Most Mental Health Providers Feel Unprepared to Treat Functional Neurological Disorders, Survey Finds

When a patient receives a diagnosis of a functional neurological disorder, the recommended next step is almost always psychotherapy, either on its own or woven into an interdisciplinary treatment plan. Yet the clinicians expected to deliver that therapy may not feel ready to accept the referral. A new survey of 286 practicing psychological service providers in the United States, published in Frontiers in Psychiatry, finds that most clinicians in the sample had limited exposure to functional neurological disorders in routine practice, reported only modest confidence in treating them, and described a training landscape in which FND-focused education is scarce, self-initiated, and often impractical to pursue. The study is one of the few to examine these questions among the mental health workforce that ultimately receives FND patients after neurologists rule out other conditions.

Functional neurological disorders are characterized by involuntary sensory, motor, or cognitive symptoms that lack the expected medical or neurological explanation. In the DSM-5-TR, the condition is listed as Functional Neurological Symptom Disorder, with Conversion Disorder noted parenthetically. Two subtypes dominate clinical presentations: functional movement disorder, which requires diagnosis through a physical examination by a neurologist trained in movement disorders, and functional or dissociative seizures, formerly called psychogenic non-epileptic seizures, which are confirmed when video electroencephalogram captures seizure-like behaviors without epileptic cortical activity. A recent review cited in the study estimates FND incidence at 10 to 22 per 100,000 people and minimum prevalence at 80 to 140 per 100,000, with broader prevalence estimates ranging as high as 1,600 per 100,000. Because the symptoms outwardly mimic neurological ones, patients typically present in neurology clinics or emergency departments, and prognosis is generally unfavorable, although younger age of onset and earlier diagnosis are associated with better outcomes.

The evidence base for psychological treatment is substantial. For functional or dissociative seizures, randomized controlled trials point to significant improvement with cognitive behavioral therapy and neurobehavioral therapy. FND-tailored CBT has improved seizure frequency and severity, quality of life, and comorbid psychological conditions. The large multi-site CODES trial found that adding CBT to standard medical care produced greater effectiveness at 12-month follow-up with respect to time without seizures, albeit without differences in seizure frequency, and subjective quality of life indicators such as being less bothered by seizures. For functional movement disorder, physiotherapy is part of the first-line approach, and randomized trials including the Physio4FMD study demonstrate efficacy, with 59 percent of patients working with a physiotherapy specialist reporting improvement in subjective control over motor symptoms after 12 months versus 38 percent given treatment as usual. Other approaches with evidence include retraining and control therapy for pediatric seizures, mindfulness-based therapy, psychoeducation, psychodynamic therapy, and trauma-focused treatments. No medication directly ameliorates FND symptoms, making psychotherapy the cornerstone of care.

To understand whether the mental health workforce is positioned to deliver that care, researchers from the University of Arizona, Arizona State University, and the Northeast Regional Epilepsy Group conducted an online survey of psychologists, psychiatrists, counselors, social workers in private practice, and neuropsychologists. The final sample of 286 included 177 neuropsychologists and 109 other psychological service providers. Participants were recruited nationwide through emails, listserv announcements, and direct outreach, and recruitment materials explicitly invited providers with no knowledge of FND, since the goal was to map the scope of understanding across the full range of clinicians. The survey assessed demographics, practice characteristics, knowledge of FND through an open-ended definition task, caseload composition, services provided, attitudes toward FND patients, training experiences, and perceived barriers to further education.

The knowledge findings were sobering. Seven percent of participants reported not knowing what FND was and offered no further information. Among the 93 percent who attempted a definition, close to half, 45 percent, indicated a relatively strong understanding, while the other 55 percent conveyed a moderate or relatively weak understanding. Only 18 percent mentioned conversion disorder in their definitions, and just 2 percent referenced secondary gain or malingering, a strikingly low figure compared with prior studies of medical providers in which stigmatizing attributions were common. Providers reported a mean FND caseload of 13.3 percent of patients, but 79.4 percent said they provided psychotherapy, psychological assessment, or neuropsychological assessment for FND, indicating that when they did see these patients, they delivered direct clinically relevant services.

Attitudes told a nuanced story. The most strongly endorsed belief, with a mean rating of 4.0 on a 5-point scale, was that FND symptoms can improve. Providers on average perceived FND patients as challenging to work with, with a mean of 3.8, but did not report high negative expectations, which averaged 2.7. Confidence in treating FND was modest, averaging 2.9. Correlational analyses revealed that greater perceived adequacy of psychotherapy training for FND and a higher percentage of FND patients in one’s practice were each associated with more positive attitudes, including greater confidence, greater enjoyment in treating FND, fewer negative expectations, and a stronger belief that symptoms would improve. Confidence in particular showed strong associations, correlating at .56 with perceived psychotherapy training adequacy and .43 with the percentage of FND patients in practice. Notably, attitudes were not related to years in practice, suggesting that experience alone does not build FND competence without targeted exposure.

Provider type comparisons highlighted the unique position of neuropsychologists, who are trained as clinical psychologists while also receiving specialized training in brain-behavior relationships and often work closely with neurologists, epileptologists, and movement disorder specialists. Neuropsychologists demonstrated significantly greater understanding of FND, with a mean definition score of 2.5 versus 1.4 for other providers, and nearly all of the participants who said they did not know the FND definition were in the non-neuropsychologist category. Neuropsychologists also reported a higher percentage of FND patients, at 15.7 versus 9.1 percent, and greater confidence in treating FND. However, they also reported greater negative expectations about working with FND patients, a pattern the authors suggest may reflect closer contact with medical settings where stigma has been documented previously, or the structured nature of assessment itself, which may build preparedness and confidence even when working with a complex condition.

Training experiences emerged as a critical bottleneck. Most training that participants reported was self-initiated, informal, or time-limited, with relatively few receiving FND-related coursework or a formal rotation on an epilepsy or movement disorders unit. Providers felt more prepared to provide psychological or neuropsychological assessment for FND, with mean ratings of 3.5 on both, than therapy, which averaged 2.7. When asked about barriers to obtaining FND education at present, cost, time, and access to in-person training locations were the top three, but these mean ratings were not particularly elevated. Instead, the low volume of FND patients encountered was cited repeatedly in open-ended responses as the real obstacle, because learning FND treatment does not justify the time or cost when a provider sees few or no such patients. Several participants also noted a lack of available supervisors for FND cases. The authors describe this as a cost-benefit barrier rather than a lack of interest, and paradoxically note that while FND patients are present in epilepsy monitoring units and movement disorders clinics regardless of provider expertise, community psychologists may never encounter them, requiring greater effort to learn how to treat this population effectively.

The discussion carries significant implications for how the field builds an adequate treatment pipeline. In contrast to existing studies of medical providers that revealed stigma as a major barrier to adequate FND care, the authors suggest that lack of knowledge and lack of access to FND patients may be the limiting factors for mental health providers, potentially creating a self-perpetuating cycle of less knowledge, greater reluctance, and fewer available clinicians. They recommend targeted training and consultation for mental health providers, collaboration between diagnosing neurologists and community clinicians, and expanded use of the growing number of FND clinics embedded in inpatient and outpatient settings as treatment models. They also emphasize that clinicians already possess a strong skillset applicable to FND, since treatments adapted for the condition draw on widely practiced modalities such as CBT for anxiety, dialectical behavior therapy, and prolonged exposure therapy, which has mounting evidence for functional or dissociative seizures. Bridging gaps in terminology among conversion disorder, dissociative disorders, and FND, and helping clinicians recognize how their existing tools apply, could meaningfully expand the workforce capable of delivering effective treatment.

The authors acknowledge several limitations, including sampling bias, a high proportion of neuropsychologists in the sample, reliance on self-report subject to social desirability bias, use of single-item measures not formally psychometrically validated, and a focus on U.S. providers that may not generalize to other healthcare systems. They also did not assess whether participants had different training experiences with FND subtypes, which differ in important treatment ways. Nevertheless, the study offers an encouraging counterpoint to prior narratives of widespread provider stigma. Open-ended comments in the sample conveyed empathy for patients and optimism about symptom improvement, and negative remarks focused largely on systemic issues rather than patient-specific ones. The authors conclude that the psychological community is in a strong position to establish larger networks of FND-capable providers through education and training at graduate and postgraduate levels, and that even integrating a small number of FND patients into a clinical practice could make a meaningful difference in treatment availability for a population whose needs have long outpaced the system built to serve them.

Subject of Research: Mental health providers' knowledge, attitudes, and training regarding treatment of functional neurological disorders

Article Title: Attitudes toward treating functional neurological disorders: psychological service provider perspectives

Article References: Garrett, R., Hoti, L., Roberts, N. A., Burleson, M. H., Myers, L., & Wang, A. (2026). Attitudes toward treating functional neurological disorders: psychological service provider perspectives. Frontiers in Psychiatry, 17, Article 1892903. https://doi.org/10.3389/fpsyt.2026.1892903

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1892903

Keywords: functional neurological disorder, psychotherapy, mental health providers, neuropsychology, conversion disorder, functional dissociative seizures, provider attitudes, training barriers, survey study, stigma, cognitive behavioral therapy, treatment access