Physical, Psychological, and Social Factors—and How to Judge Claims

---

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For the Person With FND

What can affect my life with FND?

Imagine someone with FND who also has migraine.

They need to pick up a few groceries. It sounds simple enough, but today their head hurts, the supermarket is noisy, and they’re worried about becoming unwell while they’re out.

Before long, they’re heading home with half their shopping unfinished.

So, what made shopping difficult?

Was it their migraine? Their FND? The noise? Their worries about getting home safely?

Perhaps several things played a part.

This is where the biopsychosocial approach comes in.

That’s quite a mouthful! We met this idea earlier in the course. It means looking at the whole picture: our physical health, our thoughts and feelings, and the world around us.

Each part can affect how we manage everyday life. Understanding them can help us find ways to make things a little easier.

Let’s look at each one using everyday examples.

The physical side

Our physical health includes our body, brain, sleep, pain, medicines and any other health conditions we may have.

Some people with FND also live with migraine. Others have different health problems alongside their FND.

Each condition deserves proper attention and care.

Let’s return to our shopper.

Their doctor helps them find a migraine treatment that works. With less pain, they can stay in the supermarket longer and finish their shopping.

Their FND symptoms may stay much the same. Yet something important has improved: an everyday activity has become easier.

That’s a win worth having.

One community member described how treatment helped, while some difficulties remained:

“I started treatment at a clinic in October, which has helped a little, but I’m still extremely sensitive and can crash if I push past my threshold even slightly.”

Figure 1 — Lived experience. [10]

That experience may sound familiar. Sometimes treatment helps with one problem while we continue working around others.

We can build on what helps, adjust what we do, and find support for the things that are still difficult.

The important idea: Caring for our whole physical health can make life better, whatever our particular FND symptoms may be. [1][5][7]

Thoughts and feelings are part of health, too

Living with FND can bring all kinds of feelings.

Maybe you’ve felt frustrated when symptoms interrupted something important. Or perhaps you’ve worried about what might happen when you’re away from home.

For our shopper, the thought of becoming unwell in public makes going out feel uncertain.

They wonder, “What if I need help getting home?”

Having a plan could make the trip feel more manageable.

Perhaps they arrange to call someone they trust if they need a ride. Now they know they have an option if things become difficult.

The plan gives them something useful: a little more confidence about going out.

Our thoughts and feelings are part of how we experience health. Paying attention to them can help us understand what kind of support we need.

Some people with FND also have anxiety, PTSD or another mental-health condition. These deserve care in their own right. Each diagnosis tells us something about a person’s health, rather than telling the whole story of why their FND began. [1][2][4]

Here’s another everyday situation.

One community member described how seizures interrupted conversations:

“[S]ometimes I get stressed and have a seizure and our conversation sort of ends, is interrupted.”

Figure 2 — Lived experience. [11]

Imagine trying to talk through something important with someone you love, only to have the conversation interrupted.

Both people might be left wondering what happens next.

They could agree to return to the conversation later, when they’re ready. That gives them a way to finish talking and understand each other.

It may seem like a small change, but important relationships are built on moments like these.

The important idea: Understanding our feelings and experiences can help us find ways to feel safer, communicate and enjoy more of everyday life.

What about the world around me?

Now let’s look beyond our bodies and feelings.

The social side includes the people around us, the places we go and the practical things that shape our days.

Think about a teenager with FND who finds bright classroom lights difficult.

They enjoy learning and want to spend time with their friends. But the lighting makes getting through the school day exhausting.

Now imagine their school arranges a room with softer lighting.

The teenager can concentrate more comfortably, keep learning and spend more time with friends.

Their neurological symptoms may still be there, but their school day has become more manageable.

Sometimes the surroundings can make a big difference.

For someone else, the difficulty might be getting to appointments. A ride from a friend could make receiving care much easier.

Occupational therapists often help people find ways to adapt activities and surroundings so they can take part in things that matter to them. [9]

The important idea: Changes to our surroundings and support can open doors to activities that have become difficult.

Putting the pieces together

Remember our shopper?

A migraine treatment helps with their pain.

Shopping when the store is quieter makes the outing more comfortable.

And knowing they have someone to call gives them a little more confidence.

Each change helps with a different part of the problem.

Put them together, and grocery shopping might become something they can enjoy again.

That’s the value of the biopsychosocial approach. It helps us see the bigger picture and discover where useful changes might be possible.

When psychology and FND get tangled

“It’s hard to separate psychology from FND when my FND is so sensitive to psychology.”

Figure 3 — Lived experience shared with the project. [12]

Have you ever noticed how your feelings can affect your body?

Maybe your stomach feels funny before something exciting. Or your heart beats faster when you’re frightened.

Our brains and bodies are always talking to each other.

For some people with FND, this connection can be especially noticeable.

Imagine you’re getting ready to visit a friend. You’re looking forward to it. Then your symptoms suddenly get worse.

Maybe your words become difficult to find, your legs feel heavy, or you struggle to concentrate.

Now you’re worried you might have to cancel.

Your symptoms have affected your feelings.

But sometimes things happen the other way around.

You might feel nervous before an important appointment and notice your symptoms becoming stronger.

And on another day? Your symptoms might change for no clear reason at all.

It can get confusing.

If only our nervous systems came with a little button marked “Why did that happen?”

Here’s one way to untangle it.

Imagine bright sunlight makes someone’s headache worse.

Does that mean sunlight caused their headache condition in the first place?

On its own, that tells us what affects their headache today. Understanding how the condition began is a separate question.

FND can be complicated in a similar way.

For some people, thoughts, feelings and attention may influence symptoms. Living with symptoms can also influence how we think and feel. The pattern varies from person to person. [1][3]

Something that affects our symptoms isn’t necessarily what caused our FND to begin.

That difference helps us ask useful questions about explanations for FND. Let’s try a little detective work.

How can I judge an explanation about my FND?

You may have heard someone suggest that an illness, an injury or a stressful experience caused your FND.

Researchers are studying many possible connections. Some findings are well supported, while other ideas are still being investigated.

It’s natural to want an answer. An explanation that fits our experience can bring relief and help us feel understood.

We can also ask how much evidence supports it.

Evidence means the information or findings that support an explanation.

Let’s try four questions that can help us make sense of what we’re hearing.

We’ll use our shopper again.

Imagine someone tells them:

“Your migraines are what caused your FND.”

That sounds like an explanation. But how much do we really know?

1. What do we actually know?

Our shopper has been diagnosed with FND and migraine.

They’ve also noticed that shopping can be especially difficult when their migraine is painful.

These are things we know about their experience.

We’ve made a good start. We know what is happening, even though we’re still learning why.

2. What is still an idea?

Someone has suggested that migraine caused their FND.

That idea needs more evidence.

Researchers have found connections between migraine and FND, but a connection in a group of people tells us only part of the story.

It takes more evidence to establish what caused a condition in one person.

We can keep an interesting idea in mind while scientists continue investigating it.

3. What else could explain the difficulty?

Let’s think about the shopping trip again.

Perhaps the migraine pain made things harder. The bright lights and noise might have added to the difficulty.

Our shopper may also have been concerned about getting home if they became unwell.

Now we can see several things worth considering.

It’s a bit like looking at a puzzle. Each piece helps us understand the picture, and some pieces may fit together.

4. What can we do with this information?

This is where the questions really earn their keep!

Our shopper can ask about migraine treatment. They can choose a quieter time to shop and make a plan for getting home.

These choices could help them enjoy shopping again.

And here’s the encouraging part: they can benefit from these changes while researchers continue looking for answers about FND.

That’s what the four questions are for.

They help us understand what we know, recognize what we’re still learning, consider other possibilities and find useful ways forward.

What does this mean for my recovery?

We’ve covered quite a bit of ground.

We’ve seen how physical health, thoughts and feelings, and our surroundings can all affect daily life.

We’ve also learned a way to think about explanations for FND.

Each person’s situation will be different. Some people have symptoms that change often. Others experience difficulties that stay much the same. And something that helps one person may have little effect for another.

Understanding our own needs gives us a place to start.

Maybe you want to spend more time with friends, return to a hobby, feel safer going out or simply have a more comfortable day.

Those are meaningful goals.

Key idea: Understanding what affects our daily lives can help us make choices about care, support and recovery. We can work toward things that matter to us while science continues to learn more about FND.

Questions to reflect on

How could a change to someone’s physical health, feelings or surroundings make an everyday activity easier?

What would you most like your treatment and support to make possible in your own life?

One small step

Think of something you enjoy or value that has become difficult.

What might make it a little easier?

Maybe there’s a health concern you could discuss with your clinician, a change you could make to your surroundings or some help you could ask for.

Choose one possibility that feels manageable.

Sometimes a small change can make room for something important.

If you experience a new symptom or a major change in an existing one, your healthcare team can help assess it.

Optional learning activity

Crossword

Revisit the physical, psychological and social factors covered in this lesson. The easy edition has a word bank.

Browse this crossword in the puzzles collection.

Optional colouring activity

Try the Lesson 9 colouring page, based on the shopper’s journey through a difficult day toward a more manageable grocery trip.

Choose the preview to open the printable PDF in a new tab or window. When printing, select landscape orientation and fit to page. You can also visit the colouring-page collection.

---

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Family, Friends, and Other Supporters

Looking at the whole picture

Imagine someone with FND who wants to attend a family gathering.

They’re looking forward to seeing everyone, but they’re also dealing with a painful migraine. They’re concerned about becoming unwell while they’re there, and they know the house will be busy and noisy.

That’s quite a lot to manage for what should be an enjoyable afternoon!

This is where the biopsychosocial approach can be helpful. It encourages us to consider physical health, thoughts and feelings, and everyday surroundings together.

In our example, the migraine may need medical treatment. Worries about having an episode might be easier to manage with an agreed safety plan. And somewhere quiet to spend time with family could make the gathering more comfortable.

Each part of the situation suggests a different way to help.

That’s the important lesson: understanding the whole picture can reveal opportunities to make life easier, even when the person’s FND symptoms remain unchanged.

Making room for the things that matter

Let’s stay with our family gathering for a moment.

Perhaps the person decides that a shorter visit would be more manageable. They might arrive before things get busy, spend time with a few relatives and head home earlier than everyone else.

They still get to enjoy something that matters to them.

For someone living with FND, having choices like these can make a meaningful difference. It can help them remain involved in family life while respecting their own needs and limits. [9]

And what works may change. A person might enjoy a longer visit one week and need a quieter afternoon the next. Some symptoms vary, while others are more persistent or unpredictable.

Support becomes more useful when there’s room for that variation.

A simple conversation can help. Something like, “We’d love to see you. What would make the visit work best for you?” gives the person a chance to share what they need.

It also leaves the decisions where they belong: with the person whose life we’re talking about.

Understanding what helps

Over time, families and friends may notice things that make everyday activities easier or more difficult.

Perhaps a quieter setting makes conversation more comfortable. Maybe having transport arranged ahead of time takes some pressure off an outing.

These observations can be useful because they point toward practical adjustments.

They can also help the person’s healthcare team understand what daily life is like beyond the clinic.

For example, knowing that migraine pain regularly interferes with activities may encourage a discussion about migraine care. Difficulties with sleep or a separate mental-health condition may deserve attention of their own.

These details help build a fuller picture of someone’s health. They don’t have to explain why the person originally developed FND to be important.

When the person welcomes it, a supporter can help remember questions, share observations or take notes during an appointment. Having another pair of ears can be especially useful when there’s a lot of information to take in.

New or substantially different symptoms also deserve medical attention, just as they would for anyone else.

Support is part of the bigger picture

Living with FND can affect friendships, relationships and family routines. It can also change how people spend time together.

Sometimes support means helping someone get to an appointment. Other times, it might mean changing a family plan, listening to a concern or making an activity easier to enjoy.

These things can help preserve a person’s independence, confidence and connection with others.

They also remind us that improvement can mean more than a change in symptoms. Feeling included, having choices and being able to take part in something enjoyable are worthwhile outcomes.

The important idea: You don’t need to solve the mystery of FND to make a positive difference. Understanding what matters to someone, and finding ways to support it, can be a valuable part of their care and recovery.

---

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Clinicians and the Care Team

Why use a biopsychosocial formulation?

A positive FND diagnosis identifies clinical features supporting a functional neurological presentation.

A biopsychosocial formulation builds on that diagnosis. It brings together the medical, psychological and social factors that may influence a person’s health, daily functioning and opportunities for recovery.

Consider a patient with FND and migraine who wants to attend a family gathering.

Migraine pain may make the afternoon difficult. The patient may feel concerned about managing symptoms away from home. A crowded, noisy environment could add to the challenge.

Each part of this situation raises a useful clinical question.

The migraine invites medical assessment and treatment. Concerns about attending suggest a conversation about confidence, accessibility and planning. The environment offers opportunities for practical adjustments.

Together, these considerations can guide care that addresses the patient’s health and personal goals. [1][2]

Understanding the physical dimension

Physical health deserves careful attention in FND, partly because accompanying medical conditions are common and may add substantially to disability.

Steinruecke and colleagues’ 2024 systematic review and meta-analysis found that pain symptoms and pain-related diagnoses are common among people with FND. [5]

This finding matters because pain can affect mobility, sleep, concentration and participation in rehabilitation. Recognizing and assessing pain creates opportunities for more comprehensive care.

Research into migraine offers another example.

Stone and colleagues’ 2025 review examined the overlap between migraine and FND, including possible relationships between their clinical presentations. [7]

For a patient living with both conditions, the review supports considering their interaction while also using established migraine assessment and treatment approaches.

Migraine treatment may improve comfort and daily functioning. Whether it also changes FND symptoms is an additional clinical outcome that can be evaluated.

Physiological research is expanding this picture.

Paredes-Echeverri and colleagues’ 2022 systematic review and meta-analysis examined autonomic, endocrine and inflammatory findings in FND. The studies explored measurable bodily processes that may contribute to a fuller understanding of the condition. [8]

Differences in study populations and measurements make this an evolving area of research. The findings provide questions for further investigation and encourage attention to relevant accompanying symptoms.

The broader clinical principle is straightforward: a patient’s physical health provides valuable information and opportunities for treatment, regardless of how each condition relates to the original development of FND.

Understanding the psychological dimension

The psychological dimension includes emotional processing, expectations, attention, coping and mental health.

These processes are closely connected with neurological function and everyday behaviour.

Pick and colleagues’ 2019 review explored how emotional processing may interact with neural processes involved in FND. The authors proposed a biopsychosocial research model that brings together findings from several areas of neuroscience. [3]

This work is useful because it identifies relationships that researchers can investigate and clinicians can explore within an individual’s presentation.

For example, consider a patient who experiences functional seizures and feels apprehensive about travelling alone.

Their concern may reflect previous experiences of injury, uncertainty about receiving help or difficulty predicting when an episode might occur.

Understanding these concerns helps identify an appropriate response.

An individualized safety plan may support greater confidence when travelling. Where a separate anxiety disorder is present, treatment may improve emotional well-being and participation.

The purpose of exploring these factors is to understand the patient’s experience and identify useful care.

Psychological assessment can also recognize strengths, sources of support and coping strategies that the person already finds helpful.

The clinical value lies in understanding how psychological processes and mental-health needs affect the person’s present circumstances, while distinguishing these from hypotheses about the original cause of FND.

Understanding the social dimension

Health is experienced within a person’s everyday environment.

Family relationships, employment, finances, housing, transport and healthcare access can all influence what someone is able to do.

Consider two people with similar neurological symptoms.

One has reliable transportation, flexible work arrangements and supportive relationships. The other faces long journeys to appointments, financial pressure and an inaccessible workplace.

Their symptoms may be similar, but their opportunities to participate in treatment and daily life could be very different.

Recognizing these differences helps clinicians develop realistic, individualized care plans.

Sekine and colleagues’ 2025 systematic review examined biopsychosocial factors associated with longer-term outcomes in FND. Such research helps identify factors worth considering when planning care. Study populations, follow-up periods and outcome measures vary, so individual prognosis requires a broader clinical assessment. [6]

Patients’ perspectives also provide important information.

Butler and colleagues’ 2021 international online survey collected responses from 1,048 people with FND about their experiences and perceived influences. [4]

The self-selected sample offers insight into patients’ reported experiences and priorities. It is particularly useful for understanding questions that matter to people living with FND and for informing further research.

Occupational-therapy consensus recommendations offer a practical connection between these findings and clinical care. They describe individualized approaches to activity, participation and environmental adaptation. [9]

Together, these sources support considering the social environment as part of understanding disability, treatment access and personally meaningful outcomes.

How does the evidence guide clinical reasoning?

Different research methods help answer different questions.

An observational study may reveal that two conditions frequently occur together. This finding establishes an association and provides a starting point for investigating their relationship.

A mechanism model proposes how a neurological or psychological process might contribute to symptoms. Such models can guide experimental research and suggest approaches to rehabilitation.

A controlled treatment study examines whether an intervention improves specific outcomes in a studied population. Its results help inform treatment decisions, including which benefits are supported by evidence and which require further investigation.

These forms of evidence complement one another.

For instance, an association between migraine and FND encourages assessment of migraine. Research into possible mechanisms may eventually clarify how the conditions interact. Treatment studies can then help determine which interventions improve particular outcomes.

This is the distinction introduced earlier in the course between what has been observed, what may explain it and what can help. [2][3][5][7]

Bringing the evidence into an individual care plan

Let’s return to the patient who wants to attend a family gathering.

A useful formulation begins with the established clinical findings: the evidence supporting the FND diagnosis and the separately diagnosed migraine.

The next consideration is what currently affects participation.

Migraine pain, concerns about symptoms away from home and a crowded environment may all make attending difficult.

The patient’s goal gives these findings their practical meaning. They want to spend time with family.

Care can then be organized around that goal.

Migraine treatment may improve physical comfort. A suitable safety plan, where indicated, may help address concerns about being away from home. A shorter visit or quieter setting could make participation easier.

The care team can review what changes, including symptom burden, confidence, comfort and participation.

This approach allows clinical decisions to be evaluated against outcomes that matter to the patient.

It also makes space for further assessment and evolving scientific understanding.

Explaining the reasoning to patients

Patients often want to understand how clinicians reached their conclusions.

Sharing the reasoning can help them distinguish established findings from developing scientific explanations.

For example:

“The clinical findings support your FND diagnosis, and we also know that you have migraine. Both are important parts of your health. Research is helping us understand how these conditions may interact. In the meantime, treating your migraine and finding ways to make activities more manageable may improve your daily life. We can review together what helps.”

This explanation offers the patient something concrete: an evidence-based diagnosis, an account of the research and a plan connected to their own priorities.

The central clinical principle: A biopsychosocial formulation connects scientific evidence with the individual’s lived experience. Its value comes from helping clinicians understand the person’s needs, identify appropriate interventions and measure progress toward meaningful goals.

---

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

Further reading in the Reference Library: Assessment and everyday function.

---

Research and Sources

What this evidence can and cannot establish

The diagnostic and clinical reviews support a positive diagnosis and an individualized understanding of care needs. Pick’s emotional-processing model and Butler’s survey address different questions: possible mechanisms and patients’ reported experiences. [1][2][3][4]

The pain, prognosis, migraine and autonomic reviews examine different populations and outcomes. Their findings help identify questions for care and research; associations alone do not establish what caused one person’s FND. [5][6][7][8]

The occupational-therapy recommendations support individualized activity and participation goals. They are professional consensus, rather than a trial proving that a particular environmental change will help every person. [9]

Citation table

Citation	Figure	Full citation
[1]	—	Bennett K, Diamond C, Hoeritzauer I, Gardiner P, McWhirter L, Carson A, Stone J. A practical review of functional neurological disorder (FND) for the general physician. Clinical Medicine. 2021;21(1):28–36. FND-CIT-0001. https://doi.org/10.7861/clinmed.2020-0987
[2]	—	Espay AJ, Aybek S, Carson A, et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurology. 2018;75(9):1132–1141. FND-CIT-0002. https://doi.org/10.1001/jamaneurol.2018.1264
[3]	—	Pick S, Goldstein LH, Perez DL, Nicholson TR. Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda. Journal of Neurology, Neurosurgery & Psychiatry. 2019;90(6):704–711. FND-CIT-0005. DOI: 10.1136/jnnp-2018-319201
[4]	—	Butler M, Shipston-Sharman O, Seynaeve M, et al. International online survey of 1048 individuals with functional neurological disorder. European Journal of Neurology. 2021;28(11):3591–3602. FND-CIT-0014. https://doi.org/10.1111/ene.15018
[5]	—	Steinruecke M, Mason I, Keen M, McWhirter L, Carson AJ, Stone J, Hoeritzauer I. Pain and functional neurological disorder: a systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry. 2024;95(9):874–885. FND-CIT-0015. https://doi.org/10.1136/jnnp-2023-332810
[6]	—	Sekine ER, Kanaan RA, McMillan J, Oxford S, Iles RA. Biopsychosocial prognostic indicators in Functional Neurological Disorder: a systematic review. Journal of Psychosomatic Research. 2025;195:112201. FND-CIT-0017. https://doi.org/10.1016/j.jpsychores.2025.112201
[7]	—	Stone J, Coebergh J, Khoja L, Butler M, Nicholson TR, Dodick DW. Migraine and functional neurological disorder (FND)—a review of comorbidity and potential overlap. Brain Communications. 2025;7(4):fcaf288. FND-CIT-0049. https://doi.org/10.1093/braincomms/fcaf288
[8]	—	Paredes-Echeverri S, Maggio J, Bègue I, Pick S, Nicholson TR, Perez DL. Autonomic, endocrine, and inflammation profiles in functional neurological disorder: a systematic review and meta-analysis. Journal of Neuropsychiatry and Clinical Neurosciences. 2022;34(1):30–43. FND-CIT-0064. https://doi.org/10.1176/appi.neuropsych.21010025
[9]	—	Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. Journal of Neurology, Neurosurgery & Psychiatry. 2020;91(10):1037–1045. FND-CIT-0011. DOI.
[10]	1	Public community post, “Extremely sensitive nervous system.” Reddit, r/FND. Original post. Accessed and quotation verified October 21, 2026. Individual lived experience. FND-CIT-0285.
[11]	2	Public community post, “I need advice.” Reddit, r/FND. Original post. Accessed and quotation verified October 21, 2026. Individual lived experience. FND-CIT-0286.
[12]	3	Project contributor. First-person reflection on psychology and FND, supplied directly and approved for anonymous use, October 21, 2026. Individual lived experience. FND-CIT-0287.

This page still needs review by people with FND, supporters, clinicians and researchers, especially to check that each factor’s possible role and evidence level remain clear.

Plain-language draft prepared: September 4, 2026 · Research package added September 4, 2026 · Editorial audit completed October 17, 2026 · Human editing completed October 20, 2026 · Evidence and editorial audits completed October 21, 2026 · Clinical review pending