Functional Neurological Disorder (FND)
Understanding Functional Neurological Disorder (FND)
Functional neurological symptoms (FNS) or Functional Neurological Disorder (FND) is an umbrella term for a wide spectrum of sensorimotor symptoms that resemble neurological conditions. FND include functional movement disorders and tremors, idiopathic non-epileptic seizures, drop-attacks, visual symptoms such as blindness, photophobia and double vision, speech impairment and stutter, touch sensitivity, chronic pain, gate and balance problems, as well as paralysis and weakness. Cognitive and emotional challenges, memory loss, brain fog, fatigue, anxiety, or avoidance often accompany FND. In addition, symptoms of altered awareness, including dissociative symptoms, derealization, and depersonalization, are very common.
Individuals experiencing functional neurological symptoms are often semi-conscious and clients have described that they can hear what is being said, but cannot speak, feel foggy, out-of-their-body, numb, or overtaken by a strong energy. Individuals diagnosed with FND often experience anxiety, depression, symptoms of PTSD, and difficulty concentrating.
Watch Dr. Moenter's contribution to the 2020 FND virtual conference talking about her treatment approach to FND.
Watch Dr. Moenter's Contribution To The 2023 FND & Me Virtual Workshop For Teens With FND.
How is FND diagnosed?
The diagnostic process relies on finding clear positive physical features of the condition which makes FND not a diagnosis of exclusion. Due to similarities, FND can be misdiagnosed as a neurological disorder, and it can take years for the patient to find out that he, she, or they does not actually have a neurological disorder. FND has been diagnosed in children, teenagers, and adults.
The Causes of FND
Contrary to popular belief, anybody can experience the sudden onset of FND. Age, gender, mental health, level of education, or other demographic factors seem to not have direct bearing on the onset of FNS.
Research suggests that an existing chronic illness such as MS or Parkinsons, and/or accumulated stress and trauma in a person’s life can lead to the development of FND. Reports show that approximately 70% of individuals with FND have been exposed to accumulated stress and/or trauma during their life. Underlying conditions are in many cases depression (50-90% of individuals with FND are also clinically depressed), post-traumatic stress disorder (25-58% of individuals are diagnosed with PTSD), and/or anxiety disorders (about 50% of individuals with FND). In a sense, functional neurological symptoms can be seen as a physical manifestation of a dysregulated nervous system.
At the Boulder Center for NeuroHealth we have seen a correlation not only between PTSD and FND, but also between being “highly sensitive” and FND. A highly sensitive person is an individual who has a sensory processing sensitivity, including hypersensitivity to external stimuli, a greater depth of cognitive processing, and high emotional reactivity.
Treatments for FND
If you have been diagnosed with FND you might feel confused. What does this diagnosis mean? Where do you go from here? How can you have symptoms that look like seizures or paralysis but not be diagnosed with a neurological diagnosis such as epilepsy?
Somatic psychotherapy can be useful to help a patient explore, understand and manage the stressors that lead to FND. Identifying precursors, reducing stressors while learning about effective stress coping strategies, working with emotions and belief systems, while treating symptoms of PTSD can all be helpful tools on the journey of reducing or possibly eliminating FND.
Here at the Boulder Center for NeuroHealth we specialize in offering support for the underlying conditions of functional neurological symptoms.
I believe that no one needs to be alone (confused, isolated, hopeless) in this frightening experience and everyone has the ability to walk through and away from the reality of having functional neurological symptoms when educated and equipped with proper tools.
Afra Moenter, Ph.D.
For some individuals with FND, symptoms are more pronounced in the realm of a hypo-activated nervous system (not enough activation). When the nervous system is in a state of parasympathetic-dominant Hypo-activation (or dorsal vagal collapse), the body shuts down. This shut-down can be experienced as partial or full paralysis or weakness.
Other symptoms that can accompany the dorsal vagal collapse can be the inability to think, slurred speech, drop attacks and blackouts, spaciness and extreme fatigue, loss of bladder/bowel function, collapse, numbness, depersonalization, or derealization.
Many individuals with FND experience sensory sensitivities or sensory symptoms. Sensory sensitivities can impact all senses (touch, smell, sound, taste, vision, and interoception). Lights can feel too bright, touch uncomfortable or even painful, sounds intrusive, smells overpowering, taste intolerable and the ability to sense inner body sensations (interoception) is often lacking.
The central nervous system is designed to filter out redundant and unnecessary stimuli and organize sensorimotor information into an integrated experience. This process is called the “gating mechanism,” and it may be dysregulated in many clients with FND who describe a variety of sensory challenges that manifest as over-sensitivity or under-sensitivity.
Over-sensitivity, or “sensory overload,” implies a heightened sensitivity to touch, sounds, sights, textures, smells, and other sensory stimuli. Under-sensitivity can manifest as a lack of responsiveness to factors such as temperature, touch, or noise. It is possible that these symptoms are caused by sensorimotor gating impairments that prevent individuals from integrating information from internal and external sources as normal.
As part of the FNDcourage course, Dr. Moenter explains how sensory processing works and how you can regulate and increase your ability to be with sensory stimuli. Learning about the gating mechanism of the brain, your boundary style, and concrete boundary tools might increase your ability to process sensory stimuli and feel less negatively impacted by sensory stimuli.
Trauma is the result of experiencing inescapably stressful events that overwhelm an individual’s existing coping mechanisms while obstructing information-processing abilities. It affects memory in two ways, modifying both sensorimotor and affective levels of memory formation and recall and often producing the symptoms of somatoform and psychoform as seen in FND.
Some individuals with FND have experienced chronic stress or trauma prior to the onset of FND. The exposure to life-altering adverse events can contribute to the dysregulation of the autonomic nervous system. Since FNDcourage is based on the idea that FND is an expression of a dysregulated nervous system (too much or too little activation), part of the healing process is undoubtedly the work with and resolution of any adverse nervous system changes resulting from chronic stress and/or trauma.
Although a direct causal connection between trauma and the onset of FND has not yet been identified, trauma is widely believed to be a contributing factor, alongside adverse childhood experiences (ACE). For instance, several studies have concluded that individuals with FND exhibit elevated rates of post-traumatic stress disorder (PTSD), and those with FND display disproportionately high incidence of involuntary dissociative states.
As part of your FNDcourage course, you will learn about resilience and how to increase your on resilience in the face of stressful external and internal experiences. Resilience is your ability to quickly and fully recover from challenging, stressful, and traumatic events.
Being resilient means you have the capacity to face stressors, to lean into discomfort, instead of avoiding challenges. Part of the model of FNDcourage is to NOT use the word “triggers.” Many professionals talk about “triggers” in the context of FND. What Dr. Moenter has seen in her work with FND is that people naturally orient away from “triggers” creating a pattern of avoidance. Such avoidance, over time, leads to a very limited lifestyle and a lack of trust and strength necessary to lean into the discomfort of FND, which eventually will help reduce symptoms.
Dr. Moenter introduces the concept of “precursors” feelings, thoughts, and physical sensations that can be an indicator that your nervous system is at the beginning stages of dysregulation.
“True freedom means living our lives fully, not avoiding, not “coping,” but truly developing the capacity to be with all that life offers us.” Afra Moenter, Ph.D.
Functional Movement Disorders can be divided into tremors, twitches and jerks, gait problems (difficulty walking), functional weakness. These functional symptoms are not caused by damage or disease of the nervous system.
As part of FNDcourage Dr. Moenter talks about involuntary and voluntary movements, and how to relate to and potentially ease involuntary symptoms in your body.
In the FNDcourage course, Dr. Moenter explores emotional imbalances as part of FND. Research shows that individuals with FND have
a higher autonomic sensitivity to emotional stimuli, especially threat signals, and therefore a high autonomic arousal at baseline
increased orienting responses > high sensitivity to threat signals and motor mobilization
higher amygdalar activity
Unusual limbic-motor interactions in reaction to emotional stimuli: neuroimaging evidence addressing motor activation during the processing of emotional information in FND patients
higher functional connectivity between the amygdala and supplementary motor area (SMA) during processing of both positive and negative emotional stimuli.
Common emotions that individuals with FND feel are shame, anxiety, despair, hopelessness, helplessness, and fear. Dr. Moenter’s explains how emotions can be an expression of a regulated (sadness, curiosity, anger, fear etc.) or a dysregulated (terror, rage, shame, obsession etc.) nervous system. As part of the FNDcourage course you will learn how to identify your emotions as they relate to your nervous system activation and learn how to self-regulate your emotional state. Such emotional self-regulation can positively impact your functional neurological symptoms.
Dr. Moenter also explores how emotions contribute to your body posture, how you hold yourself in your body, and how in turn that experience might make you more susceptible to certain FND symptoms. By learning about and changing your Emotional Anatomy (Stanley Keleman) you will increase your interoception (body awareness) and increase your ability to regulate your nervous system.
Many individuals with FND describe functional cognitive symptoms. Symptoms vary, but can often include:
Difficulty remembering events or conversations
Brain fog or sluggishness
Problems remembering names
Problems with multitasking
Challenges when learning and retaining new information
Problems with attention span
If you experience any of these symptoms as part your FND, your challenges might not be due to you loosing your intellectual capacity or curiosity. Dr. Moenter views cognitive symptoms as an often temporary limitation; potentially caused by severe dissociative states and/or a result of the chronic stress of FND (or other life-altering events). the exposure to chronic stress and trauma can impair the functionality of the pre-frontal cortex (responsible for executive function, decision making, etc.) and therefore can leave you with a limited capacity to think clearly or make sound decisions for yourself.