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DOI: 10.1055/a-2753-9092
Epidemiology of Functional Neurological Disorder: The Clinical Spectrum
Authors
Abstract
Functional neurological disorder (FND) is a prevalent, neuropsychiatric condition characterized by symptoms of impaired motor, sensory, cognitive, or perceptual systems. This study reviews the incidence, prevalence, demographic factors, risk factors, comorbidities, prognosis, and economic impact of FND and its subtypes. FND affects individuals across the lifespan and is more common in women, with socioeconomic and cultural factors also playing critical roles. FND is frequently comorbid with other functional syndromes, psychiatric and neurological disorders. Incidence estimates range from 10 to 16 per 100,000, with prevalence estimates between 79 and 144 per 100,000. Prognosis is poor without early intervention, with long diagnostic delays contributing to chronic symptoms and disability. FND accounts for significant healthcare utilization and economic burden. Evidently, there is a clear need for standardized diagnostic approaches and interdisciplinary collaboration to improve epidemiological accuracy and clinical outcomes.
Publication History
Received: 15 October 2025
Accepted: 23 November 2025
Accepted Manuscript online:
25 November 2025
Article published online:
08 December 2025
© 2025. Thieme. All rights reserved.
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References
- 1 Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol 2022; 21 (06) 537-550
- 2 Ahmad O, Ahmad KE. Functional neurological disorders in outpatient practice: An Australian cohort. J Clin Neurosci 2016; 28: 93-96
- 3 Stone J, Carson A, Duncan R. et al. Which neurological diseases are most likely to be associated with “symptoms unexplained by organic disease.”. J Neurol 2012; 259 (01) 33-38
- 4 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Diagnostic and Statistical Manual of Mental Disorders. Published online March 18, 2022.
- 5 Finkelstein SA, Diamond C, Carson A, Stone J. Incidence and prevalence of functional neurological disorder: a systematic review. J Neurol Neurosurg Psychiatry 2025; 96 (04) 383-395
- 6 Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. Brain 2010; 133 (Pt 5): 1537-1551
- 7 Rief W, Hessel A, Braehler E. Somatization symptoms and hypochondriacal features in the general population. Psychosom Med 2001; 63 (04) 595-602
- 8 McWhirter L, Ritchie C, Stone J, Carson A. Functional cognitive disorders: a systematic review. Lancet Psychiatry 2020; 7 (02) 191-207
- 9 Ball HA, McWhirter L, Ballard C. et al. Functional cognitive disorder: dementia's blind spot. Brain 2020; 143 (10) 2895-2903
- 10 Madrigal J, Herrón-Arango AF, Bedoya MJ, Cordero Chen J, Castillo-Bustamante M. Persistent challenges: a comprehensive review of persistent postural-perceptual dizziness, controversies, and clinical complexities. Cureus 2024; 16 (05) e60911
- 11 Staab JP, Eckhardt-Henn A, Horii A. et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res 2017; 27 (04) 191-208
- 12 Chouksey A, Pandey S. Functional movement disorders in elderly. Tremor Other Hyperkinet Mov (N Y) 2019; 9
- 13 Harris SR. Psychogenic movement disorders in children and adolescents: an update. Eur J Pediatr 2019; 178 (04) 581-585
- 14 Yong K, Chin RFM, Shetty J. et al; Edinburgh Paediatric FND Study Group. Functional neurological disorder in children and young people: incidence, clinical features, and prognosis. Dev Med Child Neurol 2023; 65 (09) 1238-1246
- 15 Raper J, Currigan V, Fothergill S, Stone J, Forsyth RJ. Long-term outcomes of functional neurological disorder in children. Arch Dis Child 2019; 104 (12) 1155-1160
- 16 Park JE. Functional movement disorders: updates and clinical overview. J Mov Disord 2024; 17 (03) 251-261
- 17 Duncan R, Razvi S, Mulhern S. Newly presenting psychogenic nonepileptic seizures: incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav 2011; 20 (02) 308-311
- 18 Lidstone SC, Costa-Parke M, Robinson EJ, Ercoli T, Stone J. FMD GAP Study Group. Functional movement disorder gender, age and phenotype study: a systematic review and individual patient meta-analysis of 4905 cases. J Neurol Neurosurg Psychiatry 2022; 93 (06) 609-616
- 19 Pennington C, Hayre A, Newson M, Coulthard E. Functional cognitive disorder: a common cause of subjective cognitive symptoms. J Alzheimers Dis 2015; 48 (Suppl. 01) S19-S24
- 20 Carson A, Lehn A. Epidemiology. Handb Clin Neurol 2016; 139: 47-60
- 21 Asadi-Pooya AA, Homayoun M. Psychogenic nonepileptic seizures: the sex ratio trajectory across the lifespan. Seizure 2020; 75: 63-65
- 22 Baizabal-Carvallo JF, Jankovic J. Gender differences in functional movement disorders. Mov Disord Clin Pract 2019; 7 (02) 182-187
- 23 Bradlow RCJ, Meyer B, Kanaan R. Research letter: functional neurological disorder in transgender people: a case series. Aust N Z J Psychiatry 2024; 58 (03) 277-280
- 24 Bradlow RCJ, Zwickl S, Reardon P, Cheung AS, Kanaan RA. A systematic review of functional neurological disorder in transgender people. Int J Transgend Health 2025;
- 25 How Many Adults and Youth Identify as Transgender in the United States? - Williams Institute. Accessed September 3, 2025 at: https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/
- 26 Serranová T, Di Vico I, Tinazzi M. et al. Functional neurological disorder in Europe: regional differences in education and health policy. Eur J Neurol 2024; 31 (10) e16350
- 27 Deka K, Chaudhury PK, Bora K, Kalita P. A study of clinical correlates and socio-demographic profile in conversion disorder. Indian J Psychiatry 2007; 49 (03) 205-207
- 28 Kuloglu M, Atmaca M, Tezcan E, Gecici O, Bulut S. Sociodemographic and clinical characteristics of patients with conversion disorder in Eastern Turkey. Soc Psychiatry Psychiatr Epidemiol 2003; 38 (02) 88-93
- 29 Naidoo L, Bhigjee AI. The spectrum of functional neurological disorders: a retrospective analysis at a tertiary hospital in South Africa. S Afr J Psychiatr 2021; 27: 1607
- 30 Osman AH, Alsharief SM, Siddig HE. Functional neurological disorder: Characteristics and outcome in a limited-resources country (Sudan). Epilepsy Behav 2020; 111: 107151
- 31 Benbadis S, Ledford R, Sawchuk T, Dworetzky B. A broader perspective: functional symptoms beyond neurology. Epilepsy Behav Rep 2021; 18: 100506
- 32 Hoeritzauer I. 11 The bladder and the brain: exploring functional urological symptoms. J Neurol Neurosurg Psychiatry 2019; 90 (Suppl. 02) A5-A6
- 33 Jȩdrzejczak J, Owczarek K, Majkowski J. Psychogenic pseudoepileptic seizures: clinical and electroencephalogram (EEG) video-tape recordings. Eur J Neurol 1999; 6 (04) 473
- 34 Kutlubaev MA, Xu Y, Hackett ML, Stone J. Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: systematic review and meta-analysis of frequency, correlates, and outcomes. Epilepsy Behav 2018; 89: 70-78
- 35 Ambar Akkaoui M, Geoffroy PA, Roze E, Degos B, Garcin B. Functional motor symptoms in Parkinson's disease and functional Parkinsonism: a systematic review. J Neuropsychiatry Clin Neurosci 2020; 32 (01) 4-13
- 36 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 Commun 2025; 7 (04) fcaf288
- 37 Chakravarty A, Mukherjee A, Roy D. Migraine, epileptic seizures and psychogenic non-epileptic seizures: observations in Indian patients in a clinic-based study. Neurol India 2010; 58 (04) 631-633
- 38 Cuoco S, Scannapieco S, Barra F. et al. Functional neurological disorder in multiple sclerosis: a prospective study. Mult Scler Relat Disord 2025; 94: 106264
- 39 Kurtis MM, Pareés I. Functional movement disorder comorbidity in Parkinson's disease: unraveling the web. Parkinsonism Relat Disord 2021; 82: 138-145
- 40 Carrozzino D, Bech P, Patierno C. et al. Somatization in Parkinson's disease: a systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2017; 78: 18-26
- 41 Gonzalez-Herrero B, Happé F, Nicholson TR. et al. Functional neurological disorder and autism spectrum disorder: a complex and potentially significant relationship. Brain Behav 2024; 14 (12) e70168
- 42 Fernandez A, Jaquet M, Aubry-Rozier B, Suter M, Aybek S, Berna C. Functional neurological signs in hypermobile Ehlers-Danlos syndrome and hypermobile spectrum disorders with suspected neuropathic pain. Brain Behav 2024; 14 (02) e3441
- 43 Nisticò V, Iacono A, Goeta D. et al. Hypermobile spectrum disorders symptoms in patients with functional neurological disorders and autism spectrum disorders: a preliminary study. Front Psychiatry 2022; 13: 943098
- 44 Ludwig L, Pasman JA, Nicholson T. et al. Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies. Lancet Psychiatry 2018; 5 (04) 307-320
- 45 Steffen-Klatt A, Fiess J, Beckh J, Schmidt R, Rockstroh B. The impact of adverse childhood experience on symptom severity in patients with functional neurological symptom disorder (FNSD). Ment Health Prev 2019; 13: 169-175
- 46 Levita L, Mayberry E, Mehmood A, Reuber M. Evaluation of LiNES: a new measure of trauma, negative affect, and relationship insecurity over the life span in persons with FND. J Neuropsychiatry Clin Neurosci 2020; 32 (01) 43-49
- 47 Goleva SB, Lake AM, Torstenson ES, Haas KF, Davis LK. Epidemiology of functional seizures among adults treated at a university hospital. JAMA Netw Open 2020; 3 (12) e2027920
- 48 Mavroudis I, Franekova K, Petridis F. et al. Comorbidities across functional neurological disorder subtypes: a comprehensive narrative synthesis. Life (Basel) 2025; 15 (08) 1322
- 49 Gilmour GS, Langer LK, Lang AE, MacGillivray L, Lidstone SC. Neuropsychiatric phenotypes in functional movement disorder. CNS Spectr 2023; 28 (06) 747-755
- 50 Kletenik I, Sillau SH, Isfahani SA, LaFaver K, Hallett M, Berman BD. Gender as a risk factor for functional movement disorders: the role of sexual abuse. Mov Disord Clin Pract 2019; 7 (02) 177-181
- 51 WHO Team of Sexual and Reproductive Health and Research. Violence against women, 2018 estimates. WHO. Published online 2021:1–87. Accessed September 6, 2025 at: https://www.who.int/publications/i/item/9789240022256
- 52 Epidemiology of functional neurological disorder, active component, U.S. Armed Forces, 2000–2018 - PubMed. Accessed September 2, 2025 at: https://pubmed.ncbi.nlm.nih.gov/32726111/
- 53 Jones E, Wessely S. War syndromes: the impact of culture on medically unexplained symptoms. Med Hist 2005; 49 (01) 55-78
- 54 Yang TU, Kim HJ, Lee YK, Park YJ. Psychogenic illness following vaccination: exploratory study of mass vaccination against pandemic influenza A (H1N1) in 2009 in South Korea. Clin Exp Vaccine Res 2017; 6 (01) 31-37
- 55 Buttery JP, Madin S, Crawford NW. et al. Mass psychogenic response to human papillomavirus vaccination. Med J Aust 2008; 189 (05) 261-262
- 56 Frey J, Black KJ, Malaty IA. TikTok Tourette's: are we witnessing a rise in functional tic-like behavior driven by adolescent social media use?. Psychol Res Behav Manag 2022; 15: 3575-3585
- 57 Hallab A, Sen A. Epilepsy and psychogenic non-epileptic seizures in forcibly displaced people: a scoping review. Seizure 2021; 92: 128-148
- 58 Raynor G, Baslet G. A historical review of functional neurological disorder and comparison to contemporary models. Epilepsy & Behavior Reports 2021; 16: 100489
- 59 Gelauff J, Stone J, Edwards M, Carson A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry 2014; 85 (02) 220-226
- 60 Durrant J, Rickards H, Cavanna AE. Prognosis and outcome predictors in psychogenic nonepileptic seizures. Epilepsy Res Treat 2011; 2011: 274736
- 61 Fredwall M, Terry D, Enciso L, Burch MM, Trott K, Albert DVF. Outcomes of children and adolescents 1 year after being seen in a multidisciplinary psychogenic nonepileptic seizures clinic. Epilepsia 2021; 62 (10) 2528-2538
- 62 Mcloughlin C, Lee WH, Carson A, Stone J. Iatrogenic harm in functional neurological disorder. Brain 2025; 148 (01) 27-38
- 63 Tinazzi M, Geroin C, Erro R. et al. Functional motor disorders associated with other neurological diseases: beyond the boundaries of “organic” neurology. Eur J Neurol 2021; 28 (05) 1752-1758
- 64 LaFaver K, Lang AE, Stone J. et al. Opinions and clinical practices related to diagnosing and managing functional (psychogenic) movement disorders: changes in the last decade. Eur J Neurol 2020; 27 (06) 975-984
- 65 Nightscales R, McCartney L, Auvrez C. et al. Mortality in patients with psychogenic nonepileptic seizures. Neurology 2020; 95 (06) e643-e652
- 66 Carson A, Stone J, Hibberd C. et al. Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by organic disease.’. J Neurol Neurosurg Psychiatry 2011; 82 (07) 810-813
- 67 McLoughlin C, McWhirter L, Pisegna K. et al. Stigma in functional neurological disorder (FND) - a systematic review. Clin Psychol Rev 2024; 112: 102460
- 68 Stone J, Carson A, Duncan R. et al. Who is referred to neurology clinics? -The diagnoses made in 3781 new patients. Clin Neurol Neurosurg 2010; 112 (09) 747-751
- 69 Hellwig K, Frank B, Michaelis R, Kleinschnitz C, Popkirov S. Frequency and characteristics of functional neurological disorder in the emergency department. J Neurol 2025; 272 (09) 640
- 70 Stephen CD, Fung V, Lungu CI, Espay AJ. Assessment of emergency department and inpatient use and costs in adult and pediatric functional neurological disorders. JAMA Neurol 2021; 78 (01) 88-101
- 71 O'Mahony B, Nielsen G, Baxendale S, Edwards MJ, Yogarajah M. Economic cost of functional neurologic disorders: a systematic review. Neurology 2023; 101 (02) e202-e214
- 72 Bodde NMG, Brooks JL, Baker GA, Boon PAJM, Hendriksen JGM, Aldenkamp AP. Psychogenic non-epileptic seizures–diagnostic issues: a critical review. Clin Neurol Neurosurg 2009; 111 (01) 1-9
- 73 Lagrand TJ, Jones M, Bernard A, Lehn AC. Health care utilization in functional neurologic disorders: impact of explaining the diagnosis of functional seizures on health care costs. Neurol Clin Pract 2023; 13 (01) e200111
- 74 New prevalence and incidence data now available in the Atlas of MS - MS International Federation. Accessed October 12, 2025 at: https://www.msif.org/news/2023/08/21/new-prevalence-and-incidence-data-now-available-in-the-atlas-of-ms/
- 75 Luo Y, Qiao L, Li M, Wen X, Zhang W, Li X. Global, regional, national epidemiology and trends of Parkinson's disease from 1990 to 2021: findings from the Global Burden of Disease Study 2021. Front Aging Neurosci 2025; 16: 1498756
- 76 Fiest KM, Sauro KM, Wiebe S. et al. Prevalence and incidence of epilepsy: a systematic review and meta-analysis of international studies. Neurology 2017; 88 (03) 296-303
- 77 Li X, Feng X, Sun X, Hou N, Han F, Liu Y. Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2019. Front Aging Neurosci 2022; 14: 937486
- 78 von Brevern M, Radtke A, Lezius F. et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78 (07) 710-715