Functional Neurological Disorder (Formerly Conversion Disorder)

Functional neurological disorder (FND), formerly known as conversion disorder, is a neuropsychiatric (or brain-based) disorder that affects the way your brain sends, receives and processes messages.

With this condition, the structure of your brain is normal. Scans like CTs usually look healthy. The difference is in how your brain communicates with your body. In FND, the signals can get interrupted, and that leads to real symptoms.

When these signals are mixed up, it can affect your movement, feeling, speech or other body functions. To others, it might seem like you’re faking or seeking attention. This can be extremely frustrating (invalidating) because they can’t see the cause. It can affect both your physical and emotional health.

Another name for this rare condition is functional neurological symptom disorder (FNSD). A team of healthcare providers can help you manage symptoms.

Why is it no longer called conversion disorder?

In the past, healthcare providers saw functional neurological disorder as only a mental health disorder. They believed a person “converted” hidden stress or trauma into physical symptoms. That idea gave the condition its old name.

Research now tells us that this name isn’t accurate.

A specific brain scan called a functional MRI can show your brain activity at rest and during specific tasks. These scans reveal that FND changes how your brain sends and receives signals.

Research also shows that people with FND may have unusual activity in brain areas linked to their symptoms. Also, not everyone with FND has a history of trauma or stress.

Symptoms of functional neurological disorder

Symptoms usually appear suddenly and may interfere with your daily functioning. They might get worse when you pay attention to them and get better when you use distraction techniques.

The most common FND symptoms include:

• Psychogenic non-epileptic seizures (PNES): PNES are episodes that look like seizures related to epilepsy. An electroencephalogram (EEG), typically used to detect abnormal electrical activity in the brain, is usually normal in PNES.
• Movement issues: You might have tremors (shakiness), jerks or difficulty walking or controlling your movements. These movements feel out of your control.
• Problems with your senses: You might have trouble with your sense of vision, hearing, smell, taste or touch. Examples include double or tunnel vision, hearing loss and numbness.
• Thinking and memory changes: You may have brain fog, lose your train of thought, forget words or misplace important things. You might also find it harder to keep your attention for long periods of time.
• Dizziness and balance issues: You might feel unsteady, lightheaded or as if you’re rocking or swaying (without spinning).
• Pain: You may feel aches or sharp, stabbing or burning sensations. Pain could range in severity, be long-lasting or come and go. You might have frequent migraines.

You might also notice:

• Chronic fatigue or lack of energy
• Difficulty speaking or stuttering
• Muscle weakness or paralysis
• Trouble swallowing

Functional neurological disorder causes

Healthcare providers aren’t sure exactly what causes FND. It happens when there’s a problem in how your brain and body communicate.

It’s very common to describe FND as a software issue. Think of your brain as the computer’s hardware, and your nerves as the wires that carry information. The “software” is the program that tells your brain and nerves how to work together. In FND, the hardware and wires are fine, but the software has a glitch. This glitch changes the way your brain sends and receives signals. This can cause a lot of physical symptoms that aren’t otherwise explained medically.

Just like a computer with a software bug, nothing’s broken inside. But things don’t work as they should. Treatment helps “retrain” your brain and nervous system so the signals flow normally again.

What triggers functional neurological disorder?

Certain situations may trigger FND, including:

• Infections
• Migraines
• Physical injuries
• Stressful or traumatic events

Sometimes, instead of stopping, triggers can cause symptoms to cycle on a loop. This happens because your brain gets stuck on them. This pattern can lead to FND. Experts are still studying how and why this happens.

Risk factors

FND can develop at any time, including during childhood. It’s more likely to affect females than males.

You may be more at risk if you have:

• Adverse childhood experiences (ACEs), like bullying, unhealthy family dynamics and child abuse
• Chronic pain, fatigue or stress
• Another nervous system condition
• Other mental health disorders, like depression or anxiety

You might not have any of these risk factors, but still have symptoms.

How doctors diagnose functional neurological disorder

FND care ideally consists of a multidisciplinary team of healthcare providers, including, but not limited to, neurologists, psychiatrists, psychologists and physical/occupational/speech therapists.

Healthcare providers use different tests to diagnose functional neurological disorder. It’s a complex condition, and symptoms can look like those of other conditions. This can make it hard to tell them apart.

Getting a diagnosis may feel like a long process with many tests. You’ve likely seen many providers before getting an FND diagnosis. But finding the right care is important.

Once you get a diagnosis, your providers will focus on building trust. You may have gone through a long process to get here. Along the way, people may have even told you that your symptoms were “made up.” That stigma can keep many people from getting care and can affect their mental well-being. But you’ve made real progress by getting this far.

Your care team will reassure you that your symptoms are real and that you’ve done the right things. They’ll explain the condition in detail and answer any questions you have.

What tests diagnose FND?

The exams and tests your provider offers will depend on what symptoms you have. They may include:

• Blood tests
• CT scan
• Electroencephalogram (EEG)
• Electromyogram
• Evoked potentials test
• Functional MRI (fMRI)
• Neurological exams
• Physical exams

After your provider gets the results of your tests, they’ll use the following criteria to make an official diagnosis:

• You have one or more symptoms related to your brain’s control over your movement or senses.
• Your symptoms aren’t consistent with medical conditions that affect the structure of your brain or nervous system.
• The symptoms or issues disrupt your life, like your ability to work and maintain relationships.

How is functional neurological disorder (FND) treated?

Functional neurological disorder is complex and requires a multidisciplinary approach. This often includes:

• Cognitive behavioral therapy (CBT): This is a treatment that shows how your thoughts, feelings and behaviors connect. It can help you spot thoughts that trigger certain emotions, which can then affect how you act and respond.
• Psychodynamic therapy: This explores past trauma and emotional conflicts throughout your development. It can help you understand how symptoms may link to past events.
• Family therapy: Family therapy can help your loved ones understand the condition and offer support.
• Biofeedback: This uses sensors to help you see how your body reacts to stress. It can help you learn to manage certain body functions to reduce symptoms.
• Physical therapy: This may improve movement and coordination. It also encourages better movement patterns and prevents muscle weakness.
• Medication: This treatment may help if you also have depression, anxiety or chronic pain. Your provider will choose medicine based on your needs.

When should I see my healthcare provider?

If you have FND, the best thing you can do is work closely with your healthcare provider. They’re here to guide you through treatment and help you find what works best for you. If something feels off or if you notice changes in your body that you don’t understand, reach out. Your care team wants to know what’s going on so they can support you.

Functional neurological disorder prognosis

The outlook for FND can vary. The condition isn’t life-threatening. But it can affect your mental health and overall well-being. You may have severe symptoms that keep you from working or enjoying your daily activities.

Factors that may improve your outlook include:

• Getting an early diagnosis
• Having a good relationship with your healthcare provider
• Having clear stress triggers
• Having symptoms for a short time
• Having symptoms that start suddenly

Recovery with FND isn’t always a straight path. You may go through times when getting better feels hard. Your symptoms might even get worse before they improve. This is common. But it doesn’t mean you’re failing or that things are hopeless.

Still, it can be complicated as you go through treatment. It’s important to know that help is available if you need it. If you’re in a rough spot or thinking about suicide, call or text 988 (U.S.) to reach the Suicide and Crisis Lifeline. Someone is available to help you 24/7.

How long does functional neurological disorder last?

FND can last for a short or a long time. If symptoms last fewer than six months, it’s called an acute case. If symptoms last more than six months, it’s called a persistent case.

Getting diagnosed early and starting treatment right away can improve your chances of recovery. For some, symptoms may last for years or even be lifelong, especially if care is delayed or there’s an interruption to treatment.