Functional Neurological Disorders: Modern Diagnosis & Evidence-Based Management | Dr. Caitlin Adams

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Jul 28, 2025

Dr. Caitlin Adams, a psychiatrist at Massachusetts General Hospital, specializes in functional neurological disorders (FND). She breaks down the complexities of FND and debunks misconceptions about voluntary control over symptoms like functional weakness. Dr. Adams emphasizes the importance of effective communication and reducing stigma in treatment. The discussion includes key diagnostic signs, the biopsychosocial model, and therapeutic strategies such as cognitive behavioral therapy and specialized physical therapy, all aimed at enhancing patient engagement and recovery.

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INSIGHT

FND as Brain Connectivity Issue

Functional neurological disorders are characterized by brain connectivity issues resembling "software" rather than hardware problems.
This explains the difficulty in identifying specific structural brain lesions despite real symptoms.

INSIGHT

FND Prevalence and Commonality

FND is common and often underdiagnosed, with incidence comparable to Parkinson's.
It is the second most common reason for outpatient neurology visits after headaches.

ADVICE

Use Positive Signs to Diagnose

Diagnose FND using positive clinical signs instead of excluding other conditions.
Look for physical exam signs like Hoover's sign and tremor entrainment to rule in the disorder.

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Functional Neurological Disorder (FND) sits at the crossroads of neurology and psychiatry and for many clinicians, it’s still one of the most challenging diagnoses to understand, explain, and treat. In this episode, I’m joined by Dr. Caitlin Adams, psychiatrist at Massachusetts General Hospital, for a deep dive into how to recognize, diagnose, and manage FND using a modern, evidence-based, and patient-centered approach.
We trace the evolution of the diagnosis from hysteria to conversion disorder to today’s understanding of FND and explore what neuroscience now tells us about how these symptoms arise. Dr. Adams breaks down the myths around voluntary control, shows how to make a positive diagnosis based on key exam findings like Hoover’s sign, tremor variability, and seizure features distinguishing PNES from epilepsy, and shares how to communicate the diagnosis in a way that reduces stigma and builds engagement. We also unpack the biopsychosocial model of FND: the predisposing, precipitating, and perpetuating factors that keep symptoms alive and how to intervene through cognitive behavioral therapy (CBT), specialized physical therapy, mindfulness, and psychodynamic approaches.

Takeaways:

FND is a positive diagnosis, not a diagnosis of exclusion. Key findings like Hoover’s sign and tremor variability distinguish functional from organic presentations.
Symptoms are not “faked.” FND symptoms are involuntary and arise from disrupted brain networks controlling movement, sensation, and perception.
How you explain the diagnosis matters. Patients do better when clinicians validate symptoms, offer clear language, and emphasize that FND is common and treatable.
Treatment is multidisciplinary. Evidence-based care combines psychoeducation, CBT, and physiotherapy that retrains motor and sensory patterns.
Chronic cases require flexibility. Reassess the diagnosis, re-engage the patient, and adjust treatment around functional goals, not full symptom elimination.

Key References:

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