Imagine being told that your debilitating symptoms are all in your head. For millions of people with functional neurological disorder (FND) this phrase has been both a source of frustration and a beacon of hope. While it may seem dismissive, it actually underscores the neurological basis of their condition.
Dr. Laura Strom, a neurologist at a leading multidisciplinary clinic, often reassures her patients, Well, it’s good that it’s all in your head – because that’s where your brain is. This statement encapsulates the shift in understanding that FND is a real, neurological condition, not a figment of the imagination.
The neurological basis of functional neurological disorder
Functional neurological disorder is characterized by symptoms that are real and debilitating, yet do not have a clear structural cause in the brain. These symptoms can include movement disorders, seizures, and sensory disturbances. The condition arises from disrupted communication between different brain networks responsible for movement, attention, emotion, body awareness, and sensory processing.
One leading theory explaining FND is predictive processing. This theory suggests that the brain constantly makes predictions based on past experiences, current surroundings, and internal body signals. When new information doesn’t match these predictions, the brain updates its predictions. Researchers believe that disruptions in this updating process may be a key mechanism behind FND.
For example, after an injury has healed, the brain may continue to predict that a movement or activity is unsafe. This can lead to persistent weakness or difficulty walking, even though there is no ongoing harm to the body. The result is symptoms that are involuntary, physically real, and profoundly disabling.
The historical context of functional neurological disorder
Our understanding of FND has evolved significantly over the past century. Historically, the condition was labeled as hysteria or conversion disorder with symptoms attributed primarily to psychological factors rather than biological changes in the brain. These labels reflected the best explanations medicine had at the time but often led to stigma and misunderstanding.
Many of the symptoms now recognized as part of FND were primarily attributed to the emotional and psychological state of women and subsequently dismissed. These explanations reflect broader gaps and biases in how doctors approached women’s health concerns throughout history, contributing to decades of stigma and misunderstanding around FND and other conditions.
As neuroscience advanced, researchers began recognizing that symptoms could arise from changes in brain function rather than visible changes to the brain. Today’s models focus more on brain networks and the dynamic, interconnected relationship between the brain, body, and environment.
The prevalence and impact of functional neurological disorder
Functional neurological disorder is more common than many people may realize. A 2026 review estimated that up to 5 million Americans are living with the condition. Researchers estimate that mortality rates among patients with the condition are more than twice that of the general population.
Despite its prevalence, access to specialized care remains limited. Many healthcare professionals receive little to no formal education about FND during training. This lack of understanding can lead to delayed diagnosis and inappropriate treatment. Patients often become the ball in a game of medical ping-pong, referred back and forth between psychiatry and neurology without receiving the care they need.
People with FND experience disproportionately high use of healthcare services, cycling repeatedly through emergency departments and specialty clinics in search of answers and validation. Some receive medications they don’t need. Others undergo invasive procedures before receiving the correct diagnosis.
Future research and treatment
The story of functional neurological disorder is beginning to turn a corner. New multidisciplinary clinics are opening, research is accelerating, and understanding of the disorder continues to grow.
The treatment landscape for FND is evolving to help the brain learn new, healthier patterns to process the world. Psychotherapy, physical therapy, occupational therapy, and speech therapy each play a role in retraining disrupted brain networks. Recovery looks different for everyone, but growing evidence shows that improvement is possible.
The most important step forward, however, happens before any therapy begins: when a healthcare provider believes their patient. Understanding may be the beginning of recovery rather than another dead end.
