Functional Movement Disorder

What is functional movement disorder?

Functional movement disorder (FMD) is a condition that affects how your brain controls movement. It happens when your brain has trouble sending and receiving signals correctly. This can cause movements that feel out of your control (involuntary), such as shaking, jerking, twisting, spasms, slowness or difficulty walking.

These abnormal movements aren’t caused by damage to your brain, spinal cord or nerves. In fact, brain scans and blood tests often come back normal. However, this doesn’t mean nothing is wrong or that the condition isn’t real. The problem lies in how your brain processes movement signals. This is similar to a computer with fully working hardware but malfunctioning software.

Functional movement disorder is one of many subtypes of functional neurological disorder (FND).

Symptoms of functional movement disorder

The main symptoms of functional movement disorder are abnormal movements that feel out of your control. You may just experience one type of movement or you can have a combination of movement issues.

Examples of common FMD movements include:

• Dystonia-like movements. This causes abnormal muscle contractions. You may make repetitive or twisting movements. These are often accompanied by pain. Specific examples include clenched fists, flexed ankles and repetitive facial movements.
• Gait and balance issues. Gait is your walking pattern. There are different types. For example, you may have an abnormal “walking-on-ice” gait, dragging gait or knee-buckling gait.
• Jerks or myoclonus-like movements. These are abnormal muscle movements that are sudden and brief. Examples include jerking movements of your head, neck, body, arms or legs.
• Muscle weakness. You may experience muscle weakness in your face or an arm or leg that comes and goes.
• Tremors or shaking. A tremor is a shakiness that affects any body part, like your head, arm and/or leg. This is the most common symptom of FMD.

Less common movement symptoms in FMD include:

• Chorea-like movements. This involves movements that make you look like you’re dancing, restless or fidgety.
• Parkinsonism-like movements. This involves slowed movements.
• Tic-like movements. These are fast and repetitive muscle movements that involve small muscle groups.

Common symptoms that often occur alongside FMD include:

• Brain fog
• Fatigue
• Migraines
• Pain
• Sleep issues

While these may not be directly caused by FMD, they’re frequently seen with the condition.

The majority of cases have a sudden onset of symptoms. This means that symptoms reach their most severe state quickly. However, you may have a stable (static) course. This means symptoms may fluctuate or change gradually over time.

Functional movement disorder causes

The leading theory behind functional movement disorder is that it stems from dysfunction in brain networks that control movement. Functional brain scans show that certain areas of the brain may be overactive or underactive, both at rest and during specific tasks.

One key network, called the “self-agency” network, helps you feel in control of your movements. Research suggests this network may not function properly in FMD. This could explain why movements that appear voluntary feel out of your control.

Other brain networks involved may include those regulating emotions, sensation awareness and interpretation.

What triggers functional movement disorder?

Triggers are events or stressors that bring on FMD symptoms. These may include:

• A minor injury, illness, surgery or physical trauma
• A major life stressor, such as the loss of a loved one, work pressure or emotional distress
• A significant change in environment, interpersonal conflict or overwhelming responsibilities

The following factors can make it harder for symptoms to improve and may cause FMD to become chronic:

• Your brain “learning” the abnormal movement pattern, making it continue even after the trigger is gone
• Fear of movement, leading to avoidance, increased distress and worsening disability
• Lack of support from family or healthcare providers, reinforcing feelings of hopelessness
• Lack of confidence in your diagnosis, repeated medical tests or pursuing additional diagnoses instead of participating in treatment
• Ongoing legal battles, disability claims or workers’ compensation cases that create additional stress and reinforce the focus on the illness

Symptoms aren’t caused by a single factor but rather by a combination of influences. This understanding helps guide treatment approaches that focus on education, rehabilitation, psychological support and lifestyle adjustments to improve symptoms and your overall well-being.

Risk factors of functional movement disorder

FMD tends to develop in adulthood, around 40 years of age. But it can affect anyone, including children.

The following factors make you more at risk of developing FMD:

• A history of migraines, chronic pain or an overactive nervous system
• Anxiety, depression or a past history of trauma
• Early life stress, childhood adversity or a lack of emotional support

How doctors diagnose functional movement disorder

A healthcare provider will start by asking about your symptoms and medical history. They’ll then do a physical exam and a neurological exam. During the neurological exam, they may assess things like your reflexes, coordination, muscle strength, muscle tone, walking pattern and mobility.

The main way providers diagnose functional movement disorder is by looking for specific signs during the physical and neurological exam that are unique to FMD and not seen in other neurological disorders. These signs can help providers confirm the diagnosis without the need for extensive testing.

How is functional movement disorder treated?

Because FMD isn’t caused by permanent brain damage, your brain has the potential to “relearn” movements. The main goal of treatment is to reduce symptoms, improve function and restore quality of life.

Your provider may recommend the following treatment options for FMD:

• Physical therapy. Physical therapy focuses on regaining control of movement, improving balance and reducing abnormal movements.
• Occupational therapy. Occupational therapy helps you perform daily tasks, like getting dressed, cooking or writing.
• Speech therapy. If FMD affects your speech, swallowing or thinking, a speech therapist can help improve these functions.
• Stress and emotional management. FMD isn’t a psychological disorder, but stress and anxiety can make symptoms worse or harder to manage. Talking to a therapist may help you understand how emotions, thoughts and behaviors may be affecting your symptoms. Therapy can also help you develop healthier ways to cope.
• Daily routines. Getting regular exercise, eating well and sleeping enough can all help your brain function better.
• Staying engaged. Keep doing things you enjoy and spending time with people who support you.
• Medications. Medications don’t directly treat FMD. But if you have other conditions, like depression, anxiety and/or chronic pain, taking medication to manage them can prevent their symptoms from getting in the way of FMD treatment.

Not all therapists are familiar with FMD, so it’s best to see a therapist who has experience treating FMD.

The length of treatment varies from person to person. It depends on the type of abnormal movements and other factors unique to you. Treatment may range from weeks to months or even take years. Your healthcare team will give you a better idea of what to expect. It’s important to stay committed to your treatment plan and recovery for best results.

What is the prognosis for someone with functional movement disorder?

It’s common for people with FMD to have “good days” and “bad days” or periods when symptoms are better or worse.

Studies on long-term outcomes for people with FMD show mixed results:

• Some people recover completely
• Others see major improvements but still have occasional symptoms
• Some may continue to have symptoms despite best efforts

Possible obstacles to recovery include:

• Confusion about your diagnosis
• Delayed diagnosis
• Lack of support from loved ones
• Barriers to healthcare access and treatment
• Lack of access to providers who have experience treating FMD

Factors that increase your chances of treatment success include:

• Good physical health
• Positive social life
• Viewing the treatment as effective
• Positive stress management techniques

Experts hope that increased awareness about FMD, reduced stigma and improved access to treatment may lead to better outcomes in the future.