Functional Disorders Explained

Disclaimer: While I am a speech pathologist, I am not your speech pathologist. The information provided below is my own experiences and opinions. If you have medical questions on a personal level, please seek guidance from your medical team.

Have you been told you have a functional disorder? Perhaps you’ve been diagnosed with a “conversion” disorder? Has a physician told you “it’s all in your head?” 

Over the years, I’ve seen numerous patients express their frustration over a functional diagnosis. Many feel dismissed by the diagnosing physician. In some way, shape or form, they have been told their problem is “in their head.” Psychology evaluation and treatment is recommended. The patient leaves the appointment feeling angry, confused, frustrated, and dismissed. It doesn’t help that many patients take this recommendation the wrong way.

I’m here to tell you: I hear you. I know your pain and suffering is real. I’d like to take this opportunity to tell you about my own presentation of a functional disorder. If you stick around to the end, I’ll also give my explanation of what a functional disorder is, and why you should seek professional services to improve your quality of life.

My Story

In late July of 2010, I was anxiously anticipating moving to Iowa to pursue my second Master’s degree in speech pathology. One day, I was feeling particularly stressed. I started to develop a terrible case of hives! I went to my primary care nurse practitioner, and said, “I know this is probably related to my stress level. I’m sure it’s all in my head.” 

She replied: “Stacey, it may be ‘all in your head,’ but it’s manifesting itself in your skin, so let’s treat your skin.” I arrived in Iowa a few weeks later. I was still taking the antihistamine she gave me, but no longer covered in terrible blotchy patches of hives.

How Does a Functional Disorder Start? 

Stress can present itself in many forms – physical, emotional, environmental, etc. Our brains have to figure out how to maintain all of our systems in the presence of stress. Sometimes, while trying to “maintain” one system, our brains cause other systems to go haywire. The brain is in charge of so much! When too much stress is present, the subconscious portions of the brain pick and choose what’s the most important process. 

Other times, the brain notices something is wrong in the body and tries to “fix” it. Sometimes it does this by sacrificing a different system. After a while, the brain starts to view these changes as “normal.” The brain starts to use the new pathways in place of the previously normal pathways. 

Defining Functional Disorders

In medicine, organic causes are things we can “see.” For instance: we can see abnormal lab results, imaging results, and pathology results. These are usually fairly concrete and point to the cause of most disorders. Something is physically wrong in the system. Functional disorders, on the other hand, present with a physical problem that has no identifiable underlying cause. All tests come back normal, again and again. Functional disorders are a physiologic (function) change without a known change in anatomy (structure). Sometimes functional disorders can be secondary to an anatomical issue. Other times, functional disorders occur on their own.

Functional disorders occur on a spectrum. One side of the spectrum is malingering (“faking it”). This is usually for some type of gain, like money or attention. The other side of the spectrum is being completely unaware of the changes the brain has made. I have seen my fair share of patients who were malingering. This is usually because their presentation is completely odd and fits parts of several disorders. That being said, the majority of patients I see with functional disorders, aren’t faking their problem. This second set of patients is what this blog post is about.

For this set of patients, it’s important to recognize that these changes occur subconsciously. The brain is constantly looking for the “path of least resistance.” This is part of what makes our bodies so amazingly efficient – and fascinating. Purely functional disorders occur without an organic cause. 

Muscle Tension Dysphonia - An Example of a Functional Disorder

You’ll hear neurologists say “nerves that fire together, wire together.” Once these nerves “wire together,” the brain now has a fast-track to that process. Muscle tension dysphonia (MTD) is a functional disorder of the voice. Read more about MTD here. Some kind of change (stressor) occurs to the voice (e.g., swelling from lots of coughing). The brain interprets this change and tries to “fix” it. This compensation leads to use of additional muscles to force the voice to happen. Sometimes this new pattern is learned so well that the brain continues to use the new pattern despite the elimination of the original cause. The voice continues to sound strained well after the upper respiratory infection has resolved.

Keep in mind, a cold is not the only cause of muscle tension dysphonia. Increased stress, voice overuse, lesions on the vocal folds, etc, can cause MTD. The same is true of most functional disorders. Something changes, which causes the brain to react. Once the brain learns the new pattern, it can be difficult to return to the old pattern on your own. Especially since you didn’t know the pattern was changing in the first place!

What’s the Treatment for Functional Disorders?

As I mentioned above, most physicians will offer psychology evaluation and treatment for functional disorders. This is the best treatment for some disorders. Other types of therapy may be warranted as well. For example, muscle tension dysphonia is treated by a voice pathologist. That being said, if the cause of your MTD is suspected to be related to psychological trauma, then seeing a psychologist in conjunction with a speech pathologist may be in your best interest. In other cases of functional disorders, seeing a physical or occupational therapist may be your best route. It all depends on the muscle groups involved. Working with a physician you trust will be the best route to find appropriate treatment options. 

The Good News

Most physicians aren’t accusing the patient of “faking it” or being “crazy.” They’re usually just trying to explain that there isn’t an organic cause. There isn’t a tumor or abnormality they could find to cause your symptoms. This is good news! It means there’s no need for surgery or other medical treatments that could cause additional side effects. Treatment is important. The treatment for functional disorders is frequently some type of “therapy.” Remember, any kind of therapy prescribed for you is meant to change the brain. It may be changing your outlook, changing the motor plans your brain has begun to use – or both! 

Second Opinions

It is completely reasonable to ask for second opinions. However, if numerous physicians are telling you it’s functional, it’s worth trying whatever therapy they recommend. I’ve had plenty of patients over the years tell me that they didn’t believe voice therapy was going to be effective. And yet, we still managed to restore their voice. If therapy doesn’t work, then that’s additional information for your physician to narrow down other possible diagnoses.

For a more in-depth discussion of functional disorders, check this out. I wish you success on your wellness journey!

Was this helpful? What else would you like to learn? Let me know in the comments.