People with functional neurological disorder, or FND, may experience weakness, tremor, seizures, gait changes, speech or sensory symptoms, sometimes after repeated appointments and contradictory explanations. Reassuring scans can leave them confused if nobody explains how severe symptoms can occur without the structural changes those investigations were designed to find.
FND involves changes in nervous-system functioning, and the symptoms are not consciously produced. An explanation needs to connect that diagnosis with the person's experience and the clinical signs identified during assessment, so that a referral for treatment has a clear rationale.
How the diagnosis is established
The 2025 Australian treatment recommendations advise diagnosing FND through positive clinical signs, including particular patterns of inconsistency or incongruence that a trained clinician can identify. Negative investigations alone do not establish the diagnosis, and patients should have the relevant signs explained in terms they can understand.
I would expect a person to know the name of the condition, how the clinician reached that conclusion and what treatment is being proposed. A recommendation to see a psychologist can feel like a dismissal when it arrives without that neurological explanation.
FND can coexist with neurological disease and other medical conditions, so appropriate investigation remains necessary. A change in the clinical picture needs to be assessed on its own merits, even when an FND diagnosis has already been established.
Attention and automatic function
Movement and sensation usually involve little conscious supervision, as the brain integrates incoming information with expectations about what the body is doing. Attention, expectation and learned patterns can contribute to disrupted functioning in FND, which may help explain why increased effort to control a movement sometimes makes it harder.
Rehabilitation may therefore use redirected attention, rhythm, automatic movement and graded practice to help a person experience and develop a different pattern. Those methods concern how function is retrained and do not imply that the person chose or imagined their symptoms.
Stress is relevant for some people, as it can be in other neurological conditions, but is neither necessary nor sufficient for an FND diagnosis. Trauma should be assessed when the person's history warrants it, without assuming that a hidden traumatic experience must explain the condition.
Coordinating treatment and interpreting the trials
The Australian recommendations describe care coordinated across the disciplines relevant to the presentation, which may include neurology, general practice, physiotherapy, occupational therapy, speech pathology, psychology and psychiatry. The contribution of each profession depends on the person's symptoms and functional needs.
In the large Physio4FMD randomised trial, specialist physiotherapy did not significantly outperform community neurological physiotherapy on the primary physical-function outcome at twelve months. Several secondary outcomes favoured specialist treatment, and participants reported better perceptions of improvement, leaving a mixed result that needs to be discussed in terms of the outcomes actually measured.
A 2024 scoping review also identified a growing range of interventions alongside considerable variation in symptoms, study quality and outcome measures. That evidence allows for treatment possibilities while limiting promises about the extent or timing of an individual's recovery.
The role of psychological care
Therapy may address symptom-related fear, avoidance, attention, dissociation or boom-and-bust activity, depending on the formulation. Sleep, pain, depression and the effects of being disbelieved may also need attention, alongside trauma where it is supported by the history and current difficulties.
Psychological care should help the person understand factors that amplify or maintain their symptoms and work towards functional goals alongside rehabilitation. Recovery varies, with some people experiencing remission and others gaining function while still needing support or longer-term adaptation.
The treatment team and person can review concrete changes in daily function and participation, as well as symptoms, so that continuing care reflects what is improving and where further help is needed.
Research drawn on
- Lehn A, Petrie D, Palmer D, et al. Managing functional neurological disorder: treatment recommendations for health professionals in Australia. BMJ Neurology Open. 2025.
- Nielsen G, Stone J, Lee TC, et al. Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD). The Lancet Neurology. 2024.
- Sireci F, Ragucci F, Menozzi C, et al. Exploring therapeutic interventions for functional neurological disorders: a comprehensive scoping review. Journal of Neurology. 2024.
AI disclosure
Brent Munro researched, wrote and reviewed this insight, with ChatGPT assisting in literature searches, limited research comparisons, editing and image generation. He retains full responsibility for the published content.