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What is FND?
Functional Neurological Disorder (FND) occurs when the brain struggles to send and receive signals properly to and from the body. Previously known as Conversion Disorder, it causes real physical symptoms - such as movement difficulties, seizures, or sensory changes - without damage to the brain or nerves. The problem lies in how brain areas communicate, like traffic lights (robots) falling out of sync. Scientists call this disrupted brain connectivity.
FND is now understood as a brain-network disorder, not a psychological issue, and certainly not “all in your head.” It involves areas of the brain responsible for movement, emotions, and our sense of control over actions (self-agency). It likely develops through a combination of how the brain processes information and the impact of psychological stressors, adding to the complexity of FND.
Symptoms are 100% real, often disabling, and can vary greatly between people. The level of disability is similar to conditions like Parkinson’s disease or multiple sclerosis (MS). They may appear suddenly and fluctuate over time. Research shows that both certain brain areas and wider brain networks are involved, but studies are still ongoing. It’s important to note that each person may experience a different combination of symptoms.
Anyone can develop FND, regardless of age or background. However, it most commonly begins during the teenage years, adolescence, or middle age (up to around 65). Women are more frequently diagnosed and tend to seek help more often than men.
FND Symptoms & Mechanisms
The symptoms of Functional Neurological Disorder (FND) are 100% real and can be disabling. Symptoms often appear suddenly, vary in severity, differ from person to person, and can be deeply distressing.
It's common for people with Functional Neurological Disorder to experience multiple sets of symptoms (known as sub-types), or to shift between sub-types over time.
Read more on our infographics.
In addition, many people experience associated symptoms such as chronic fatigue, chronic pain, headaches, migraines, anxiety, and depression. While often considered secondary, these symptoms can significantly worsen the core features and contribute to the overall burden of FND.
Together, they form a comprehensive clinical picture that should guide an effective treatment plan.
FND Diagnosis & Treatments
Diagnosing Functional Neurological Disorder (FND) is different from diagnosing many other conditions. Rather than relying on scans or blood tests, neurologists diagnose FND based on positive signs they observe during a physical exam - such as symptoms that change with distraction or movement patterns that don’t match typical neurological diseases. This is called a “rule-in” approach, meaning the diagnosis is based on what is seen, not just what’s missing.
A detailed medical history is also crucial, including how symptoms began, any stressors or injuries around that time, and the person's overall physical and mental health. It is essential for healthcare professionals to distinguish FND from feigning.
Scans and tests are often normal, which can feel confusing or even invalidating for patients. However, no visible structural damage doesn’t mean the symptoms aren’t real. They are - and they can be just as disabling as conditions like Parkinson’s or MS.
When assessing and treating FND, healthcare teams often use the biopsychosocial model. This model recognises that biological factors (how the brain and body function), psychological factors (thought patterns, emotions, trauma), and social factors (life, work, financial constraints, support systems) all interact to influence health. FND is best understood through this lens - not as “all in the head,” but as a condition where brain-body communication is disrupted by a combination of influences that can be addressed and improved.
Understanding the diagnosis is the first step in recovery. When patients receive a clear explanation and feel believed, it often leads to better outcomes.
Understanding the diagnosis is the first step in recovery. When patients receive a clear explanation and feel believed, it often leads to better outcomes. From there, personalised therapy is key, with the focus on restoring function and not just managing symptoms.
FND care should also be cost-conscious. Since many tests aren’t helpful once FND is suspected, it's important not to over-investigate.
This approach protects the patient’s time, energy, financial resources, supports early access to therapies that can make a real difference, and helps reduce overall healthcare system costs.
FND Risk Factors
Research highlights several risk factors associated with FND, which is shown in the image below.
Understanding the neurobiology of FND is crucial for challenging stigma, fostering empathy, and enhancing patient care.
FND History & Stigma
Functional Neurological Disorder (FND) is one of the oldest recognised neurological conditions, yet it has long been misunderstood and overlooked in both research and medical training. Previously known as Conversion Disorder, FND has historical roots dating back to the 1800s when it was called "Hysteria." While the term “Hysteria” reflected outdated and often gender-biased views, our understanding has evolved significantly.
Today, the name Functional Neurological Disorder more accurately reflects the condition - highlighting a problem in how the nervous system functions, rather than damage to its structure. This shift in terminology marks real progress in both medical science and patient advocacy.
S
Symptoms fluctuate
T
Treatment is Trial & Error
I
Invalidation
G
Getting Help is Hard
M
Misconception
A
Acceptance within Yourself
FND stigMa
Because FND sits at the intersection of neurology and psychiatry, it’s not uncommon for healthcare practitioners to hesitate in taking full responsibility for its management. Unfortunately, this gap has come at a significant cost to patients, allowing stigma to persist.
Stigma remains high, and patients are often caught in the crossfire of a fragmented system, facing a constant battle between medical disciplines. Greater understanding of FND’s true nature has helped drive important changes in how it is classified and diagnosed. FND is now formally recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under the category of Functional Neurological Symptom Disorder. This inclusion helps guide diagnosis and access to appropriate treatment, while also supporting awareness and research into this complex, often misunderstood condition.
Furthermore, the ICD-10 (International Classification of Diseases, 10th Revision) is a global coding system used to classify medical conditions and plays a key role in the billing of healthcare services. FND is typically listed under the code F44 – "Dissociative [Conversion] Disorders."
Despite this, recognition by South African private medical aids remains limited, leaving many patients struggling with coverage gaps and financial strain in the private sector. In the public sector, ICD-10 codes are also used, but access to diagnosis, therapy, and coordinated care is often inconsistent due to resource shortages and long waiting times.
While the ICD-10 code F44 provides a medical classification for FND, the South African Government has yet to formally recognise FND as a disability. This lack of recognition means there is no clear protocol for accessing disability-related benefits or support, forcing individuals and organisations to navigate a fragmented and often unclear system.
Improved awareness and recognition of ICD-10 codes like F44 – particularly within insurance systems and disability frameworks – could help validate the condition, reduce stigma, and expand access to essential care and support services.
A coordinated effort is needed to ensure that individuals living with FND are no longer overlooked. Better training for healthcare providers, greater recognition and support from medical aid/insurance providers, and streamlining access to multidisciplinary services are vital steps toward delivering equitable, compassionate, and effective care.
Resources
South Africa (SA)
Functional Neurological Disorder (FND) - A common but misunderstood condition
Functional Neurological Disorder (FND) Brochure: FND - What Now? NPC
FND - What Now? NPC Support Group
Costs of adult functional neurological disorders at a tertiary hospital in central South Africa
Functional Neurological Disorder - SADAG Mental Health Matters Journal, (MHMJ)
The spectrum of functional neurological disorders: A retrospective analysis at a
tertiary hospital in South Africa
The long reach of trauma: Psychogenic seizures in middle age
People with psychogenic non-epileptic seizures: A South African perspective
Podcasts
Triggers of FND and how it affects working abilities
The Sault'd Rose Podcast - FND Unwrapped: Audrey's Blueprint for Awareness
Cape Talk 567AM - Health and Wellness: What is Functional Neurological Disorder?
Resources
International
Incidence and prevalence of functional neurological disorder: A systematic review
FND is a Feminist Issue - Response Letter
What Are the Risk Factors and Triggers for Functional Neurological Disorders?
Diagnosis and management of functionalneurological disorder
A Practical Review of Functional Neurological Disorder (FND) for the General Physician
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
Functional disorders in the Neurology section of ICD-11
Podcasts
An Updated Round Table Discussion on:
FND: How and Why Does FND Occur?
Diagnosis of FND and New Phenotypes
FND Statistics
FND can affect anyone, but it most commonly emerges during adolescence and middle age, up to around 65 years.
In clinical practice, women are more frequently diagnosed and tend to seek help more often than men.
FND is more common than many people realise.
While most of these figures come from international studies, it's likely that the rates in South Africa (SA) are similar - or possibly even higher - given the added challenges in healthcare access, awareness, and diagnostic resources here.
However, because FND is under-recognised and underreported locally, exact South African statistics are still limited.
FND Billing
Clearer recognition of Functional Neurological Disorder is vital to ensure patients receive the multidisciplinary care and medical coverage they need.
FND is therefore coded under the International Classification of Diseases (ICD-10) Codes as F44 - Dissociative [Conversion] Disorders, which is used for medical billing and insurance claims.
FND care should also be cost-conscious. Since many tests aren’t helpful once FND is suspected, it's important not to over-investigate.
This approach protects the patient’s time, energy, financial resources, supports early access to therapies that can make a real difference, and helps reduce overall healthcare system costs.
Healing FND isn’t about replacing hardware - it’s about debugging the system. With rest, retraining, and patience, the brain can reconnect. Recovery takes time, but it’s possible.
