Season 7, Episode 4: FND (Functional Neurological Disorder) with Simone Mangelsdorf-Collett
We’re super excited to bring you this week’s episode with Senior Clinical Neuropsychologist Simone Mangelsdorf-Collett (she/her). We chat with Simone about Functional Neurological Disorder (FND) – or, as Simone puts it “the most common disorder you’ve never heard of”.
Simone specialises in FND, neurodegenerative syndromes, and movement disorders and practices out of Yarra City Psychology in Richmond, Melbourne. She is experienced in both ends of patient care, including assessment and diagnosis and rehabilitation and intervention.
If you’ve been wondering about FND, this episode is for you!
In this episode, we cover:
What is Functional Neurological Disorder (FND), and how does FND differ from other neurological disorders (like epilepsy, stroke, Parkinson’s, etc.)
What does the term ‘functional’ mean in this context?
The historical context of FND and how our understanding of this condition has evolved over time.
Some of the currently known mechanisms behind FND, including predictive coding theory.
Some common vulnerabilities and triggers for FND.
The overlap between FND, neurodivergence, and gender.
Simone takes us through treatment options for FND and who would be involved in the treatment team.
How Simone came to specialise in FND and her work in FND advocacy and education.
[00:01:11] What is Functional Neurological Disorder (FND), and how does FND differ from other neurological disorders (like epilepsy, stroke, Parkinson’s, etc.)?
Key Takeaways:
Functional Neurological Disorder (FND) is an umbrella term for a range of symptoms caused by a problem in the functioning, not the structure, of the nervous system.
FND is like a software glitch rather than a hardware glitch, meaning the brain’s structure appears normal on scans, but the communication between brain cells and nerves is disrupted.
In functional seizures, the brain’s electrical signals are scrambled without structural damage to the brain, differing from epileptic seizures, which show structural abnormalities and characteristic patterns on EEG.
The experience of symptoms like seizures or motor issues in FND is very real and disabling, not imagined or faked, despite the lack of visible damage.
FND is not just a diagnosis of exclusion (i.e. diagnosed after ruling everything else out), there are also ‘positive’ diagnostic signs, which means that there are specific signs that doctors can look out for which would indicate FND and distinguishing it from structural neurological conditions.
[00:11:20] What does the term ‘functional’ mean in this context?
Key Takeaways:
The term ‘functional’ in Functional Neurological Disorder refers to a problem with the functioning of the nervous system, not with the structure of the brain or nerves.
In healthcare, ‘functional’ usually means a person can function in their environment, which creates confusion because in FND the nervous system is not functioning properly even though the person’s structural scans look normal.
Simone explains that functional MRI and PET scans can show disrupted brain function despite normal structural imaging, supporting the use of the term ‘functional’ from a neurological perspective.
Monique reflects that the name ‘functional’ can be confusing and contribute to stigma, and feels a clearer name would better support understanding for Autistic individuals and the general public.
Simone shares that some people find the term validating because it acknowledges the reality of their symptoms, while others find it confusing. The evolution of language from ‘psychogenic non-epileptic seizures’ to terms like ‘functional seizures’ reflects attempts to reduce stigma.
“These symptoms are very real. They’re very disabling, and a key element of diagnosis is that these symptoms cause day-to-day difficulties for the person who has them. They’re not feigned. They’re not imagined.”
[00:19:05] The historical context of FND and how our understanding of this condition has evolved over time.
Key Takeaways:
Symptoms of FND have been recognised for centuries, initially explained through supernatural beliefs and later linked to the concept of hysteria for women, with misogynistic beliefs about women’s reproductive organs being the cause of their suffering.
Freudian psychoanalytic theory proposed that unexpressed trauma or painful memories were repressed and manifested physically, while neurologists like Charcot questioned this with early scientific observations.
The concept of conversion disorder dominated until the DSM-IV, where physical symptoms were thought to result from emotional distress, despite trauma often not being present in many cases.
Conversion disorder referred specifically to neurological-type symptoms like paralysis or functional blindness, while somatoform disorders covered multiple organ systems and were grouped together under similar assumptions.
Advances in brain imaging and neurological testing have shifted understanding away from purely psychological explanations, leading to the modern view of FND as a disorder of nervous system function rather than imagined or fabricated symptoms.
[00:28:35] Some of the currently known mechanisms behind FND, including predictive coding theory.
Key Takeaways:
Brain imaging studies show that FND affects the areas controlling voluntary movements, specifically disrupting the Self-Agency Network, which is responsible for our awareness that we are causing an action to happen and that we are in control of the movement.
Reflexive actions like pulling away from pain still work in FND, which helps distinguish it from conditions like stroke, where reflexes are impaired.
Predictive coding theory explains FND as the brain failing to update its predictions after an injury or change, leading to persistent symptoms even when the original structural cause has resolved.
Biological, psychological, and social risk factors contribute to FND, but a significant proportion of people with FND have no identifiable major trauma, challenging older conversion disorder models.
Perfectionism and a strong identity linked to high achievement can increase the distress experienced by people with FND, particularly in a culture that often demands visible evidence of illness to validate suffering.
[00:41:10] Some common vulnerabilities and triggers for FND.
Key Takeaways:
Predisposing vulnerabilities for FND include chronic conditions like fibromyalgia, CFS/ME, POTS, and chronic pain, with triggers such as injuries, surgeries, or physical stress sometimes tipping a vulnerable nervous system into dysfunction.
Perpetuating factors like medical uncertainty, misdiagnosis, and not being believed can prolong and worsen FND symptoms, often leading to years without a clear diagnosis.
The nocebo effect, where negative expectations cause real symptoms, can play a role in FND, particularly when beliefs about vulnerability are reinforced by experiences like injury or chronic illness.
Simone shares that sometimes belief in an inevitable illness, like in a client who was gene-positive for Huntington’s disease, can trigger (very real) functional symptoms long before the expected onset.
Stress, illness, and physical setbacks are known to worsen symptoms (e.g. we see this in chronic illness and structural neurological disorders), highlighting the delicate balance of the nervous system and the complex interactions that underlie FND.
[00:51:05] The overlap between FND, neurodivergence, and gender.
Key takeaways:
FND is highly prevalent, accounting for up to 15–20% of neurology outpatient presentations, and studies show Autistic people are more likely to experience functional symptoms compared to neurotypical people (see links to some relevant research below).
Shared mechanisms between Autism and FND include sensory sensitivity, difficulties filtering sensory input, and interoceptive challenges, which may contribute to functional symptoms.
Preliminary research shows a significant overlap between FND and neurodevelopmental conditions, with file reviews and screening studies finding high rates of Autism traits among adults diagnosed with FND.
Around 70% of FND cases occur in women across all age groups, with no clear biological explanation yet, and women face greater risks of medical gaslighting and delayed diagnosis, which worsens outcomes.
Historical and ongoing gender biases in medicine have shaped the way conditions like FND are perceived and treated, reinforcing harmful narratives that women's experiences are less real or valid.
[01:11:16] Simone takes us through treatment options for FND and who would be involved in the treatment team.
Key takeaways:
Access to FND treatment can be inequitable, but ideally, the treatment team should include a neurologist for diagnosis, physiotherapy for movement retraining, and psychology or psychiatry for symptom management and support.
A clear and supportive explanation at the time of diagnosis can significantly improve outcomes, with some people not needing further treatment if they understand their condition early.
Physiotherapy, particularly neurophysiotherapy, is considered a gold standard treatment. Psychology interventions focusing on practical strategies to manage symptoms, rather than necessarily exploring mood or mental health, can also be helpful.
Comprehensive rehabilitation programs may also involve occupational therapists, speech pathologists, and neuropsychiatrists tailored to the individual's symptoms and needs.
Simone advises people with FND to ask questions about their care, seek support from FND Australia and FND Australia Support Services, and remember that having one diagnosis does not mean other conditions should be dismissed.
[01:19:20] How Simone came to specialise in FND and her work in FND advocacy and education.
Key takeaways:
Simone was drawn to specialise in FND after seeing the significant disability, stigma, and lack of treatment options faced by people with FND during her early work in neuropsychology.
She pursued extensive external training, self-directed learning, and focused her private practice on providing therapy for people with FND while also delivering education to healthcare services across Victoria.
Simone is passionate about raising awareness and advocating for better understanding and services for FND, recognising it as a common but highly stigmatised condition.
Simone works at Yarra City Psychology in Richmond alongside other psychologists and neuropsychologists with an interest in FND, and encourages professionals to connect with organisations like FND Australia and the FND Society for training and resources.
People newly diagnosed with FND, or their supporters, are encouraged to join Facebook support groups to connect with others and find helpful information and community.
Connect with Simone Mangelsdorf-Collett:
Yarra City Psychology in Richmond, Melbourne.
@neurohealthsimone on Instagram
Things We Mentioned:
Functional Neurological Disorder Society (FNDS), for professionals.
Here are some studies on the link between FND and Autism
Tamilson et al., 2024, Gonzalez-Herrero et al., 2024, Pun et al., 2020
Link between gender and FND – McLoughlin et al., 2023.
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