Co-existing Conditions

Many individuals with FND describe functional cognitive symptoms. Symptoms vary, but can often include:

• Difficulty remembering events or conversations

• Difficulty concentrating

• Wordfinding difficulties

• Brain fog or sluggishness

• Problems remembering names

• Problems with multitasking

• Challenges when learning and retaining new information

• Problems with attention span

If you experience any of these symptoms as part your FND, your challenges might not be due to you loosing your intellectual capacity or curiosity. Dr. Moenter views cognitive symptoms as an often temporary limitation; potentially caused by severe dissociative states and/or a result of the chronic stress of FND (or other life-altering events). The exposure to chronic stress and trauma can impair the functionality of the pre-frontal cortex (responsible for executive function, decision making, etc.) and therefore can leave you with a limited capacity to think clearly or make sound decisions for yourself.

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that usually starts after an injury or surgery. Pain is stronger than expected and the affected area can change in appearance and function.

Common features:

• Severe, burning, throbbing, or “out of proportion” pain (often after a limb injury)

• Sensitivity to touch or cold/heat (even light contact can hurt)

• Swelling and warmth or coolness compared with the other side

• Changes in skin color or texture

• Changes in sweating or hair/nail growth

• Stiffness, weakness, and reduced range of motion; sometimes tremor or muscle spasms

Typical pattern:

• Starts in one area (often an arm or leg)

• Can spread somewhat or remain localized

• Symptoms can fluctuate but tend to persist without treatment

Current research on dissociation builds on a tradition dating back to Janet’s (1887) distinction between psychological phenomena, or psychoform dissociative symptoms, and bodily phenomena, or somatoform dissociative symptoms. FND is typically understood to primarily involve the latter (Nijenhuis et al., 1996; Pick et al., 2017; Vuilleumier & Cojan, 2011).

Explanations for why individuals with FND are experientially disconnected from their bodies are manifold: dissociation as a survival response to trauma; cultural, familial, or religious reasons; alexithymia (difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal); or impaired interoception (the ability to sense the internal states of the body). The most widely accepted contributing etiologic factor, however, is prior exposure to chronic stress and trauma.

Dr. Moenter talks about dissociation happening on a continuum from “spacing out” to out-of-body experiences and full dissociative states such as non-epileptic seizures. The healing process involves learning how to self-regulate dissociative states early so as to not fully disconnect from the present moment experience. The ability to stay present allows for a greater capacity to be mindful of changes in nervous system activation (FND symptoms).

Dysautonomia is when your autonomic nervous system—your body’s automatic control for things like heart rate, blood pressure, sweating, digestion, and temperature—doesn’t work properly. It can cause symptoms that change with position or stress, such as fast heart rate or palpitations, dizziness or lightheadedness (sometimes fainting), fatigue, shakiness, sweating changes, nausea/diarrhea or constipation, headaches, and feeling worse when standing and better when lying down. Common forms include POTS and vasovagal syncope, and it can occur alone or alongside other conditions.

Dr. Moenter explores emotional imbalances as part of FND. Research shows that individuals with FND have

1. a higher autonomic sensitivity to emotional stimuli, especially threat signals, and therefore a high autonomic arousal at baseline

2. increased orienting responses > high sensitivity to threat signals and motor mobilization

3. higher amygdalar activity

4. Unusual limbic-motor interactions in reaction to emotional stimuli: neuroimaging evidence addressing motor activation during the processing of emotional information in FND patients

5. higher functional connectivity between the amygdala and supplementary motor area (SMA) during processing of both positive and negative emotional stimuli.

Common emotions that individuals with FND feel are shame, anxiety, despair, hopelessness, helplessness, and fear. Dr. Moenter’s explains how emotions can be an expression of a regulated (sadness, curiosity, anger, fear etc.) or a dysregulated (terror, rage, shame, obsession etc.) nervous system. As part of the FNDcourage course you will learn how to identify your emotions as they relate to your nervous system activation and learn how to self-regulate your emotional state. Such emotional self-regulation can positively impact your functional neurological symptoms.

Dr. Moenter also explores how emotions contribute to your body posture, how you hold yourself in your body, and how in turn that experience might make you more susceptible to certain FND symptoms. By learning about and changing your Emotional Anatomy (Stanley Keleman) you will increase your interoception (body awareness) and increase your ability to regulate your nervous system.

Hypermobility spectrum disorders (often shortened to “hypermobility syndrome”) means your joints move more than normal, and that extra movement can cause symptoms—most often joint pain and instability. Some people also have other body-wide symptoms like fatigue or stomach and autonomic (circulation/heart-rate) issues.

Hypermobility spectrum disorders (HSD) is related to, and sometimes discussed alongside, these other names/labels:

• Joint hypermobility syndrome (JHS) (older term)

• Hypermobile Ehlers-Danlos syndrome (hEDS) (a specific Ehlers-Danlos type)

• Ehlers-Danlos syndrome (EDS) (the broader group; hEDS is the hypermobile subtype)

• Ehlers-Danlos—hypermobility type (older/alternate phrasing for hEDS)

• Connective tissue disorder with joint hypermobility (general wording you may see)

• Benign hypermobility (being flexible without symptoms; not the same as HSD/hEDS)

IBS (Irritable Bowel Syndrome) is a common condition where the intestines become overly sensitive or don’t coordinate as they should, so people experience ongoing stomach discomfort and bowel habit changes even though routine tests (like scans or stool tests) often look normal. Symptoms can include cramping or pain (often linked to bowel movements), bloating, gas, and diarrhea and/or constipation, with patterns that may switch over time. Because it’s “functional,” the issue is how the gut is working rather than a clear structural disease, and symptoms frequently flare with triggers such as certain foods, stress, hormonal changes, or after a stomach infection.

Mast cell activation (often called mast cell activation syndrome, MCAS, when diagnosed) is when mast cells—a type of immune cell—release chemicals (like histamine, leukotrienes, and others) too easily or inappropriately. Those chemicals can irritate nerves and blood vessels and affect the skin, lungs, and gut, causing symptoms that can flare suddenly and then improve.

Mast cell activation can sometimes resemble FND (or co-occur with FND) because its symptoms can affect the whole body and change quickly—e.g., episodes of dizziness, weakness, flushing, GI upset, shortness of breath, headache, tremor-like sensations, or “adrenaline” feelings that come and go. Those patterns can look neurologic or functional, especially if tests for a single structural cause are negative.

POTS (Postural Orthostatic Tachycardia Syndrome) is a condition where your heart rate jumps when you stand up, causing symptoms because your body doesn’t regulate blood flow well.

Common symptoms:

• Fast heartbeat/palpitations when standing

• Dizziness or lightheadedness, sometimes fainting

• Fatigue, weakness

• Brain fog, headaches

• Shakiness, sweating

• Nausea or stomach discomfort

• Symptoms often improve when lying down

Typical pattern:

• Symptoms get worse with standing and better with lying down.

• It’s not just “being out of shape”—it’s a recognizable autonomic (nervous system blood-pressure/heart-rate) problem.

Trauma is the result of experiencing inescapably stressful events that overwhelm an individual’s existing coping mechanisms while obstructing information-processing abilities. It affects memory in two ways, modifying both sensorimotor and affective levels of memory formation and recall and often producing the symptoms of somatoform and psychoform as seen in FND.

Some individuals with FND have experienced chronic stress or trauma prior to the onset of FND. The exposure to life-altering adverse events can contribute to the dysregulation of the autonomic nervous system. Since FNDcourage is based on the idea that FND is an expression of a dysregulated nervous system (too much or too little activation), part of the healing process is undoubtedly the work with and resolution of any adverse nervous system changes resulting from chronic stress and/or trauma.

Although a direct causal connection between trauma and the onset of FND has not yet been identified, trauma is widely believed to be a contributing factor, alongside adverse childhood experiences (ACE). For instance, several studies have concluded that individuals with FND exhibit elevated rates of post-traumatic stress disorder (PTSD), and those with FND display disproportionately high incidence of involuntary dissociative states. 

You will learn about resilience and how to increase your on resilience in the face of stressful external and internal experiences. Resilience is your ability to quickly and fully recover from challenging, stressful, and traumatic events. 

Being resilient means you have the capacity to face stressors, to lean into discomfort, instead of avoiding challenges. Part of the model of how Dr. Moenter works is to NOT use the word “triggers.” Many professionals talk about “triggers” in the context of FND. What Dr. Moenter has seen in her work with FND is that people naturally orient away from “triggers” creating a pattern of avoidance. Such avoidance, over time, leads to a very limited lifestyle and a lack of trust and strength necessary to lean into the discomfort of FND, which eventually will help reduce symptoms.

Dr. Moenter introduces the concept of “precursors” feelings, thoughts, and physical sensations that can be an indicator that your nervous system is at the beginning stages of dysregulation. 

Look-alikes for FND are other conditions that can cause similar neurologic symptoms but have a different cause. Common ones clinicians consider include:

• Stroke/TIA, seizures, and other serious brain/nerve emergencies

• Multiple sclerosis (MS) and other demyelinating disorders

• Migraine (including hemiplegic/basilar types) and other neurological headaches

• Epilepsy (including non-epileptic seizures can look similar)

• Neurodegenerative conditions (e.g., Parkinson’s and related disorders)

• Peripheral nerve disorders (neuropathy, radiculopathy)

• Autoimmune/inflammatory neurologic disorders

• Myasthenia gravis (weakness that can be misread as neurologic “functional”)

• Movement disorders (tremor, dystonia) from non-functional causes

• Metabolic/endocrine problems (thyroid disease, electrolyte issues, B12 deficiency)

• Medication or substance effects

• Sleep disorders

• Psychiatric conditions that can mimic neurologic symptoms (or co-occur)