Functional Neurological Disorder (FND): Can Hypnosis help?
(6 min read)

Jerry Knight

When my first client with Functional Neurological Disorder (FND) and her parents asked me if I could help, I had to admit that I had never heard of FND. In fact, few of the medical practitioners I was working with at the time had heard of it either. It was 2017 and I needed to do some background research where I very quickly became perplexed by the number of names it had!

I must first say that I am not a medical practitioner and I don't have a medical background. I don't diagnose my clients because I'm not qualified, so when they present, they have already been diagnosed with their condition, or I work with what they tell me. In this case, I'd read extensively on the condition prior to the client's first appointment.

Back then it was called Non-Epileptic Attack Disorder (NEAD), a common term used in the UK and Australia. In the USA it was referred to as Psychogenic Non-Epileptic Seizures (PNES)¹. I published an article in 2017 in the ASCH Journal Vol 39 No2 Spring 2017² as a hypnotherapy guide to working with NEAD and another in 2019 (NCH Vol19 ed4) as a successful hypnotherapy case study which was published in the UK, Australia and USA using the term NEAD.

Many other terms are used to describe the condition: Non-Epileptic Attacks (NEAs), non-epileptic events, dissociative seizures, stress seizures, functional seizures, conversion seizures, dissociative attacks and dissociative non-epileptic seizures. Other names used for the condition are pseudo seizures, hystero-epilepsy, hysterical seizures and pseudo-epileptic seizures.

These are terms clients often talk about when they feel they are not being taken seriously. This is especially true when they have had one of their many dealings within the non-sympathetic side of the medical world. There remains a persistent ambivalence amongst health professionals when reporting those with a FND diagnosis and many are told they are faking their symptoms.

There now seems to be a consensus that the new name emerging is that of Functional Neurological Disorder (FND). I will refer to it as FND in this article.

What is FND? FND describes a problem with how the brain receives and sends information to the rest of the body. It's often helpful to think of your brain as a computer. In someone who has FND, there's no damage to the hardware or structure of the brain. It's the software, or program running on the computer, that isn't working properly. The problems in FND are going on in a level of the brain that you cannot control. It includes symptoms like arm and leg weakness and seizures.

FND Hope International³ states FND is considered a rare disease, however, the exact prevalence is unknown, and the mechanisms which cause FND continue to be poorly understood, despite its prevalence within neurological clinics. Some researchers claim that functional symptoms are often seen in neurological services making it a common disorder. One report indicates approximately one third of outpatient neurology clinic attendances are patients reporting functional symptoms.

The Royal College of Physicians Journal⁴ states that FND disproportionately affects women (around 3:1) although, as age of onset increases, the proportion of men affected increases. Incident cases demonstrate that FND can occur across all ages, from young children (although it is rare before age 10) up to patients in their 80s. From my own client base, there are two clear groups affected: teenage girls from age 13-19 and women in their late 20s to mid-30s. I have worked with just two teenage boys.

In therapy, we talk a lot about the fight or flight response, but we rarely mention the freeze response. From my observations of FND, it appears that the mind and body freeze; they simply stop functioning in the normal way. There are those who have FND but have not had some kind of trauma⁵. From my own experience, all my FND clients have had traumas. These have ranged from sexual abuse in early childhood manifesting in seizures at puberty, with a full understanding of what had happened to them. One client, who had a gastrointestinal bug, found that much of her vocal, eating and walking functions ceased to operate properly. She was afraid to eat again in case the gastro bug returned. This resulted in anorexia nervosa, which required further medical intervention. Another client, a teenage girl, who had been stalked repeatedly when out training as an athlete, experienced twitches and seizures.

Most suffered a range of physically minor to major whole-body seizures, which mimic epileptic seizures, and which might also include twitching of the hands and/or feet. Other symptoms include head dropping suddenly, eyes rolling into the back of their sockets, and collapsing to the ground. There are many other symptoms; I am outlining just some of them.

I've worked with dozens of FND clients since 2017, most of whom have seen medium- to high-level improvements in their conditions. A reduction in the intensity of their seizures and overall symptoms has increased the quality of their lives and enabled them to get back on track.

How can hypnosis help?

There is limited research on hypnosis and FND, however, there are promising findings that require further research. The paper Hypnosis and suggestion as interventions for functional neurological disorder: A systematic review⁶ identified studies across 1,584 FND participants. The findings include:

• more than 85 per cent of patients demonstrated clinically significant improvements
• more than 75 per cent had a resolution or near resolution of symptoms in the short term.

Hypnotherapy teaches the art of:

• relaxing deeply and completely
• improving emotional and physical self-regulation
• controlling the intensity of pain
• disassociating emotions from trauma, without relieving the trauma
• building a sense of control over symptoms, and increasing confidence, self-esteem and quality of life.

A good place to start is by asking the client what has happened to them in the past, or what was happening in their lives when the FND first occurred. Then we identify triggers, potentially using the APET Model^TM (activating agent leading to a pattern match, leading to an emotion and, sometimes, to certain thoughts) from the Human Givens Institute⁷. However, with FND, symptoms sometimes appear for no apparent reason, so patience is essential.

The focus is on identifying and dealing with clients' traumas and moving them forward. I use the rewind technique extensively for specific events or for traumatic periods. One of the main benefits of the rewind technique is that clients deal with their traumas from a safe place without reliving them. What I have observed is that getting clients to talk about their traumas in any detail can trigger a seizure. From the outset, I make it clear that the treatment approach will not need a client to relive trauma. This can be a big help, as many clients have had multiple talk therapies, which have only reinforced their traumas.

Working with the inner child can help to heal hardship and trauma that occured in a client's early years.

Parts therapy can also be effective. as it assumes that each of us has many different parts to our minds. One FND client I worked with had a part of her mind called Bob. who was driving the condition. Using parts therapy, we gave Bob permission to feel safe and to let go, which proved an effective approach.

I'm also a big fan of using amnesia (Yapko 2019, p315) and broad language to suggest the client forget or let go of certain emotions or memories.

Occasionally, FND seizures occur under hypnosis. These can be treated as an abreaction, whereby the intensity and duration of the seizure are reduced. In hypnosis, one client had a full-body seizure where her entire body and muscles seized up. Her seizures usually lasted up to 15 minutes, but treating them as an abreaction reduced the intensity and time down to around four minutes.

Since COVID, I have worked online, which has enabled me to work with FND clients across the world, with the exception of the USA and Canada due to insurance restrictions. Working online does come with a few additional considerations when clients are not in close proximity or in an office environment. I always ensure that a family member is close by or that I have an additional phone number in case a client needs assistance during their appointment.

In conclusion, treating FND clients using hypnosis can be complex, challenging, successful, and rewarding. Most clients have seen a significant reduction in their symptoms and improvement to their quality of life. Their symptoms can vary significantly and all the clients I have worked with have had degrees of trauma in their lives. Working with the traumas can result in a reduction in symptoms, and ongoing treatment can see them almost eliminated.

References

Australian Society of Clinical Hypnotherapists (ASCH) Journal Volume 39 Number 2 Spring 2017.

National Council Hypnotherapy (NCH) Winter Wonderland Edition Vol 19 edition 4.

Yapko, M. (2019). Trancework, edn 5th, Routledge Taylor & Francis Group, New York and London.

Jerry Knight has had an extensive career in the UK military (Royal Navy) and Australian Defence Force (ADF) and saw active service in the Falklands conflict, Kosovo, Macedonia, Sierra Leone and Iraq. He trained as a hypnotherapist in 2013 at the Australian College Hypnotherapy (ACH) in Sydney and lives in Newcastle NSW, Australia, where he has built a busy hypnotherapy practice working with a wide range of issues, focusing on PTSD and FND.