For a long time, functional neurological disorder was regarded as a “diagnosis of exclusion”: only when imaging and lab tests found nothing did FND remain as a residual category. This often sent those affected into a wearing odyssey – and nourished the suspicion that it was “nothing proper”.
The new S2k guideline “Functional Movement Disorders” of the German Society of Neurology (DGN, 2026, AWMF register 030/148) reverses this. Its central sentence: the diagnosis should be made through positive clinical signs, not by mere exclusion. There are typical findings that can be tested in the examination – such as Hoover’s sign (a functional leg weakness normalises briefly when the healthy leg becomes active) or entrainment (a functional tremor takes over the rhythm of a given movement). The typical variability of symptoms through attention is also a diagnostic feature. FND is therefore something that can be established – not something that is left over.
Equally important is how the diagnosis is communicated. The guideline emphasises an empathetic communication of the diagnosis: those affected should understand what FND is and why the symptoms are real. This understanding is no accessory, but counts as part of the treatment, because it promotes acceptance of the diagnosis and understanding of the illness.
For therapy, the guideline gives a clear direction: transdisciplinary and integrated. Recommended are physiotherapy with active methods (fewer passive applications), psychotherapy in case of persistent symptoms and individually coordinated treatment plans under the main responsibility of a specialist. A parallel psychiatric/psychosomatic assessment is recommended. Expressly it holds: there are no medications against the underlying disorder itself – active substances are used at most for accompanying complaints.
With this, FND today stands where those affected deserve: as a condition that one can recognise with acknowledged signs and treat with effective, mutually coordinated therapies. As a contribution in the Deutsches Ärzteblatt puts it – it is about releasing FND “from the stigma of hysteria”.
Sources: DGN – S2k guideline Functional Movement Disorders (2026, AWMF 030/148) · Deutsches Ärzteblatt – “Releasing from the stigma of hysteria”
This article serves general education and does not replace medical advice.