Overview
Diagnosis
Functional neurologic disorder (FND), also known as functional neurological symptom disorder or conversion disorder, has no standard diagnostic test. Instead, healthcare providers diagnose it by identifying specific patterns of signs and symptoms while ruling out other neurological or medical conditions that could explain your symptoms.
The key to diagnosis is recognizing what is present—the particular way symptoms appear—rather than relying solely on what is absent, such as normal imaging results. A diagnosis typically involves a neurologist, and may include a psychiatrist or other mental health professional.
Evaluation and Assessment Process
Your healthcare provider will likely use multiple approaches to evaluate your condition. A physical exam includes an in-depth discussion of your health history and symptoms, along with specific tests designed to rule out neurological disease or other medical disorders. The exact tests depend on your particular signs and symptoms.
If appropriate, you may be referred for a psychiatric examination where a mental health professional will ask about your thoughts, feelings, and behaviors related to your symptoms. With your permission, information from family members can also provide valuable context.
Your healthcare provider may compare your symptoms against the diagnostic criteria listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). According to the DSM-5, functional neurological symptom disorder includes one or more symptoms affecting body movement or senses that cannot be explained by a neurological or other medical condition. Additionally, symptoms must cause significant distress or problems in social, work, or other important areas of life.
Treatment
Treatment varies based on your specific symptoms and needs. Many people benefit from a multispecialty team that may include a neurologist, psychiatrist or mental health professional, physical therapist, occupational therapist, and speech therapist.
Education and reassurance form an essential foundation of treatment. Understanding what functional neurologic disorder is, knowing that your symptoms are real, and learning that improvement is possible can significantly impact your recovery. For some people, simply understanding the condition and receiving reassurance that it does not indicate a serious underlying neurological disorder leads to symptom improvement.
Therapeutic Interventions
Physical and occupational therapy can help improve movement symptoms and prevent complications. Regular movement of affected limbs helps prevent muscle tightness and weakness, and gradual increases in exercise improve your overall function.
If your symptoms include speech or swallowing difficulties, speech therapy with a speech-language pathologist can be beneficial. Stress reduction techniques such as progressive muscle relaxation, breathing exercises, and physical activity can help manage symptoms. Distraction techniques like music, conversation, or consciously changing how you move may also provide relief.
Mental Health Treatment Options
While functional neurological symptoms are not simply psychological, emotions and thinking patterns can influence both symptoms and recovery. Cognitive behavioral therapy (CBT) helps you recognize inaccurate or negative thinking patterns so you can respond to situations more effectively. CBT is particularly helpful for managing stress and symptoms, and may be especially beneficial for nonepileptic seizures.
Other types of psychotherapy can address interpersonal problems or a history of trauma or abuse. Treating underlying mental health conditions like anxiety, depression, or other mood disorders is important because these conditions can worsen functional neurologic disorder symptoms.
Medications and Follow-Up Care
While no FDA-approved medications specifically treat functional neurologic disorder, certain medications may help manage associated conditions. Antidepressants can be useful if you also have depression or other mood disorders, or if you experience pain or insomnia.
Regular follow-up with your medical team remains important to monitor your progress and adjust your treatment plan as needed. Involving loved ones throughout the treatment process helps them understand your condition and provide meaningful support for your recovery journey.
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