Functional Neurological Disorder is recognized as one of the most common reasons for neurology consultation, often cited as second only to headache in outpatient neurology settings. ¹
Imagine feeling like something is seriously wrong with your body, you can't move your arm, you're having seizure-like episodes, you've lost your voice, yet every report comes back normal. Confusing? Absolutely. But for people living with Dissociative Conversion Disorder, this is an everyday reality. If you are experiencing this condition or you know someone who is, then this article is for you.
A recent study published in the International Journal of Molecular Sciences highlights that Functional Neurological Disorder (FND) (formerly called Conversion Disorder; DSM-5 term: Functional Neurological Symptom Disorder) is far more common than previously recognized, representing the second most frequent reason for neurology consultations, right after headache. Yet it remains one of the most misunderstood conditions today.
What exactly is it?
To get some clarity, we turned to a psychiatrist who works closely with patients navigating this kind of uncertainty every day.
MedBound Times connected with Dr. Pallavi Sharma, MD, MBBS, a Psychiatrist at Fortis Escorts, New Delhi, Mental Wellness Lead at Step Up Joints and Consultant Psychiatrist at BHEL, India.
Dr. Pallavi explains, ”Dissociative (conversion) disorder, now termed Functional Neurological Symptom Disorder (FNSD), refers to a condition in which patients present with neurological symptoms such as paralysis, loss of speech, sensory deficits, or non-epileptic seizures (PNES) that are not explained by an identifiable structural neurological disease.”
Functional Neurological Symptom Disorder may include:
Seizure-like episodes
Movement problems
Problems with cognitive function
Dizziness
Speech difficulties, such as a sudden onset of stuttering or trouble speaking
Problems with vision or hearing
Pain (including chronic migraine)
Extreme slowness and fatigue
Numbness or inability to sense touch
According to Dr. Sharma, the symptoms are not intentionally produced and often arise unconsciously. Unlike disorders such as stroke or epilepsy, where there is clear evidence of brain pathology, FND reflects a disturbance in function rather than structure.
Clinical signs may show internal inconsistency, for example, weakness that does not follow known neuroanatomical patterns, but the patient’s distress and disability are entirely genuine.
A study by Amy D. Fobian and Lindsey Elliott (2018) suggests that Functional Neurological Disorder arises from a complex interplay of psychological, biological, and social factors.
Biological Factors: Some people may have a genetic predisposition or differences in brain connectivity, particularly in areas that process emotions and control movement.
Psychological Factors: Past trauma, childhood adversity, or extreme stress are often present. Stress and trauma may contribute to disruptions in brain-body signaling that influence how symptoms emerge. ²
Social Factors: Cultural beliefs and social environments can influence how symptoms are expressed and maintained.
The development of such symptoms is often linked to psychological stressors or internal conflicts, which may be acute or long-standing. These could include interpersonal difficulties, trauma or overwhelming life events leading to adjustment issues.Dr. Pallavi Sharma, MD, MBBS, Psychiatrist
The mind, in a sense, “converts” emotional distress into physical expression. So it is important to communicate to patients that their symptoms are real, involuntary, and not imagined.Dr. Pallavi Sharma, MD, MBBS, Psychiatrist
Unlike most conditions, there's no single blood test or brain scan that can confirm Functional Neurological Symptom Disorder(FND). There is no specific biomarker or definitive result, which is part of what makes it so tricky to diagnose.
Instead, diagnosis is based on the full picture: a person's history, symptoms, and hands-on physical examination. Doctors are essentially looking for patterns rather than a clear-cut answer from a lab report.
Importantly, FND is diagnosed through positive clinical signs, not simply because other tests are normal. ³
There are, however, some specific physical signals that point toward Functional Neurological Symptom Disorder. One is called Hoover's sign — a simple test where a doctor checks for functional weakness in the legs. Another is entrainment, used when tremors are involved.
Beyond these tests, the doctor will go through the person's full medical and family history to rule out any neurological conditions that could be causing the symptoms. It's also worth knowing that Functional Neurological Symptom Disorder doesn't always show up alone; it can co-exist with other disorders, which makes careful assessment even more important.
In some cases, doctors may order additional tests like an EEG or an EMG. These aren't to confirm Functional Neurological Symptom Disorder directly but to rule out other conditions and get a clearer look at symptoms like tremors, weakness, or vision problems.
Dr. Sharma explains that the condition is commonly misunderstood because it blurs the traditional divide between physical and psychological illness. As a result, patients may be incorrectly perceived as exaggerating or feigning symptoms when in fact they are experiencing a genuine disorder rooted in complex neuropsychological mechanisms.
Patients with Functional Neurological Symptom Disorder frequently carry a significant emotional burden beyond their physical symptoms. Many experience feelings of helplessness and frustration, particularly when repeated investigations fail to provide a diagnosis.Dr. Pallavi Sharma, MD, MBBS, Psychiatrist
Treatment often focuses on improving function and reducing disability. Depending on symptoms, care may involve education about the diagnosis, physiotherapy, psychotherapy such as cognitive behavioral therapy, and management by neurology and psychiatry working together. ³
Dr. Sharma says that recovery in conversion disorder is possible and, in many cases, favorable, especially when the condition is identified early and managed appropriately.
Treatment typically involves clear communication of the diagnosis, reassurance and a focus on restoring normal function, often through psychiatry, psychological therapies (such as CBT), and physiotherapy interventions.
In the early stages, a common mistake made by families and even healthcare providers is either over-medicalizing the condition with excessive investigations or conversely dismissing the symptoms. Both these approaches can be counterproductive!
Professional help should be sought when neurological-like symptoms appear suddenly and persist despite normal investigations or significantly impair daily functioning.Dr. Pallavi Sharma, MD, MBBS, Psychiatrist
Functional Neurological Symptom Disorder sits in a space where medicine is still learning to fully understand its complexity, right in the middle of mental and physical health. That's what makes it so difficult, not only for doctors to identify, but for patients to live with every single day. But here's what's important to hold onto: the symptoms are very much real, the struggle is real, and so is the possibility of getting better.
If you or someone you love is experiencing unexplained symptoms and unanswered questions, know that this isn't just "all in your head." It's the brain responding to stress, trauma, or emotional overload in a way it didn't know how to process otherwise, and this is exactly when seeking professional help becomes important.
The good news?
According to Dr. Sharma, a collaborative approach involving both neurologists and psychiatrists ensures accurate diagnosis and timely intervention.
The first step is simply being taken seriously. And with growing awareness around Functional Neurological Symptom Disorder, more patients would move towards recovery.
If any of this resonates with you, don't wait for symptoms to get worse. Reach out, ask questions, and remember that understanding what's happening is already halfway to healing.
National Institute of Neurological Disorders and Stroke. (2026, March 13). Functional Neurologic Disorder. U.S. Department of Health and Human Services, National Institutes of Health. https://www.ninds.nih.gov/health-information/disorders/functional-neurologic-disorder
Fobian, A. D., & Elliott, L. (2018). A review of functional neurological symptom disorder etiology and the integrated etiological summary model. Journal of Psychiatry & Neuroscience : JPN, 44(1), 8. https://doi.org/10.1503/jpn.170190
Pick, S., Goldstein, L. H., Perez, D. L., & Nicholson, T. R. (2018). EMOTIONAL PROCESSING IN FUNCTIONAL NEUROLOGICAL DISORDER: A REVIEW, BIOPSYCHOSOCIAL MODEL AND RESEARCH AGENDA. Journal of Neurology, Neurosurgery, and Psychiatry, 90(6), 704. https://doi.org/10.1136/jnnp-2018-319201
Lee TY, Kim M, Kwon JS. Early Identification of Psychiatric Disorders. Adv Exp Med Biol. 2019;1192:341-352. doi: 10.1007/978-981-32-9721-0_18. PMID: 31705504. https://link.springer.com/chapter/10.1007/978-981-32-9721-0_18