Functional Neurological Disorder (FND) Explained: What It Is and How It Overlaps With Dizziness

Functional Neurological Disorder (FND) is often misunderstood... but it’s real, common, AND treatable. In this episode of Talk Dizzy To Me, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Carly Lochala, PT, NCS sit down with Dr. Julie Hershberg, PT, NCS to explain what FND is, why it’s been minimized in healthcare, and how it overlaps with dizziness, migraine, dysautonomia/POTS, hypermobility/EDS, and vestibular disorders.

They break down brain networks like the default mode network and salience network, discuss common clinical clues (variability, attention-related shifts), and explain how treatment often starts with nervous system regulation, trust-building, and whole-person care—not just exercises.

If you’ve been told your symptoms are “all in your head,” this episode is for you.

Guest: Dr. Julie Hershberg / Reactive PT Instagram: @reactivept

Resources: FND resources hub, reactivept.com/FNDresources

Hosted by:

🎤 Dr. Abbie Ross, PT, NCS

🎤 Dr. Carly Lochala, PT, NCS

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This episode is for educational purposes only and is not a substitute for medical advice. Always consult a qualified healthcare provider for diagnosis and treatment. The views expressed by guests are their own and do not necessarily reflect those of the host(s).

Timestamps

00:00 Welcome to Talk Dizzy To Me (intro)
01:42 What is Functional Neurological Disorder (FND)? How to explain it to patients
02:08 FND as a brain network dysfunction (function vs structure)
03:32 Why education improves outcomes in vestibular care + FND
04:02 Why FND has been misunderstood/minimized in healthcare
04:12 From “hysteria” and “conversion disorder” to modern neuroscience
06:05 Harmful stigma: being told symptoms are “fake” + medical trauma
08:19 What to look for when you suspect FND (clinical clues)
09:13 Variability, attention-related shifts, symptoms “moving”
10:35 Screening for other diagnoses + doing a thorough neuro screen
11:04 Common comorbidities missed: migraine, EDS/hypermobility, POTS/dysautonomia, vestibular disorders
12:53 What you’ll hear in the subjective history that suggests FND
15:13 Why “one test” (like Hoover) isn’t enough + signs vary by symptom type
16:54 Diagnostic criteria: what exists, what’s lacking, what needs improvement
19:12 Risk factors & triggers: sex differences, pain, sleep, physical injury/illness
21:01 Dizziness in FND: how common is it + vestibular system connection
21:59 Autonomic + sensory overlap (vestibular sympathetic reflex, otolith sensitivity)
24:44 Treatment approach: why there’s no one-size-fits-all protocol
25:38 Whole-person assessment + “pie chart” contributors + education foundation
29:00 Building trust, validation, and safety (especially after medical trauma)
31:18 Why play, fun, and salience matter for nervous system regulation + motor learning
32:45 Default mode network vs salience network explained simply
37:48 Social media + FND: what we think vs what research shows
41:26 Adapting vestibular rehab when FND is part of the picture
44:26 Safety + motor symptoms: when you prioritize regulation over exercise
48:18 Sensory inventory & building a regulation toolkit (OT-informed strategies)
51:00 Not everyone needs “calm”—some people need safe movement to regulate
52:18 “Mic drop” messages for people who feel stuck
55:21 Where to find Dr. Julie Hirschberg’s FND resources