3.13 Functional Neurological Disorders

Dr. Caitlin Adams, psychiatrist at Massachusetts General Hospital, provides an overview of functional neurological disorder (FND). This episode covers how to recognize, explain, and treat FND using a modern, evidence-based, and patient-centered approach. 

We begin by defining FND and discussing nomenclature from hysteria through conversion disorder and into our current construct of FND. Dr. Adams directly addresses one of the most critical misconceptions in clinical practice: whether symptoms like functional weakness or psychogenic non-epileptic seizures (PNES) are under voluntary control. We explore what current neuroscience tells us about the pathophysiology of FND and how this can support compassionate and effective care. 

The episode outlines how to positively diagnose FND—including key physical exam findings such as Hoover’s sign, tremor variability, and features that distinguish PNES from epileptic seizures. We also review how to communicate the diagnosis to patients, reduce stigma, and improve treatment engagement. 

Dr. Adams describes the biopsychosocial model of FND, including common predisposing, precipitating, and perpetuating factors. We discuss the central role of cognitive behavioral therapy (CBT), the benefits of specialized physical therapy for functional movement symptoms, and additional psychotherapeutic approaches such as mindfulness and psychodynamic therapy. Finally, we address how to manage chronic or treatment-resistant FND, and when to re-evaluate the diagnosis. 

Key References:  

1. ​Incidence and prevalence of functional neurological disorder: a systematic review (Finkelstein 2025)  
2. ​Neurosymptoms.org  
3. ​Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial- (Goldstein 2020) 
4. ​FND Hope  
5. ​Overcoming Functional Neurological Symptoms Workbook (Williams)