Recognising and explaining functional neurological disorder
Abstract
### What you need to know Functional disorders are conditions whose origin arises primarily from a disorder of nervous system functioning rather than clearly identifiable pathophysiological disease—such as irritable bowel syndrome, fibromyalgia, and functional neurological disorder (FND)—they are the second commonest reason for new neurology consultations.1 FND is common in emergency settings,2 stroke,3 and rehabilitation services.4 It causes considerable physical disability and distress, and often places an economic burden both on patients and health services.5 Many clinicians have had little formal clinical education on the assessment and management of these disorders, and patients are often not offered potentially effective treatments. In practice, FND should be diagnosed by someone with specific expertise in the diagnosis of neurological conditions. Our recommendation is to refer all patients with a suspected diagnosis of FND to secondary care. However, the diagnosis may be raised as a possibility with the patient in primary care, and knowledge of how the diagnosis is confirmed greatly aids subsequent management. In this article we offer evidence based advice to generalists on how to recognise FND, based on clinical diagnostic and prognostic studies. Although the focus of this paper is on recognising FND, we have included a short box on management to make readers aware that there are good treatments available for FND and that some patients can get better. ### Sources and selection criteria We conducted a PubMed search of evidence for diagnosis of functional neurological disorder (FND) until June 2020, especially systematic reviews.14 …
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Focusing on persuading the patient that they do not have a disease and making presumptions about psychogenic factors are usually not helpful to the treatment process.
“Focusing on persuading the patient that they do not have a disease and making presumptions about psychogenic factors 47 are usually not helpful to the treatment process.”
From Persistent physical symptoms: definition, genesis, and management (2024) · cites this paper as [47]
The past decades have seen significant efforts by clinicians and academics involved in the assessment and treatment of FND generally to assist colleagues in primary and secondary care to identify and manage patients with these conditions.
“The past decades have seen significant efforts by clinicians and academics involved in the assessment and treatment of FND generally to assist colleagues in primary and secondary care to identify and manage patients with these conditions (34, 35, 36).”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [35]
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A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD).
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“The past decades have seen significant efforts by clinicians and academics involved in the assessment and treatment of FND generally to assist colleagues in primary and secondary care to identify and manage patients with these conditions [35,36].”
Eccles, C., Malik, O., & Hedderly, T. J. (2023) · Paediatrics and Child Health · doi:10.1016/j.paed.2023.07.004 · Cited by 2 · see citing works
Die interdisziplinäre – integrative – Versorgung von funktionellen neurologischen Störungen
Schmidt, R., van Husen, D. K., Gegusch, M., Steurer, A., Hausteiner‐Wiehle, C., & Schmid, D. A. (2023) · Nervenheilkunde · doi:10.1055/a-2086-2481 · Cited by 2 · see citing works
“Das liegt insbesondere auch daran, dass es für die klinische Umsetzung eines in der Tat integrativen therapeutischen Vorgehens, das über eine inhaltlich letztlich wenig koordinierte interdisziplinäre Zusammenarbeit hinausreicht und im praktischen klinischen Alltag leicht umzusetzen ist, an Konzepten und Modellen fehlt.”
BackgroundInfluentialLegg vekt på positive tegn ved diagnostisering av funksjonell nevrologisk lidelse
Myren, S., & Helgeland, H. (2024) · Tidsskrift for Den norske legeforening · doi:10.4045/tidsskr.24.0321 · Cited by 2 · see citing works
Bottemanne, H., & Joly, L. (2022) · L Encéphale · doi:10.1016/j.encep.2022.05.011 · Cited by 2 · see citing works
Psychological assessment and support in functional neurological disorder: a longitudinal study
Radin, Y., Bulfon, M., Caruso, P., Barbi, E., Manganotti, P., & Clarici, A. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1506069 · Cited by 1 · see citing works
“This emotional distress, when chronic, is deeply embedded in neural networks, as described in earlier studies (Solms and Friston, 2018; Stone et al., 2020), making early diagnosis and intervention crucial.”
Fard, T. M., Vahabie, A., Shokri, M., Rohani, M., Emamikhah, M., Esmaeeli, S. T., Habibi, S. A. H., & Mirfazeli, F. S. (2025) · Brain Disorders · doi:10.1016/j.dscb.2025.100265 · Cited by 1 · see citing works
Maassen, L., Fox, N., & Stiller, K. R. (2025) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2025.123671 · Cited by 1 · see citing works
Placebo in Functional Neurological Disorders: Promise and Controversy
Szejko, N., Abusrair, A. H., Pasierski, T., Schmitt, S., Cramer, C., Pietrzykowski, T., Dunalska, A., Saramak, K., Śmiłowska, K., Serranová, T., et al. (2025) · Healthcare · doi:10.3390/healthcare13222863 · Cited by 1 · see citing works
Henningsen, P., Bouman, T. K., & Hausteiner‐Wiehle, C. (2023) · Oxford University Press eBooks · doi:10.1093/med-psych/9780197542521.003.0022 · Cited by 2 · see citing works
Current Opinions and Practices in Functional Neurological Disorders: A Survey of Indian Neurologists
Upadhyay, J., Gulati, K., & Pandey, S. (2025) · Annals of Indian Academy of Neurology · doi:10.4103/aian.aian_116_25 · Cited by 1 · see citing works
Hausteiner‐Wiehle, C., & Henningsen, P. (2023) · Cambridge University Press eBooks · doi:10.1017/9781911623533.007 · Cited by 1 · see citing works
An introduction to functional neurological disorders in the emergency department
Eden, M. (2024) · Emergency Medicine Australasia · doi:10.1111/1742-6723.14492 · Cited by 1 · see citing works
Functional (psychogenic) movement disorders
Jankovic, J. J., Hallett, M., Okun, M. S., Comella, C., Fahn, S., & Goldman, J. G. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-31071-0.00027-5
Functioneel neurologische uitvalsverschijnselen
Tak, L. M., & Luykx, J. J. (2022) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-2801-7_12
De patiënt met neurologische uitvalsverschijnselen
van den Brand, C. L., Jellema, K., Roos, Y. B. W. E. M., Spoor, J. K. H., Haitsma, I. K., & Tak, L. M. (2023) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-2805-5_22
Functional Neurological Disorder
Lane, C. E. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-95702-1.00038-5
(2024) · Elsevier eBooks · doi:10.1016/b978-3-437-23636-5.00006-4
(2024) · Elsevier eBooks · doi:10.1016/b978-3-437-23636-5.09985-2
Hausteiner‐Wiehle, C. (2024) · PiD - Psychotherapie im Dialog · doi:10.1055/a-2249-7956
Neurological Mystery Post Travel: An Atypical Presentation and Partial Recovery With Immunotherapy
Mukundan, P. P. V., Rajendran, K., & Dixon, J. B. (2025) · Cureus · doi:10.7759/cureus.79611
(2025) · Elsevier eBooks · doi:10.1016/b978-3-437-21835-4.00116-5
Zheng, Y., Kim, T.-S., Takeyama, Y., Rossert, E. B., & Lai, Y. J. (2025) · SAGE Open Medical Case Reports · doi:10.1177/2050313x251348413
“6,7 7 Despite the exclusion of other organic etiologies, patients frequently experience persistent and debilitating symptoms that remain inadequately addressed.”
(2022) · Elsevier eBooks · doi:10.1016/b978-3-437-21884-2.00033-7
Funktionelle Störungen (Psychosomatik)
Furmaniak, A., Limburg, K., & Henningsen, P. (2022) · Elsevier eBooks · doi:10.1016/b978-3-437-21884-2.00024-6
Functional Neurological Disorder
Keatley, E. S., & Molton, I. R. (2025) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197525456.013.0040
Treatments for Functional Neurological Disorder: A Practical Guide for Program Development
Martyna, M. R., Muccini, J., Sandoval, G. M., Fusunyan, M. A., Bullock, K. D., Bajestan, S. N., Barry, J. J., & Lockman, J. (2025) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.20230213
Shimohata, T. (2025) · Rinsho Shinkeigaku · doi:10.5692/clinicalneurol.cn-002182
Functional neurological disorder in liaison psychiatry: a co-produced educational resource
Filippidou, M., Manning, M., Lomax, P., Perera, R., Bowden, F., & Röhricht, F. (2025) · BJPsych Advances · doi:10.1192/bja.2025.10178
Diagnostic labels in functional disorders
Novak, M. J. U. (2025) · Future Healthcare Journal · doi:10.1016/j.fhj.2025.100489
“Moreover, FND is not a nebulous label for uncategorisable neurological symptoms: FND has clear diagnostic criteria, 11 , 12 and common patterns of functional symptoms recur, eg typical motor, sensory, gait patterns and seizures.”
Funktionelle neurologische Bewegungsstörungen
Weissbach, A., Hamami, F., Münchau, A. M., & Ganos, C. (2025) · Neurologie up2date · doi:10.1055/a-2678-2191
Katok, A. A., Beybalaeva, T. Z., & Магомедовна, Х. Д. (2025) · Neurology Bulletin · doi:10.17816/nb679505
Mechanisms and Vulnerabilities in Functional Neurological Disorder
Prudente, E., Savioz, V., Concetti, C., & Aybek, S. (2026) · Seminars in Neurology · doi:10.1055/a-2772-7100
Mashuk, M. S., Lu, Y., Lai, L. Y. H., Shardlow, M., Saha, S., Williams, A. H., Lee, A., Lloyd, S., Mohanraj, R., & Basilio, D. D. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2025.1691724
“Furthermore, evidence indicates that FND is the second most common reason for neurological consultations after headaches (6, 10) and is linked to substantial healthcare costs for both individuals and services (11), with estimated costs exceeding US $1 billion/year in the United States (12) and £3…”
Batt, I., Fong, T., Ngan, M., & Morris, L. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2026.2632934
“FMD is a sub-category of Functional Neurological Disorders (FND) and presents with motor, sensory, and cognitive symptoms, including weakness, seizures, gait disturbance, dystonia, and fatigue [1,2].”
Estalagem, A. R., Gonçalves, I. S., & Miranda, M. (2026) · Acta Médica Portuguesa · doi:10.20344/amp.24034
Functional neurological disorder: a gap in the psychiatry curriculum
Mandagere, V., Fatima, O., & Bamford, J. (2026) · BJPsych Bulletin · doi:10.1192/bjb.2026.10237
Approach to the Patient with FND: Evaluation, Diagnosis, and Developing a Treatment Plan
DeDominicis, M., & Lidstone, S. C. (2026) · Seminars in Neurology · doi:10.1055/a-2835-0301
“50,51 Also note that ordering investigations to “ soothe ” a patient with high somatic tendencies or health anxiety generally has the opposite effect, and any reassurance is short-lived.”
Nonnekes, J. H., Vierhoven, D., Cockx, H. M., Tijssen, M. A. J., & Buurke, T. J. W. (2026) · Movement Disorders · doi:10.1002/mds.70316
Functional Neurological Disorder: A Primer for Neuropsychologists
Kavish, N., & Maietta, J. E. (2026) · Springer eBooks · doi:10.1007/978-3-032-07777-6_20
Kapfhammer, H. (2026) · Springer Reference Medizin · doi:10.1007/978-3-642-45028-0_73-2
Prolonged Functional Flaccid Paraplegia With Rapid Reversibility During Sensorimotor Facilitation
Mahmood, Q. (2026) · Journal of Clinical Neurology · doi:10.3988/jcn.2025.0758
Mollica, A., Ng, E., Nannapaneni, S., Bhayat, U., Feinstein, A., Perez, D. L., & Burke, M. J. (2026) · Brain and Behavior · doi:10.1002/brb3.71491
“Communicating the diagnosis in a transparent and empathic manner is a critical first step in management (Stone et al. 2020 ; Stone et al. 2016 ).”
Care of the Patient with Persistent Physical Symptoms
Wilson, H. (2026) · Springer eBooks · doi:10.1007/978-1-4939-0779-3_180-2
Wasserman, G., Biran, I., Ezra, Y., & Zlotogorski‐Hurvitz, A. (2026) · American Journal of Clinical Hypnosis · doi:10.1080/00029157.2026.2710805
The economic burden of functional neurological disorder
Bandyopadhyay, S., Baker, J. L., & Afrin, J. (2026) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2024.0470
“Stone et al. [1 ] further point out that ‘…many clinicians have had little formal clinical education on the assessment and management of these disorders, and patients are often not offered potentially effective treatments.’”
Imaging biomarkers in functional neurological disorders
Lozzi, I., Concetti, C., & Aybek, S. (2026) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2024.0472
“While current clinical signs specific to FND are already highly reliable [50 –52 ], it is conceivable that in the future, integrating biomarkers may further enhance diagnostic precision.”
- Authors
- Stone, J., Burton, C., & Carson, A.
- Affiliations
- University of Edinburgh (GB)
- Corresponding author
- Stone, Jon
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2020-10-21
- Volume
- 371
- Pages
- m3745
- ISSN
- 1756-1833 (ISSN-L)
- OpenAlex
- W3093898146
- Cited by
- 104
- References
- 34
- Citations by year
- 2026: 19 · 2025: 21 · 2024: 17 · 2023: 20 · 2022: 16 · 2021: 11
- FWCI
- 8.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- conversion disorder, diagnosis, clinical recognition, primary care, secondary care referral, prognosis, functional neurological symptoms, general practitioners
- MeSH terms
- Psychological Distress, Diagnosis, Differential, Disability Evaluation, Humans, Nervous System Diseases, Symptom Assessment
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