Functional Neurological Disorder (FND) Explained: What It Is and How It Overlaps With Dizziness
Talk Dizzy To MeShow Notes
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
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