1. What is Functional Neurological Disorder? 
 

Functional Neurological Disorder (FND), also known as conversion disorder, presents with symptoms that mimic neurological diseases but lack a corresponding organic pathology. These symptoms can affect movement (e.g., tremors, dystonia, gait abnormalities) and sensory systems (e.g., numbness or non-epileptic seizures). FND is a significant cause of disability worldwide, affecting quality of life and leading to considerable healthcare utilization (Espay et al., 2018). Increasingly, FND is understood not as a condition rooted purely in the mind or body, but rather as a disorder situated at the intersection of neurology and psychiatry.

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The prevalence of Functional Neurological Disorder (FND) is estimated to range between 4 and 12 cases per 100,000 people annually, though some studies suggest it could be higher due to misdiagnosis or lack of recognition in clinical settings (Espay et al., 2018). FND accounts for 6-16% of neurology outpatient visits, making it one of the most common reasons for neurological consultations (Stone et al., 2020).

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FND appears to affect women more frequently than men, with a female-to-male ratio of approximately 2:1. It can occur at any age, but is most commonly diagnosed in young to middle-aged adults, typically between 20 and 40 years old. However, it is also seen in children and the elderly (Carson et al., 2016).

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FND is often associated with psychological conditions such as depression, anxiety, or a history of trauma, and these comorbidities may play a role in its onset. Socioeconomic factors and healthcare access disparities may also influence both the diagnosis and treatment of FND, though it can occur across various social and cultural backgrounds (Pick et al., 2020).

 

The link between FND and mental health is well-established. Many patients with FND have concurrent psychiatric conditions such as anxiety, depression, or a history of trauma. These mental health factors are believed to contribute to the development of FND symptoms. The disorder can also be exacerbated by stress or emotional dysregulation. Treatment approaches that integrate psychiatric and neurological care, including psychotherapy (e.g., cognitive-behavioral therapy), hypnosis, and brain rehabilitation therapies, are showing promise in helping patients manage their symptoms and improve functioning (Carson et al., 2022).

 

2. What Causes Functional Neurological Disorder?  
 

The exact mechanisms underlying FND remain elusive, but emerging research points to a complex interaction between the brain, psychological processes, and external stressors. Brain imaging studies have been instrumental in shedding light on the neural correlates of FND. For example, functional MRI (fMRI) studies suggest that patients with FND have abnormal activity in areas of the brain involved in motor control, emotion regulation, and sensory processing (Voon et al., 2016). These areas include the supplementary motor area, the anterior cingulate cortex, and the amygdala, suggesting a disruption in the brain networks responsible for voluntary movement and emotional responses.

 

A key feature of FND is a disconnect between the intention to move and the execution of movement. Research in neurophysiology has suggested that abnormal communication between higher-order brain regions and motor areas may result in involuntary motor symptoms (Stone et al., 2020). Some theories propose that FND symptoms arise from maladaptive brain processes triggered by psychological stress or trauma. Psychological mechanisms such as dissociation, learned responses, and hypervigilance to bodily sensations may perpetuate the disorder, with patients unintentionally amplifying their symptoms in response to emotional or psychological distress.

 

From a psychiatric and psychological perspective, FND has been conceptualized as a disorder in which maladaptive coping mechanisms are deployed in response to overwhelming emotional states. Psychodynamic theories suggest that FND symptoms may represent repressed emotions or unresolved conflicts manifesting physically. Cognitive-behavioral models, on the other hand, highlight the role of attention and beliefs in shaping symptom expression. Patients with FND may experience heightened awareness of normal bodily sensations, misinterpreting them as evidence of serious neurological dysfunction (Aybek et al., 2015).

 

3. Disability and Functional Impairment in FND  
 

FND is a leading cause of disability, with patients often experiencing significant limitations in their daily functioning. The symptoms of FND can be as severe and disabling as those of organic neurological diseases. Many individuals with FND are unable to work or participate in social activities, leading to a profound impact on their quality of life. The fluctuating and unpredictable nature of the disorder often contributes to its disabling effects. For example, motor symptoms like gait disturbances or weakness can cause falls or difficulty walking, while non-epileptic seizures can lead to injuries or accidents (Edwards et al., 2019).

 

In addition to physical disability, FND is associated with high levels of psychological distress, including depression and anxiety. These mental health issues can further exacerbate the disability associated with FND, creating a cycle of worsening symptoms and reduced functional capacity. The stigma surrounding FND can also contribute to disability, as patients may feel invalidated by healthcare providers or experience difficulty accessing appropriate care. The invisible nature of the disorder can make it challenging for patients to receive support, both medically and socially (Pick et al., 2020).

 

4. Integrative Psychiatry and Brain-based Treatment Approaches for Functional Neurological Disorder (FND)
 

Traditional approaches to treating FND have often been limited to symptom management through neurological care. However, growing evidence supports the integration of psychiatric and psychological therapies in the treatment of FND, reflecting the biopsychosocial nature of the disorder (Goldstein et al., 2020).

 

Hypnosis is another promising intervention for FND, particularly in cases where dissociation or trauma is present. Hypnosis can help patients access unconscious processes, allowing them to modify maladaptive responses and reduce symptom intensity. Studies have shown that hypnosis can be particularly effective in treating motor and sensory symptoms of FND (Oakley & Halligan, 2017).

 

In addition to psychological interventions, neurorehabilitation approaches are being explored for FND. These treatments involve retraining the brain to improve movement and function, often through physiotherapy combined with psychological support. 

 

5. Current Guidelines for Treatment for FND  
 

Recent guidelines emphasize the importance of a multidisciplinary approach to treating FND, incorporating both neurological and psychiatric perspectives. The American Academy of Neurology (AAN) and the British Psychological Society (BPS) have both published guidelines supporting the use of psychological therapies as a core component of FND treatment. These guidelines recommend a patient-centered approach that includes psychoeducation, CBT, and physical rehabilitation (Stone et al., 2020).

 

Integrative psychiatry, which combines conventional psychiatric treatment with complementary therapies, is increasingly recognized as a valuable approach to managing FND. Mind-body practices such as mindfulness, yoga, and biofeedback have been shown to reduce stress and improve symptom management in FND patients. These therapies work by promoting relaxation, improving emotional regulation, and enhancing the mind-body connection, which is often disrupted in FND.

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6. Neuregen is Scottsdale, AZ is guided by Current Guidelines & Evidence-based Approaches  

Neuregen’s approach is in line with current treatment guidelines that emphasize the need for integrative, multi-disciplinary care for Functional Neurological Disorder (FND) and related conditions. For example, the use of cognitive-behavioral therapy (CBT) for FND, supported by guidelines from organizations like the American Academy of Neurology, is part of Neuregen’s repertoire.  However, we also utilize other psychotherapeutic techniques, as dictated by each case.

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7. Conclusion  

Functional Neurological Disorder is a complex and disabling condition that straddles the boundary between neurology and psychiatry. Advances in neuroimaging and psychological research are helping to unravel the underlying mechanisms of FND, highlighting the importance of integrating mental health care into its management. By combining approaches such as CBT, hypnosis, neurorehabilitation, and integrative psychiatric therapies, clinicians can offer patients a more holistic and effective pathway to recovery. Future research should continue to explore innovative treatments and refine existing therapies to better meet the needs of individuals with FND.

 

References

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Aybek, S., & Vuilleumier, P. (2015). Imaging studies of functional neurological disorders. Current Neurology and Neuroscience Reports, 15(6), 29-38. https://doi.org/10.1007/s11910-015-0554-6

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Carson, A., Lehn, A., Ludwig, L., & Stone, J. (2022). Explaining functional disorders. In Handbook of Clinical Neurology (Vol. 188, pp. 101-120). Elsevier. https://doi.org/10.1016/B978-0-12-820683-7.00023-0

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Edwards, M. J., Adams, R. A., Brown, H., Pareés, I., & Friston, K. J. (2019). A Bayesian account of “hysteria.” Brain, 135(11), 3495–3512. https://doi.org/10.1093/brain/aws129

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Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., & Stone, J. (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

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Goldstein, L. H., Robinson, E. J., & Mellers, J. D. (2020). Cognitive-behavioral therapy for psychogenic nonepileptic seizures: A pilot RCT. Neurology, 74(23), 1986–1994. https://doi.org/10.1212/WNL.0b013e3181e39691

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Oakley, D. A., & Halligan, P. W. (2017). Hypnotic suggestion and cognitive neuroscience. Trends

 

 in Cognitive Sciences, 17(2), 93-102. https://doi.org/10.1016/j.tics.2012.12.004

 

Pick, S., Goldstein, L. H., Perez, D. L., & Nicholson, T. R. (2020). Emotional processing in functional neurological disorder: A review, biopsychosocial model and research agenda. Journal of Neurology, Neurosurgery & Psychiatry, 91(6), 636–644. https://doi.org/10.1136/jnnp-2019-322180

 

Stone, J., LaFrance, W. C., Levenson, J. L., & Sharpe, M. (2020). Issues for DSM-5: Conversion disorder. The American Journal of Psychiatry, 170(1), 16-20. https://doi.org/10.1176/appi.ajp.2012.12091107

 

Voon, V., Cavanna, A. E., & Hallett, M. (2016). Mechanisms underlying functional and dissociative neurological disorders. Practical Neurology, 16(3), 172-178. https://doi.org/10.1136/practneurol-2015-001241

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