What Kills FND Patients
Functional Neurological Disorder (FND) does not cause death or shorten lifespan—it is not a degenerative or life-threatening condition, and mortality is not elevated compared to the general population. 1, 2
Why FND Is Not Fatal
FND arises from a potentially reversible miscommunication between the brain and body rather than from structural damage or degenerative disease to the nervous system. 1 The symptoms reflect altered brain network function and miscommunication, not tissue destruction, lesions, or progressive neurodegeneration. 1 This fundamentally distinguishes FND from fatal neurological conditions like ALS, multiple sclerosis, Parkinson's disease, or brain tumors, which involve ongoing destruction of neural tissue. 1
The functional changes causing FND symptoms can improve with appropriate treatment, and symptoms characteristically demonstrate variability and distractibility—they fluctuate and improve with attention redirection. 1 Recovery patterns show remission and exacerbation rather than inexorable decline, with 60-96% of patients reporting improvement after intervention. 1, 2
Secondary Complications That Can Occur
While FND itself is not fatal, secondary complications from prolonged immobility or reduced activity can develop, including:
- Deep vein thrombosis (DVT) from functional immobility and paralysis, which can occur when symptoms are severe enough to cause venous thromboembolism 3
- Deconditioning and muscle atrophy from prolonged immobility, which become more difficult to reverse over time 1
- Secondary musculoskeletal problems including pain syndromes from maladaptive movement patterns and use of assistive devices 1
- Unintended weight loss and malnutrition from functional dysphagia, along with social withdrawal 4, 1
The Real Burden of FND
The high levels of distress, disability, unemployment, and reduced quality of life experienced by many FND patients reflect the burden of symptoms and associated stigma, not a life-threatening disease process. 1, 2 Patients frequently report significant psychological comorbidity including anxiety, depression, and dissociation, which are associated with symptom severity and diminished quality of life. 1 Fatigue is reported in 47-93% of patients, cognitive symptoms in 80-85%, and psychiatric disorders in 40-100% depending on FND subtype. 5
Critical Clinical Implications
Early diagnosis and treatment are critical for optimal outcomes, as the prognosis is linked to early diagnosis and symptom duration. 1, 6 The key to preventing secondary complications is early physical therapy to improve function and prevent complications related to functional immobility. 3 Multidisciplinary rehabilitation centered on occupational therapy and physical therapy represents first-line treatment, with studies showing improvements in physical function and quality of life at 12-25 month follow-up. 1, 2
When explaining the diagnosis, clinicians should emphasize that symptoms are real but potentially reversible, avoiding language that suggests permanent neurological injury. 1 The potential for symptom reversal remains throughout the disease course. 2