THERAPY FOR FUNCTIONAL NEUROLOGICAL DISORDER (FND) IN BERKHAMSTED
Functional Neurological Disorder (FND) is a condition where individuals experience neurological symptoms that are real and often distressing, but are not caused by structural damage to the brain or nervous system. Instead, the difficulty lies in how the brain and body are functioning and communicating. At The Lotus Psychology Practice, we offer evidence-based psychological support to help individuals understand FND and work towards improving functioning and quality of life.
Understanding Functional Neurological Disorder
FND is characterised by very real, and distressing neurological symptoms such as movement difficulties, weakness, seizures, sensory changes, or cognitive difficulties. These symptoms can be highly variable and may change over time. FND is understood as a problem with how the brain sends and receives signals, rather than damage to the brain itself. A helpful analogy is that the problem is not with the “hardware” (brain structure), but the “software” (brain functioning).
Common presentations of FND may include:
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limb weakness or difficulties walking
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tremors or involuntary movements
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non-epileptic seizures (functional/dissociative seizures)
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sensory symptoms such as numbness or altered sensation
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speech or swallowing difficulties
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fatigue, pain, or cognitive difficulties
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tic-like movements
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bladder symptoms
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visual disturbances
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Importantly, FND is not imagined, fabricated, or under voluntary control. It is a recognised neurological condition and one of the most common reasons for referral to neurology services.
Current evidence suggests that FND develops through a combination of interacting factors, rather than a single cause. A helpful way of understanding this is through a biopsychosocial model, where biological, psychological, and social factors all play a role. FND is best understood as developing through a combination of interacting factors. These may include predisposing vulnerabilities (such as a sensitive or reactive nervous system, neurodevelopmental conditions), triggers (such as illness, injury, stress, or fatigue), and maintaining factors (such as ongoing symptoms, uncertainty, changes in activity, anxiety or depression). Importantly, there is often no single cause, and not all individuals will identify clear triggers.
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Types of Functional Neurological Disorder (FND) Symptoms
FND can affect multiple systems within the body, and symptoms can vary significantly between individuals. Some people experience a single symptom, while others may experience a combination that fluctuates over time. We are experienced in providing evidence-based therapy for a wide range of symptoms presentations, including:
Functional Movement Symptoms
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weakness in the limbs or difficulty walking
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tremors, jerks, or involuntary movements
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problems with coordination or balance
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episodes where movement feels “blocked” or difficult to initiate
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Functional (Dissociative) Seizures
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episodes that may resemble epileptic seizures but are not caused by abnormal electrical brain activity
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may involve shaking, loss of awareness, or altered responsiveness
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often associated with periods of stress, fatigue, or overwhelm
Sensory Symptoms
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numbness, tingling, or altered sensation
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changes in vision, hearing, or perception
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heightened sensitivity to physical sensations
Speech and swallowing difficulties
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changes in speech clarity or fluency
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difficulty initiating speech
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sensation of difficulty swallowing without structural cause
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persistent fatigue or low energy
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chronic pain without a clear structural explanation
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difficulties with concentration, memory, or “brain fog”
Fatigue, pain, and cognitive
difficulties
Functional Tics
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involuntary movements or sounds
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can be simple (cough or blink)
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or full body movements​
Working Alongside Medical Professionals
A diagnosis of FND should always involve appropriate medical assessment, typically through a GP and referral to a neurologist or specialist service. This is important to rule out other neurological or medical conditions, identify the specific type of functional symptoms, ensure accurate and confident diagnosis based on clinical signs. FND is not a diagnosis of exclusion, but one based on identifiable clinical features.
A shared understanding between professionals and the individual is a key part of treatment. Clear explanation of the diagnosis itself is often the first step in recovery, helping to reduce uncertainty and fear.
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Psychological support is often most helpful when integrated with medical care. We may work collaboratively with:
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Neurologists and medical consultants
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Pain and rehabilitation teams
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GPs and specialist services
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Physiotherapists and allied health professionals
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Our approach is:
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Evidence-based and formulation-driven
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Compassionate and collaborative
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Tailored to each individual’s needs and goals
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Focused on improving wellbeing and functioning
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Grounded in understanding the connection between mind and body
Functional Neurological Disorder (FND) in Children & Young People
Functional neurological symptoms are relatively common in children and young people, and may present as:
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functional seizures
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difficulties walking or movement problems
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pain, fatigue, or dizziness
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school avoidance or reduced functioning
FND in young people is often best understood within a biopsychosocial framework, where multiple factors interact. These may include:
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stress or changes in environment (e.g. school transitions)
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emotional difficulties such as anxiety
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developmental or neurodevelopmental differences
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physical illness or injury
Research and clinical guidance highlight that many children experience functional symptoms at some point, and early understanding and intervention can support recovery. Support often involves working with the young person, family, and school to reduce symptom impact and support a gradual return to normal activities.
FND and Neurodiversity
Some individuals with Functional Neurological Disorder also have underlying neurodevelopmental differences, such as Attention Deficit Hyperactivity Disorder or Autism Spectrum Condition.
These differences can influence how the nervous system processes information, regulates attention, and responds to internal and external demands.
For example, individuals may experience:
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increased sensory sensitivity or overload
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heightened physiological arousal or reactivity
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difficulties with regulation of attention, emotion, or energy
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increased vulnerability to fatigue or overwhelm
In this context, functional symptoms can be understood as part of a broader pattern of nervous system dysregulation, rather than as isolated neurological symptoms. Importantly, this does not mean that neurodevelopmental differences cause FND. However, recognising these patterns can be helpful in developing a more accurate and individualised formulation, ensuring that support is appropriately tailored. A comprehensive assessment considers these overlapping factors, helping to guide treatment approaches that take into account sensory needs, regulation strategies, and environmental demands.
How Can Therapy Help FND?
Psychological therapy is an important part of evidence-based treatment for Functional Neurological Disorder (FND), particularly when integrated within a broader multidisciplinary approach. Therapy focuses on developing a clear, shared understanding of symptoms and identifying the factors that may be contributing to their onset and maintenance. This often involves a formulation-led approach, drawing on cognitive and behavioural models to understand how attention, expectations, stress, and patterns of activity may influence symptoms.
Therapy aims to:
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understand how FND affects the brain and body
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reduce fear and uncertainty around symptoms
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identify and modify patterns that may be maintaining symptoms
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gradually increase activity and functioning in a structured way
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develop strategies for managing stress, fatigue, and overwhelm
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At The Lotus Psychology Practice, all of our Psychologists are trained across multiple therapeutic modalities, and the approaches are often integrated based on an individuals unique needs. All therapeutic interventions are informed by scientific research and are and in line with National Institute for Health and Care Excellence guidelines.​ The most effective treatments for FND include Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), Compassion-Focused Therapy (CFT), and Eye Movement Desensitisation Therapy (EMDR) . We are able to offer longer-term psychotherapy for individuals who may benefit from understanding and processing early life experiences that contribute to current difficulties.
When to Seek Support
It may be helpful to seek psychological support if:​
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neurological symptoms persist without a clear medical explanation
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you have received a diagnosis of FND and would like support in managing symptoms
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symptoms are impacting daily functioning, mobility, or independence
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there is associated anxiety, low mood, or distress
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there is uncertainty about how to move forward following diagnosis
We accept referrals from medical professionals following a diagnosis, or self-referrals. Early support can help reduce the risk of symptoms becoming more persistent or disabling.
Our Approach at The Lotus Psychology Practice
At The Lotus Psychology Practice, our team of HCPC registered Psychologists have specialist experience in supporting children, adolescents and adults experiencing FND. We take a collaborative, formulation-led approach to therapy, working with you to understand how your difficulties have developed and what is maintaining them. This guides a structured, evidence-based and personalised treatment plan.
Prior to your first appointment, you will be asked to complete standardised and validated questionnaire measures, which are used to inform the assessment. A comprehensive psychological assessment is completed across the first two sessions. This helps us to develop a shared understanding of your current difficulties and includes:
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Your medical and psychological history
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The impact of your health condition on emotional wellbeing and daily life
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Current challenges, distress, and coping strategies
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Strengths, supports, and goals
Following an assessment, you will receive a full report, which includes individualised recommendations and resources, as well as an agreed therapeutic plan and individual goals. This summary can be shared with medical professionals to ensure multi-disciplinary care and rehabilitation.
Based on the assessment, we will agree the most appropriate therapeutic approach, tailored to you. Psychologists are trained across multiple therapeutic modalities, and the approaches are integrated based on an individuals unique needs. All therapies at The Lotus Psychology Practice are informed by scientific research and are and in line with National Institute for Health and Care Excellence guidelines.
