FND & ALPIMS
Functional neurological disorder: looking at the wider picture
Functional neurological disorder (FND) affects how the nervous system functions. Symptoms can include weakness, movement difficulties, altered sensation or functional seizures.
Symptoms are real and involuntary. [1]
ALPIMS can help explore overlapping needs and conditions. It does not diagnose FND or explain every symptom.
FND is a neurological diagnosis, not a judgement about the person. Symptoms are not deliberately produced. Stress or trauma is not required, and normal scans alone do not establish FND. [1]
How is FND diagnosed?
A clinician, usually a neurologist, identifies characteristic positive features in the history or examination. These can include recognised signs of functional weakness or tremor, or typical features of functional seizures. Tests may also be needed to assess other conditions. [2]
Ask: “Which findings support my diagnosis, and what do they mean?” FND can coexist with epilepsy, migraine or other illness, so new symptoms still need appropriate assessment. [1]
Explore the six ALPIMS domains
Open a coloured panel for relevant overlaps and practical supports. These are different kinds of connections, not six proven causes of FND.
Anxiety & Autonomic
Anxiety, panic or bodily arousal may accompany FND. Faintness or a racing heart when upright can also have a separate cause, including PoTS. Functional seizures, epileptic seizures and fainting need different assessment and care.
What do we know? Anxiety is neither necessary nor sufficient for an FND diagnosis. A clinician should distinguish episodes using their features and appropriate investigations. [1] [5]
What may help?
- Describe what happens before, during and after an episode, including posture and recovery.
- Ask for a written episode plan, including when to seek urgent help.
- Use agreed grounding or calming strategies if helpful; these do not replace assessment.
Resources
Laxity & Connective Tissue
If hypermobility, HSD or hEDS coexists with FND, joint pain or instability may affect walking, movement practice and daily tasks. This panel is a prompt to adapt care, not a claim that hypermobility causes FND.
What do we know? A personalised rehabilitation plan should consider other health conditions. Joint instability and functional movement symptoms should not automatically be treated as the same problem. [2]
What may help?
- Tell your therapist about unstable joints, recurrent injuries and pain.
- Agree safe movement practice that considers joint protection and any other diagnoses.
- Review mobility aids collaboratively; do not remove needed supports abruptly.
Resources
Pain & Bodily Sensitivity
Pain, fatigue and migraine can coexist with FND. They may add to disability and make rehabilitation harder. An FND diagnosis does not mean every pain or neurological symptom is functional.
What do we know? FND can occur alongside other neurological conditions. Treating associated symptoms and conditions is part of a broader care plan. [1] [2]
What may help?
- Discuss migraine, sleep and persistent pain alongside the FND symptoms.
- Agree practical goals, such as a safer transfer or easier daily task.
- Seek review of new or changed symptoms rather than assuming another FND flare.
Resources
Immune & Inflammatory
FND may begin after a physical illness or injury. Someone may also have a separate inflammatory, allergic or autoimmune condition that needs its own care.
What do we know? FND is not, by itself, evidence of inflammation, autoimmune disease, MCAS or toxic injury. Illness preceding symptoms does not establish one particular cause. [1] [3]
What may help?
- Continue care for established medical conditions.
- Discuss new systemic symptoms or suspected medicine reactions with your clinician.
- Avoid using the FND label to explain every symptom or justify unvalidated tests and detox treatments.
Resources
Mood, Mental Health & Trauma
Depression, anxiety or trauma-related distress may be relevant for some people with FND. Others do not have these experiences. The diagnosis should not depend on finding stress or trauma.
What do we know? Psychological therapy can be one part of care, alongside rehabilitation. Trauma-focused treatment is relevant when a person has trauma-related needs; it is not a requirement for everyone with FND. [1] [3]
What may help?
- Choose care that validates symptoms and respects your preferences.
- Ask what a suggested therapy aims to help: episodes, coping, mood, trauma or daily function.
- Include practical assistance, supportive relationships and participation goals.
Resources
Sensory & Neurodevelopmental
FND can involve altered sensation or visual symptoms. Sensory overload, autism or ADHD may also affect communication, access and how treatment is delivered when they coexist.
What do we know? Functional sensory symptoms are not interchangeable with sensory processing differences, visual snow, hyperacusis or misophonia. Coexisting conditions may need separate assessment. [1] [4]
What may help?
- Ask for clear explanations, short written steps and predictable appointments.
- Adapt sound, lighting and session length where needed.
- Discuss persistent visual or hearing symptoms, and agree sensory-aware rehabilitation rather than forcing overwhelming input.
Resources
Start with one useful support
Choose one question or daily difficulty to bring to your care team. A clear explanation, an episode plan or help with an essential task may be a useful starting point.
Care can include FND-informed physiotherapy, occupational therapy, speech therapy and psychological therapy, depending on symptoms and goals. Movement retraining for functional motor symptoms differs from simply exercising harder. Improvement is possible, but progress varies and ongoing disability support may still be needed. [2] [3]
If you also have ME/CFS or post-exertional malaise (PEM)
Tell your rehabilitation team about delayed worsening after physical, cognitive or social effort. Adapt treatment to energy limits. NICE advises against fixed increases in activity for ME/CFS; an FND programme should not override that guidance. [6]
Functional seizures: plan for safety
Ask your clinician for an individual written plan. Functional seizures are not epileptic seizures, but a person can have both. Do not stop prescribed medicines or decide an unfamiliar episode is functional without medical advice. [1]
A plan should explain how supporters can protect you from injury, what helps during recovery and when emergency care is needed. Supporters should not restrain you or put anything in your mouth.
Resources & references
External resources open in a new tab.
- Neurosymptoms: a patient’s guide to FND ↗
- NHS: functional neurological disorder ↗
- FND Australia Support Services ↗
- NINDS: FND information ↗
- NINDS: Functional Neurologic Disorder — symptoms, diagnosis and treatment. ↗
- Managing functional neurological disorder: treatment recommendations for health professionals in Australia (2025). ↗
- King’s College Hospital NHS: FND and treatment options. ↗
- Neurosymptoms: neurologist-led patient information about FND. ↗
- NHS: PoTS — a separate cause of upright symptoms and faintness. ↗
- NICE NG206: ME/CFS — energy management and avoiding fixed activity increases. ↗
General information only. ALPIMS is an educational framework, not a diagnosis or treatment programme. New sudden weakness, facial droop, speech difficulty, severe headache or loss of consciousness should not automatically be attributed to FND. Call 000 in Australia for suspected stroke, a first seizure, serious injury, breathing difficulty or an episode that meets your emergency plan’s criteria.