition, but many patients experience significant improvement with proper treatment. Support groups, educational resources, and coping strategies can also help individuals manage their symptoms and improve their quality of life. It is essential for patients to feel validated and supported, as the stigma surrounding FND can sometimes lead to delayed diagnosis or inadequate care. I have gotten tons better, but my healing is coming at a snail's pace.
Conclusion
Functional Neurological Disorder is a complex condition that challenges the traditional boundaries of neurology and psychiatry. While much is still being learned about its causes and treatments, advances in understanding FND have led to better diagnostic tools and more effective treatments. Raising awareness about FND and advocating for continued research is crucial in helping patients receive the care and support they need.
Have you experienced symptoms of FND? Share your story in the comments below!
References
Edwards, M. J., Adams, R. A., Brown, H., Parees, I., & Friston, K. J. (2012). A Bayesian account of 'hysteria'. Brain, 135(11), 3495-3512. https://doi.org/10.1093/brain/aws129
Stone, J., Carson, A., Duncan, R., & Roberts, R. (2020). Recognizing and explaining functional neurological disorder: Still a long way to go. Practical Neurology, 20(2), 77-84. https://doi.org/10.1136/practneurol-2019-002438
Perez, D. L., LaFrance, W. C., & Nicholson, T. R. (2021). Advancing the diagnosis and care of patients with functional neurological disorder. JAMA Psychiatry, 78(3), 243-244. https://doi.org/10.1001/jamapsychiatry.2020.4185
Hallett, M., Aybek, S., Carpenter, K., & Carson, A. (2021). Functional neurological disorder: New subtypes and shared mechanisms. The Lancet Neurology, 20(3), 170-180. https://doi.org/10.1016/S1474-4422(20)30498-7
Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., ... & LaFrance, W. C. (2018). Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurology, 75(9), 1132-1141. https://doi.org/10.1001/jamaneurol.2018.1264
As always I have to add the disclaimer that I am not a doctor. Always consult medical professionals before making your own informed choices.
Here are some alternative terms for Functional Neurological Disorder (FND), considering various historical, medical, and psychiatric contexts:
Conversion Disorder – Commonly used in psychiatric contexts, especially in DSM-IV, emphasizing the psychological-to-physical symptom conversion.
Psychogenic Neurological Disorder – Implies a psychological origin for the neurological symptoms.
Hysteria – An outdated and stigmatizing term historically used for similar symptoms, particularly in women.
Somatoform Disorder – A broader psychiatric term that encompasses physical symptoms with no identifiable medical cause.
Dissociative (Motor) Disorder – A term found in ICD-10, particularly for movement-related symptoms in FND.
Non-Epileptic Attack Disorder (NEAD) – Describes non-epileptic seizures that occur in FND.
Functional Movement Disorder – Refers specifically to movement-related symptoms like tremors, spasms, or abnormal gait in FND.
Functional Seizures – Used to describe non-epileptic seizures, a common symptom of FND.
Functional Neurological Symptoms Disorder – A term that emphasizes the symptomatic presentation without focusing on the cause.
Functional Somatic Syndrome – A broader term used in contexts where FND is grouped with other conditions involving unexplained physical symptoms.
Functional Disorder – A general term used for disorders with no clear structural or organic cause, including FND.
Somatic Symptom Disorder – Another broad psychiatric term under DSM-5 that can include FND, particularly focusing on the patient’s response to their physical symptoms.
Functional Cognitive Disorder – Refers to FND with predominantly cognitive symptoms like memory problems and concentration difficulties.
Functional Weakness – Sometimes used to describe weakness in FND without any structural neurological cause.
Functional Tremor – Describes tremors as part of FND, distinguishing them from tremors caused by other neurological conditions.
Psychogenic Movement Disorder – A specific term for movement-related symptoms in FND that have a psychological contribution.
Psychogenic Non-Epileptic Seizures (PNES) – Specifically refers to seizure-like episodes without the abnormal electrical brain activity seen in epilepsy.
Dissociative Seizures – Another term used interchangeably with psychogenic non-epileptic seizures, often found in psychiatric classifications.
Functional Gait Disorder – Used when walking abnormalities are the predominant symptom of FND.
Medically Unexplained Neurological Symptoms (MUNS) – A term used by some clinicians to describe FND before a formal diagnosis is made.
This list reflects a variety of perspectives from neurology, psychiatry, and historical contexts. The modern term Functional Neurological Disorder (FND) is preferred as it avoids the psychological bias and stigma associated with earlier terms.
Thank you!