What happens when stress rewires the body?
Many of us push aside our own needs without realising it.
For me, it’s usually a case of throwing myself into work or ticking off whatever’s next on the list I keep adding to in my head. I have a pattern tendency to run on autopilot, like a middle-aged Duracell bunny with no off switch.
People say that if you love your job, you’ll never work a day in your life. I do love my job. But I also work a lot. And left unchecked, it can easily dominate.
Over the years, I've had to learn and implement strategies to keep myself upright and standing, but that’s not always easy. I have to intentionally check in with myself.
Case in point: I’ve just booked a completely random week out of my diary for September. No plans, no reason, other than it dawned on me over the weekend that I was tired, not feeling refreshed when I got out of bed.
“When was the last time I took leave?” I thought to myself, scrolling back through my phone.
"What—"
"No way—"
"Shit—March?!"
Why do we do it?
Sometimes ignoring rest is self-imposed, as it involves actively choosing work instead, perhaps due to internal rules about being “lazy” or feeling “guilty” if you stop. For some, it’s about keeping the mind busy instead of feeling strong emotions. For others, more dictated by circumstance: caring responsibilities, staff shortages, or being at the mercy of an overly demanding boss.
Either way, the result is the same. Ignoring the body’s need for repair allows emotional stress to build. Over time, this can lead to poor sleep, headaches, muscle tension, and digestive problems. Increased low mood and anxiety. Sexual problems. People with physical health conditions such as psoriasis, chronic pain, or irritable bowel syndrome (IBS) often notice flare-ups or worsening symptoms.1
Eventually, the body slips into autopilot, and exhaustion becomes the new normal. Perfectionistic personality types are especially prone to this, and it’s the most common I see when it comes to the physical body doing some quite peculiar stuff.
But what would happen if all those emotional, physical, and environmental pressures collide, creating a perfect storm that altered the way your body normally functions?
Imagine needing to get from London to Paris on a regular basis, perhaps for work or to care for an elderly relative. You buy your ticket each week, arrive at the right platform on time, and can clearly see that it’s the correct train.
Yet, once it leaves the station, you start seeing signs for Leeds rather than the Channel Tunnel. You complain to the operating company, and they assure you it’s a one-off. But it keeps happening. Sometimes you arrive in Paris; other times, in Leeds, Manchester, or occasionally Edinburgh.
One day, you raise a complaint with the ticket sales office. They say that no one else has mentioned it, so it must be something you’re doing yourself. “Perhaps you take pleasure in complaining, and you’re simply trying to gain attention.” Incensed, you call the head office. They admit that a few people have been affected by the same thing, but no one can explain what’s happening. You are encouraged to carry on as normal and keep trying.
So, what would happen if you woke up one morning, stepped onto the treadmill of priorities, and your body started doing something similar? Perhaps your legs give out, or you can’t stand up properly. Fatigue hits suddenly and without warning. When you try to walk, your left leg twists inward, your right leg pushes away, and your torso jerks backwards, throwing you to the floor. Or your limbs seize up entirely, locked, painful, and immobile. It occurs randomly, with no evident pattern that you can identify or control. Some days, things work; other days, they don’t.
Maybe you begin having seizures that resemble epilepsy. Just an odd sensation that someone has flicked a switch, and you’re slumped on the floor.
Would it worry you? Fearing something sinister was going on? How long before it starts affecting work, paying the bills, shopping at the supermarket, social life, important family events, and holidays?
This is a reality for many people living with a functional neurological disorder (FND).
Nathan is thirty-four years old and about to become a new dad. Until six months ago, he was in good health. Always busy and on the go, with a tendency to prioritise the needs and emotions of others over his own. His job as a ward manager in a care home for older adults is demanding. Having always been physically active, he generally manages stress through sport and exercise. In the past, he had occasionally worried about his health, but had no history of a diagnosable mental health problem.
While cycling to work one day, he was hit by a car travelling at low speed through a junction. Nathan came off his bike and hit his head. He was wearing a helmet and suffered minor cuts and bruises. Still, he was given a scan at the hospital after describing vision changes and vomiting shortly after the incident. The hospital told him nothing was wrong and that it was simply shock, giving him the all-clear. Life returned to normal over the next few weeks.
Out of the blue, he began feeling unwell during a staff meeting at work and got up to get some air. As he started walking, he had a seizure, suddenly collapsing and becoming unresponsive.
Over the following months, his seizures became more frequent, happening randomly in different situations. He was signed off work, couldn’t ride his bike, had his driver’s licence suspended and was afraid to go anywhere alone in case he had another seizure. Nathan became increasingly depressed and anxious, convinced he had a brain injury from the fall. Or worse—a tumour.
Numerous scans and tests later, the doctors finally conclude, “Congratulations, you don’t have brain damage from your fall, or a tumour.”
“So, it’s epilepsy?” asked Nathan.
“No,” the consultant replied. “We can’t see anything remarkable on your tests and scans.”
“So what’s happening to me?”
“The seizures are psychogenic.”
“Psycho-what?”
“There’s a glitch in how your nervous system is functioning. We believe that chronic emotional stress is disrupting how your body communicates with itself. It comes under the umbrella of something called functional neurological disorder, or FND for short.”
Nathan was confused. “FND?”
“Yes, FND. We used to think people were just making it up for attention or were mentally unwell. But not anymore. Research has changed our understanding.”
“So it’s neurological?”
“Kind of.”
“Can you give me some medication to control it?”
“Medication doesn’t work. In fact, it may make it worse. You need to rest and watch your stress. Have you tried Mindfulness?”
“What the fu—I thought you said it was a neurological problem?”
“It’s functional neurological. Not caused by physical structures or disease.”
“So you do think it’s all in my mind?”
“No, definitely not all in your head. I’m now going to discharge you.”
“Where to?”
“Psychiatry.”
“Why do I need a psychiatrist for seizures? Surely that’s neurology?”
“Because you don’t have epilepsy.”
Nathan became upset. “How do I get back to work? I have a baby on the way!”
“Here is a website that explains everything. Goodbye.”
Nathan went home and looked it up. Google told him he probably had a traumatic childhood and was emotionally avoidant due to insecure attachment. His dad died when he was young, but he'd always been close to his mum.
“Bullshit!” said Nathan. “Stress simply cannot cause you to lose your ability to speak, blackout, bite through your own tongue, and wet yourself at work. I’m clearly being fobbed off.”
Concerned? Confused? Who wouldn’t be?
What is FND?
Functional neurological disorder (FND) is a term used to describe physical symptoms that disrupt the body’s normal functioning but don’t stem from damage or disease. It affects how the brain sends and receives signals, including those involved in movement, sensation, memory, and speech. It can involve almost any system in the body, including gastrointestinal function. Symptoms vary widely, but the impact on daily life can be severe. One of the most common functional problems I see in clinical practice is non-epileptic (dissociative) seizures.
And they can happen to pretty much anyone.
Why psychology and psychiatry?
Historically, functional symptoms were labelled as “conversion disorder”. This was the idea that psychological conflicts were manifesting as physical symptoms in the body. But like any field of science, theories evolve. Unfortunately, when it comes to functional problems, they evolved at a snail’s pace. It was only very recently that the Diagnostic and Statistical Manual (DSM-5-TR)2 adopted the term “Functional Neurological Symptom Disorder.”
The change was aimed at trying to shift public narratives away from outdated terms and models that no longer fit with current understanding. In a similar way to how epilepsy is no longer seen as a sign of demonic possession, as it was in the Middle Ages. Nor do we rely on bloodletting to treat seizures, as was common before the discovery of bromides and barbiturates in the 1800s.
But in the case of functional neurological problems, misunderstanding and stigma still linger. And from speaking with many patients over the years, I’m not sure the constant reminder of its history is entirely helpful.
The link with dissociation
Dissociation is a temporary state in which someone becomes disconnected from their thoughts, emotions, or the environment. Mild symptoms are quite normal, particularly if someone is tired or pressured. Most people have driven home on autopilot, arriving without remembering the journey. Super common and not a clinical issue in most cases.
Problems arise when detachment from the world around us becomes more pronounced. In dissociative seizures, a person may lose conscious awareness of the external world, their ability to speak, or control over their muscles. The seizures can look pretty much identical to epilepsy from an outsider’s perspective, but the underlying mechanisms are different.
Epilepsy involves sudden, temporary bursts of abnormal electrical activity in the brain. In dissociative seizures, there is no abnormal electrical activity, so nothing unusual appears on an electroencephalogram (EEG).3 A common theory is that the seizures relate more to a process whereby the nervous system temporarily shuts down, or goes into a state of “hypoarousal”.
Diagnosis should always be made by a neurologist, who can rule out epilepsy or other medical conditions. Some people may experience both epileptic and non-epileptic seizures, which can make things even more complicated.
Although general awareness of the condition is improving, there’s still a huge amount of misunderstanding amongst health professionals. Sadly, there is also a lot of misinformation in the public domain. I’ve seen a lot on social media, from qualified therapists to influencers, coaches and even chiropractors making bold claims about root causes and cures that are not supported by research.
In 2021, I worked in a specialist NHS neurology service led by one of the world’s leading researchers on functional seizures. Most members of that team openly acknowledged that there were no clear or definitive answers when it came to FND. The presentation of patients is typically nuanced in terms of their history, the duration of treatment, and outcomes are quite unpredictable.
The current consensus between both medical and psychological disciplines is that a range of emotional, psychological, and neurological processes interact in complex ways. Genetics, trauma, stress, and life events, including socioeconomic differences, are common risk factors, but there’s no single cause.
Strong and unpleasant emotions like fear, anger, rage, and guilt can amplify symptoms.4 Hence, emotional management through psychotherapy is usually the first line of treatment for functional seizures.
Next week, I’ll share what therapy for dissociative seizures involves, the common misconceptions around trauma, some of the clinical pitfalls, and the importance of having realistic expectations from the start.
Drossman, D. A., Tack, J., Ford, A. C., & Szigethy, E. (2018). Neuromodulators for functional gastrointestinal disorders (disorders of gut− brain interaction): A Rome foundation working team report. Gastroenterology, 154(5), 1140–1160.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
Gelauff, J. M., Stone, J., & Carson, A. (2017). Recognizing and managing functional neurological symptoms: A practical guide for clinicians. Practical Neurology, 17(1), 42–48.
Pick, S., Goldstein, L. H., & Perez, D. L. (2020). Emotional processing in functional neurological disorder: A systematic review. Neuroscience & Biobehavioral Reviews, 112, 121–139.
This train metaphor is wild !