Functional Neurological Disorder

FND - Can Hypnosis help?

When my first client with this condition and her parents asked me if I could help, I had to admit that I had never heard of it. 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 at the number of names it had!

I have to first say that I’m 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 her 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) (PNES Referral site). I published an article in 2017 (ASCH Journal Vol 39 No2 Spring 2017) 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. There might be more!

Other names used for the condition are pseudo seizures, hystero-epilepsy, hysterical seizures and pseudo-epileptic seizures. These are terms clients often talk about not being taken seriously, this is especially true when they have had one of their many dealings within the medical world. There remains a persistent ambivalence amongst health professionals when reporting in those with Functional Neurological Disorders (FND) and many are told they are faking their symptoms.

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

What is FND? (NHS Inform) 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 is considered as a rare disease (FND Hope), however, the exact prevalence is unknown, and the mechanisms which cause FND continues 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 1/3 of outpatient neurology clinic attendances are patients reporting functional symptoms.

(RCP journal) 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 10 years old) up to patients in their 80s. From my own client base there are two clear groups affected, teenage girls from 13-19 and women in their late 20 to mid 30s. I have worked with just 2 teenage boys.

In therapy we talk a lot about the fight or flight mode, but we rarely mention freeze mode. From my observations of FND it appears that the mind and body freezes, it simply stops functioning in the normal way. According to (FND.org) there are those who have the condition who have not had some kind of trauma, yet still have the condition. From my own experience all my FND clients have had traumas. These have ranged from sexual abuse in early childhood manifesting in seizures when she reached puberty and fully understood what had happened to her. The client who had a gastrointestinal bug and much of her vocal, eating and walking functions ceased to function properly, and being afraid to eat again in case the gastro bug returned. This also resulted in anorexia requiring further medical intervention. To the teenage girl who had been repeatedly stalked when out training as an athlete triggering twitches and seizures.

Most suffered a range of physically minor to major whole body seizures (which mimic epileptic seizures), and 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 then collapsing to the ground. There are many other symptoms, I’m just outlining some of them here.

I’ve worked with dozens of FND clients since 2017, most of which have seen medium or high levels improvements in their condition. A reduction in the intensity in their seizures and overall symptoms, hence increasing the quality of their lives and being able to get back on track again.

How can hypnosis help? We are taught to identify potential triggers the APET Model (Human Givens Institute) being a good example and frequently with FND those symptoms come on for no apparent reason. If you ask the client what has happened to them in the past, or what was going on in their lives when the FND first happened, it’s a good place to start.

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

Working with the inner child can help to heal from hardship, and past trauma in 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. Giving permission to Bob to feel safe to let go on was an effective approach.

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

Occasionally seizures do occur under hypnosis. These can be treated as an abreaction and can reduce the intensity and duration of the seizure. One client had a full body seizure where her entire body and muscles seized up. Her seizures usually lasted up to 15 mins, but treating as an abreaction reduced the intensity and time down to around 4 minutes.

Since COVID I have worked online which has enabled me to work with FND clients across the world, with the exception of USA and Canada due to insurance restrictions. Working online does come with a few additional considerations when clients are not close by or in an office environment. I always have a family member close by or have an additional phone number I can call should a client need any 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 a greater improvement to their quality of life. Their symptoms can vary significantly. All the clients I’ve 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.