FUNCTIONAL neurologic disorder is a positive-sign diagnosis and patient perspectives show why early empathic communication matters.
Functional Neurologic Disorder as a “Rule In” Diagnosis
Functional neurologic disorder is described as a neuropsychiatric condition with involuntary neurologic symptoms linked to brain network dysfunction and variable biopsychosocial contributors. The authors emphasize that functional neurologic disorder is not a diagnosis of exclusion. Instead, it can be identified using positive clinical features such as inconsistency and incongruence with typical neurophysiology or neuroanatomy, including findings like tremor entrainment and distractibility. The perspective outlines several functional neurologic disorder phenotypes, including functional/dissociative seizures, functional movement disorders, persistent perceptual postural dizziness, and functional cognitive disorder, with mixed presentations also commonly observed.
Patient Perspective on Functional Neurologic Disorder Care Gaps
A patient observer describes the emotional and practical toll of delayed diagnosis, including persistent fear of not being believed and repeated encounters with care that lacked empathy. Their symptoms ranged from episodic leg weakness to periods of full body paralysis lasting hours to weeks. Observing other patients reinforced shared themes, long waitlists, dismissal, and limited access to functional neurologic disorder informed care. The narrative also highlights how patients often describe symptoms in vivid, personal language that can help clinicians understand lived experience and distress. Standard care was described as involving long-term physiotherapy, cognitive behavioral therapy, and follow-up, with many patients reporting improvement and nearly all finding care helpful once they reached appropriate services.
Training, Bias, and the Need for Specialized Care
A medical graduate and incoming neurology resident reflects on how earlier training fostered biases by linking functional neurologic disorder with malingering or factitious disorders, and by underemphasizing the positive signs that support diagnosis. Firsthand exposure to a multidisciplinary clinic reframed functional neurologic disorder as a legitimate, rule-in condition, while also underscoring the burden created by unnecessary testing, prolonged uncertainty, and delayed recovery. Together, the accounts argue for expanded functional neurologic disorder education across neurology, psychology, and rehabilitation training to support earlier diagnosis, reduce avoidable referrals, and improve patient outcomes.
Reference: Baker KM et al. Patient Perspective: Closing the Gap Personal and Clinical Reflections on Functional Neurologic Disorder. Neurology. 2026;106(5):e214699.
