Functional Movement Disorder

Overview

Functional movement disorder (FMD) is a real medical condition that affects how the brain controls movement. It can cause symptoms such as shaking, jerking, muscle tightness, weakness, or trouble walking. The symptoms are not made up or done on purpose. They happen because the usual signals between the brain and body are not working smoothly, even though the nerves and muscles themselves are often healthy. FMD is sometimes called a functional neurological disorder. It is not the same as pretending or being 'crazy'.

FMD is one of the more common conditions seen in neurology clinics. It is not rare, and it can affect anyone.

FMD can happen at any age, including in children and older adults. It is more often diagnosed in women, but anyone can develop it. It can occur alongside other health conditions, stress, anxiety, depression, or chronic pain.

Symptoms

Common symptoms

• Shaking or tremor that may change or stop with distraction
• Jerking or sudden movements
• Muscle tightness or abnormal postures
• Weakness in an arm or leg that does not match nerve damage
• Trouble walking, dragging a leg, or feeling unsteady
• Speech changes, such as slurring or a quiet voice
• Trouble swallowing or a lump-in-the-throat feeling
• Tics or repeated movements
• Numbness or unusual sensations
• Symptoms that vary during the day or are better or worse with attention

Symptoms in children

• Trouble walking or unexplained leg weakness
• Shaking, jerking, or tics
• Speech changes or a quiet voice
• Episodes that look like seizures but are not caused by epilepsy
• School stress, bullying, or family strain can be part of the picture
• Symptoms may improve with calm reassurance and specialist support

Symptoms in older adults

• New weakness, tremor, or walking problems that can be mistaken for other conditions
• Falls or fear of falling
• Symptoms that fluctuate or are sensitive to stress and tiredness
• Coexisting arthritis, pain, or other long-term conditions
• Need for careful review of medicines and other causes

Causes

Main causes

• Changes in how brain networks control movement and body awareness
• Stress, emotional strain, or past difficult experiences can be triggers, but not everyone with FMD has these
• A physical injury, illness, pain, or infection can start symptoms
• Learned movement patterns that the brain keeps using even after the original trigger has passed
• Anxiety, depression, or other mental health conditions can be present but do not fully explain FMD

Risk factors

• Being female
• Having anxiety, depression, or post-traumatic stress
• Chronic pain, fatigue, or long-term illness
• A recent physical injury or infection
• Adverse life events or ongoing stress
• Having another neurological condition
• Being highly focused on body sensations

When to see a doctor

See a doctor urgently if:

• New or sudden weakness, numbness, or trouble speaking
• A seizure or loss of consciousness
• A fall with injury or repeated falls
• Not able to eat, drink, or manage daily care
• Symptoms that are quickly getting worse
• Thoughts of self-harm

Book a routine appointment if:

• Movement symptoms that come and go or worry you
• Trouble walking, writing, speaking, or using an arm or leg
• Symptoms that affect school, work, or daily life
• You feel dismissed or unsure about your diagnosis
• You want to discuss treatment or a second opinion

Diagnosis

A doctor, usually a neurologist, can often diagnose FMD after taking a careful history and doing a physical exam. They look for movement patterns that are typical of FMD and for signs that other neurological conditions are unlikely. The diagnosis is based on positive clues, not just on tests being normal.

Tests that may be done

• A full neurological exam
• Blood tests to look for other causes
• MRI or CT scans of the brain or spine in some cases
• EEG (brain wave test) if episodes look like seizures
• EMG or nerve tests if nerve or muscle disease is suspected
• Review of medicines and past health records

What to expect at your appointment

You may be asked to move in different ways, walk, or do tasks that distract you. The doctor should explain the diagnosis clearly and kindly. You may be referred to a specialist team for physiotherapy, occupational therapy, speech therapy, or psychological support.

Treatment

Treatment aims to help the brain relearn normal movement and to address stress, anxiety, pain, or other factors that may keep symptoms going. The best plan is tailored to you. A specialist team often helps.

Self-care at home

• Learn about FMD so you understand that symptoms are real
• Keep a simple diary of symptoms and triggers
• Pace activities and rest before you become very tired
• Practice relaxation or breathing exercises
• Stay active within your limits
• Ask family or friends to support you without constantly focusing on symptoms

Medical treatments

Treatment may include specialist physiotherapy that retrains movement, occupational therapy for daily tasks, speech therapy for speech or swallowing problems, and psychological therapy such as cognitive behavioural therapy. A doctor may also treat related problems like anxiety, depression, or pain. Medicines are not the main treatment for FMD itself, and any medicine should be discussed with a qualified healthcare provider.

When is surgery considered?

Surgery is not used to treat functional movement disorder itself. If another condition is found, your care team will discuss whether surgery is appropriate for that condition.

Living with this condition

Symptoms can be frustrating and may change from day to day. Try to keep a steady routine, accept help when needed, and focus on what you can do rather than what you cannot. Learn your early warning signs and plan rest breaks.

Lifestyle tips

• Keep a regular sleep routine
• Reduce unnecessary stress where you can
• Stay connected with friends and family
• Avoid alcohol or drugs as a way to cope
• Plan enjoyable activities that are not focused on symptoms
• Ask your employer or school about adjustments if needed

Diet and exercise

Eat regular balanced meals and drink enough water. Gentle, regular movement is usually helpful. A physiotherapist can guide you on safe exercise and help you avoid overdoing it. Build up slowly and stop if you feel unwell.

Mental health and emotional wellbeing

FMD can cause worry, shame, frustration, or low mood, especially if people do not understand it. These feelings are common and treatable. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support service right away.

Prevention

FMD cannot always be prevented. Early support after symptoms start may help. Managing stress, treating pain and mental health problems, and getting good rest can support overall brain and body health.

Vaccines

There is no vaccine for functional movement disorder.

Screening programmes

There is no routine screening test for FMD. Your doctor may screen for other health conditions as part of normal care.

Complications

If left untreated

• Falls and injuries
• Pain and reduced mobility
• Difficulty with school, work, or daily care
• Social isolation and family strain
• Anxiety, depression, or low confidence
• Delay in getting the right support

Long-term outlook

Many people with FMD improve, especially with a clear explanation and specialist treatment. Recovery can take time and may not be a straight line. FMD is not life-threatening, and there is good reason for hope.

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