Functional Neurological Disorder (Conversion Disorder) – Diagnosis and Treatment

Functional neurological disorder (FND) is a condition where people experience neurological symptoms that cannot be explained by traditional medical tests or structural problems in the brain.

These symptoms can include problems with movement, weakness, or even seizures. While the symptoms are real and can impact daily life, their cause is not linked to obvious physical damage or disease.

Understanding functional neurological disorders is important because they are more common than many people realize.

Diagnosis

Doctors diagnose conversion disorder, also called functional neurological symptom disorder, through careful observation and medical assessment.

No standard blood tests or imaging studies directly confirm this disorder. Instead, doctors look at patterns in how symptoms show up and rule out other possible conditions.

Clinical Assessment Methods

Health professionals start with a detailed physical and neurological exam. They ask about symptoms, including when they started, how often they occur, and if anything makes them better or worse.

They select specific tests based on what symptoms are present. For example, if someone has trouble walking, they check muscle strength, reflexes, and movement coordination.

Providers often conduct a mental health evaluation. They might refer the person to a psychiatrist or psychologist to look for signs of stress, anxiety, or other psychiatric disorders. With the patient’s permission, family members can provide extra information.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines the criteria for diagnosis:

• Motor or Sensory Symptoms: At least one symptom affects movement or senses (like muscle weakness, tremors, or loss of vision).
• Lack of Another Explanation: Another health or mental condition does not explain the symptoms.
• Impact on Life: The symptoms cause real problems at work, in relationships, or in daily life, or they are serious enough to require medical attention.

Health professionals use terms like functional neurological disorder (FND), functional neurological symptom disorder, or conversion disorder interchangeably, depending on symptoms and context.

Sometimes they use more specific names, such as functional gait disorder, if a particular ability is affected.

Here’s a summary table to show key parts of the diagnosis:

Step	Purpose
Physical Exam	Check physical signs, rule out other causes
Mental Health	Detect psychiatric disorders and stress factors
DSM-5 Criteria	Compare symptoms to official guidelines

Treatment

Understanding Functional Neurologic Disorder

Learning about functional neurologic disorder (FND) is a crucial first step. When people understand that their symptoms are genuine and that positive change is possible, they often feel less anxious.

Education about the condition helps reduce fears of a life-threatening illness and makes it easier to follow through with treatments. Support from family and friends can further improve motivation and recovery through encouragement and shared understanding.

Addressing Related Medical Conditions

A team-based approach helps in FND treatment. Health professionals work together to check for any underlying medical problems that might be linked to the symptoms.

Identifying and treating these issues can remove possible triggers and may lessen the overall impact of FND.

Therapy Approaches

People can use a variety of therapies to manage FND, customized to each person’s symptoms. Common options include:

• Physical Therapy: Physical therapists help people regain movement and strength. Activities might include stretching, gentle exercises, and practice with daily tasks. Regular movement helps prevent stiffness and weakness.
• Occupational Therapy: Occupational therapists focus on improving the ability to perform daily activities. They support skills like dressing, eating, and bathing, adapting tasks to fit individual needs.
• Speech Therapy: Speech-language pathologists help with speech and swallowing difficulties, if present.
• Stress Management Techniques: People can use methods such as deep breathing, muscle relaxation, and physical activity to make symptoms less severe. Distraction strategies, like listening to music or changing walking patterns, may also be useful.

Below is a summary table of some therapy options:

Therapy Type	Purpose
Physical Therapy	Improve strength, flexibility, and movement.
Occupational Therapy	Support daily self-care and independent living.
Speech Therapy	Address speech or swallowing problems.
Stress Management	Lower symptoms by easing worries and tension.

Mental Well-being Support

Mental health influences both the cause and treatment of FND. Several strategies are helpful:

• Cognitive-Behavioral Therapy (CBT): CBT reduces unhelpful thoughts and improves responses to stress. It may be especially useful for those who experience nonepileptic seizures.
• Other Psychotherapy: Talk therapy addresses issues like trauma, anxiety, and depression, which can increase FND symptoms. Treating these mental health issues supports overall recovery.

Medication Management

Doctors may prescribe medications to help with related mental health or physical symptoms. Examples include:

• Antidepressants: Improve mood and help with anxiety or depression.
• Medication for Pain or Sleep: Used if a person struggles with pain or insomnia.

Drug therapy usually does not serve as the main focus but may play a supportive role.

Ongoing Check-Ins

Regular appointments with the healthcare team track progress and allow changes to treatment plans when needed.

These follow-ups ensure therapy remains effective and is adjusted if symptoms change over time.

Getting Ready for Your Visit

Steps to Take Before Your Appointment

Before visiting a healthcare provider, patients should collect important details to make the most of their time. Writing down all symptoms, even those that seem unconnected, can help.

Bring a list of personal, family, and social information, including recent stressful events or major changes. List all medicines, vitamins, herbs, or other supplements, and their exact doses to help doctors see the whole picture.

A friend or family member can come along for support and help remember what the provider says.

Prepare a list of key questions, such as:

• What might be causing these symptoms?
• Are there other possible causes?
• What tests are needed?
• Which treatments are recommended?
• How long will treatment last?
• What steps can help prevent these symptoms from coming back?
• Should a specialist, like a neurologist or mental health professional, be involved?
• What medicine side effects should be expected?
• Are there more affordable medicine options?
• Where can printed resources or recommended websites be found?

Write these questions down to ensure nothing is forgotten during the appointment. Patients should feel comfortable asking anything that comes to mind, even if it seems small.

Table: Checklist for Your Appointment

What to Bring	Why It Matters
Symptom list	Helps identify patterns and details.
Family and social background	Provides context and possible stressors.
All medicines and supplements	Identifies possible interactions or side effects.
List of questions	Makes sure all concerns are addressed.
Support person	Assistance with remembering information and support.

Questions Your Provider May Ask

During the visit, a health care provider will likely ask many questions. They might want to know what symptoms are present, when they started, and if they have changed over time.

The provider will ask how these symptoms affect daily life and if the patient has any ideas about what might be causing them.

Doctors may review any past or current health problems, including mental health history. They might also ask about alcohol use or recreational drug use.

Doctors may refer patients to specialists such as neurologists or mental health professionals after this first conversation. These experts focus on brain and nervous system issues, as well as mental health conditions, and can help with diagnosis and treatment planning.

Sample Questions from Health Care Providers

• What are your main symptoms?
• When did you first notice these symptoms?
• Have they gotten better or worse?
• Do your symptoms stop you from doing normal activities?
• Have you been diagnosed with any other health problems?
• Do you use any alcohol or drugs?

Being prepared to answer these questions can save time. It gives the provider more information for a better understanding of the situation.

Tip: If a question is hard to answer, pause and think or ask for clarification. Providers expect patients to need a moment and will help guide the conversation.

A clear and open conversation with the provider, whether a primary care doctor, neurologist, or psychologist, leads to more accurate help and support.