FND is one of the most common diagnoses in neurology and one of the least understood. FND Australia Support Services places it second only to headache as a reason people see a neurologist, and functional seizures alone make up to a fifth of presentations at specialist epilepsy centres.
I have spent the better part of a decade researching FND and working with people who live with it. This page explains what FND is, how it is diagnosed, where psychotherapy fits, and how I work.
What is FND?
FND is a group of conditions in which a person experiences neurological symptoms that feel involuntary and disabling, such as seizures, weakness, tremor or loss of sensation, without the structural disease that would usually explain them. The problem sits in how the brain and body work together, not in how they are built, so MRI and CT scans usually come back normal. FND touches the systems that govern attention, movement, emotion, the sense of authoring one’s own actions, and the way the brain reads signals from inside the body. Many people receive the diagnosis only after a long run of tests that showed nothing. The tests were looking in the wrong place.
There are many ways of understanding FND. Mine comes from integrative relational neuroscience: FND as a disturbance of the body’s stress system, shaped by a person’s relationships and life experience, and expressed through brain and body together.
What are the symptoms of FND?
FND can affect almost any part of the body, and most people experience more than one symptom. Commonly reported symptoms include:
- Seizure-like episodes
- Tremor, jerking, spasms or difficulty with walking, posture and balance
- Weakness or paralysis in an arm or leg
- Numbness, or loss of the sense of touch
- Difficulty speaking, including a sudden onset of stuttering
- Problems with vision or hearing
- Trouble with memory, attention and concentration
- Dizziness
- Pain, including chronic migraine
- Extreme fatigue and slowness
Two patterns are the most common. Functional or dissociative seizures look like epileptic seizures but do not involve the abnormal electrical activity that produces epilepsy. Functional movement disorder affects how the body moves, and about half the people who have it experience more than one kind of abnormal movement.
One feature causes a great deal of self-doubt, so it deserves a mention. FND symptoms often worsen when attention rests on them and ease when a person is distracted. Neurologists use this to help confirm the diagnosis. It says nothing about whether the symptoms are real.
Is FND real?
Yes. FND is a recognised neurological diagnosis, and the symptoms are not produced on purpose.
People ask because people with FND are so often disbelieved. NINDS names the problem directly: physicians may wrongly treat FND symptoms as feigned, and patients are left feeling stigmatised. The people who took part in my doctoral research described this in their own words. Many had been told there was nothing wrong with them, some by the very services they turned to for help. Being disbelieved sat close to the centre of their stories, and for some it did as much damage as the symptoms. If this has happened to you, you are in good company, and it says nothing about the reality of what you live with.
What causes FND?
There is no single cause. What we have instead is a growing body of research from neurology, psychiatry, psychotherapy and physiotherapy, with multidisciplinary teams around the world working on the condition from several directions at once. The different ways of understanding FND now fit together better than they once did.
Functional brain imaging shows altered connections between brain regions in people with FND, a weakened sense of agency, and heightened activity in the limbic system, the part of the brain most involved in emotion and the stress response. Current models describe a brain whose predictions about the body override what the body is actually reporting, alongside difficulty regulating emotion and a disturbed sense of the body from the inside.
Psychological stress and childhood adversity raise the risk, and depression, anxiety and PTSD often travel with FND. But not everyone who develops FND has these, and their absence does not rule the diagnosis out. An intense positive experience, such as a wedding, a birth or a long-awaited reunion, can trigger symptoms as readily as a painful one, because the stress system responds to intensity rather than to whether an experience is good or bad. FND is not simply stress, and it is not a psychological condition in a neurological disguise.
How is FND diagnosed, and who diagnoses it?
Diagnosing FND needs a neurologist. FND Australia Support Services puts it plainly: correct diagnosis requires neurology involvement. I do not diagnose FND, and neither does any psychotherapist. If you suspect FND and have not been assessed, start with your GP and ask for a referral to neurology.
There is no single test for FND. Neurologists diagnose it positively, from history, symptoms and examination, using reproducible signs such as Hoover’s sign for functional leg weakness and entrainment testing for tremor. This allows a confident diagnosis early rather than after years of inconclusive investigation. EEG and EMG may be used to rule other conditions out. FND can also sit alongside other neurological conditions, so an FND diagnosis does not mean nothing else is going on.
Where does psychotherapy fit in FND care?
FND care works best as a team effort. FND Australia Support Services describes the ideal as a multidisciplinary team across neurology, neuropsychiatry, physiotherapy, occupational therapy and neuropsychology, with speech therapy where speech and swallowing are affected.
NINDS names physiotherapy and psychotherapy as the two main treatments, and specifically identifies psychodynamic therapy as a way of working with the patterns of thought, belief and emotion connected to neurological symptoms. FND Australia notes that psychological therapies have the strongest evidence for helping people manage seizure-like episodes. Psychodynamic interpersonal therapy, a shorter form of the Conversational Model I trained in, has been used with functional and somatic presentations, and a 2021 meta-analysis of short-term psychodynamic psychotherapy for functional somatic disorders found improvements across a range of outcomes.
Psychotherapy does not replace neurological care, physiotherapy or occupational therapy. It works alongside them.
How I understand FND
When I analysed the interviews of people living with FND, one theme ran through every other: relationships. Relationships were where the trauma had happened, where people had been abandoned or disbelieved, and also where they found the support that helped them recover. The most connected thread across all the themes was trust versus mistrust. Many participants wanted closeness and feared it at the same time, and protected themselves in ways that kept them isolated. I call this the connection-protection paradox.
This is where trauma-informed, body-oriented psychotherapy differs from a purely cognitive approach. Cognitive therapy works with what a person thinks about their symptoms, and that has value. My research and clinical work point to something underneath the thinking: a stress-regulation system that learned its settings in relationship and can only recalibrate in relationship. Somatic Experiencing lets me work directly with the body’s states of arousal and shutdown. The Conversational Model teaches me to attend to how a person speaks, and to build slowly their capacity to stay present with their own experience. Attachment theory helps me recognise when the offer of help itself feels dangerous, which is common, so that I read it as protection rather than resistance.
What working together looks like
I start by listening, and I take my time over it. Many people with FND have told their story to people who were looking for a reason to dismiss it. I want to understand how the symptoms began, what was happening in your life at the time, what has helped, what has made things worse, and what it has been like to carry this. If you have a neurologist, physiotherapist or GP involved, I will ask your permission to be in contact with them, so we work from the same understanding.
The early sessions focus on safety and steadiness. For most people this is the real work, and it takes longer than anyone expects. We pay attention to the body: what it does under stress, what settles it, what the first signs of an episode feel like from the inside. You build the capacity to notice arousal rising and to have some say over it. People with FND often know when they are not ready to go into painful material, and I treat that knowing as wisdom.
Over time, and only at a pace the nervous system can tolerate, the work may move towards what has not yet been integrated: losses that still feel raw, relationships that taught the body to brace, memories that arrive as sensation rather than story. Some people need this. Others find that steadiness, trust and a coherent sense of themselves change how they live, and we never need to go further. I do not push.
I cannot promise an outcome. The evidence for psychotherapy in FND is encouraging, especially for functional seizures, but it is mixed, and recovery looks different for every person. Some see their symptoms ease substantially. Others find the symptoms remain but take up less of their life. What I can offer is a relationship in which you are believed, a way of working that respects the body’s timing, and a clinician who knows this condition from the research as well as the therapy room.
My experience with FND
I came to FND through the Westmead Psychotherapy Program, which developed a large collaborative study of FND with the Neurology Department at Westmead Hospital and the University of Sydney’s Brain and Mind Centre. My doctoral research grew out of that collaboration. Working from Adult Attachment Interviews conducted by a clinician colleague, I analysed participants’ accounts using interpretative phenomenological analysis and coded the interviews for attachment classification alongside senior colleagues. My PhD, The Lived Experience of Functional Neurological Disorder: An Integrative Relational Neuroscience Model, was conferred by the University of Sydney in 2026.
I published a systematic review of qualitative research on living with FND in BMJ Neurology Open, and led a second systematic review of attachment and FND that is now being prepared for publication. I am a certified reliable coder of the Adult Attachment Interview, a Somatic Experiencing Practitioner, and a faculty member and supervisor on the University of Sydney’s Master of Science in Medicine (Trauma-Informed Psychotherapy) program. My clinical training is in the Conversational Model, developed at Westmead and applied to functional presentations for decades.
For GPs, neurologists and other referrers
I am a PACFA-registered clinical psychotherapist (Reg. 22116) in private practice in Sydney’s Eastern Suburbs, offering psychodynamic and somatic psychotherapy for adults with a confirmed diagnosis of FND.
My approach is relational, trauma-informed and phase-based, drawing on the Conversational Model, Somatic Experiencing and attachment theory. I establish physiological and relational safety before any trauma-focused work, and I do not assume a trauma history where the patient does not report one. My doctoral research on attachment and FND at the Brain and Mind Centre informs how I formulate and how I pace the work.
I am a good fit for patients who have had their diagnosis explained by a neurologist, who are open to a psychological component to their care, and who may carry a history of adversity, loss or relational difficulty. I also suit patients who have found more directive approaches hard to tolerate, those whose presentations include dissociation, and those who have been through multiple services and need time to trust a clinician.
I work as part of the treating team. With the patient’s consent, I liaise with the referring neurologist, GP, physiotherapist and other clinicians, and I am glad to contribute to shared formulation. I also offer clinical supervision and attachment-informed consultation to clinicians and teams working with FND.
Where else to find support
Three organisations publish reliable, free information on FND:
- FND Australia Support Services (Australian information, resources and support)
- FND Hope International (patient-led information and community)
- NINDS (the US National Institute of Neurological Disorders and Stroke)
Related reading
- The Body Speaks: How Our Physical Sensations Shape Our Emotional World
- When Your Body Feels Like a Stranger: Introducing the Rest and Restore Protocol
- Fascia and Trauma: Why the Body Belongs in the Mental Health Conversation
- Six simple ways to regulate your nervous system
- The Safe and Sound Protocol: Navigating the Path to Balance
- Co-Regulation, Somatic Psychotherapy and Trauma Therapy
- Is it ADHD or nervous system dysregulation?
Book a session
I work with people in person in Woollahra, Sydney, and online across Australia.
If you would rather ask a question first, get in touch.
