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Specialist FND Solicitor When people consider Functional Neurological Disorder (FND) or Functional Movement Disorder (FMD), they often assume anxiety is the primary emotional trigger for symptoms. However, a fascinating new study analysing 3,486 real-world symptom logs from 1,194 patients suggests something different. While anxiety is common, sadness and hopelessness may actually have the strongest link to severe motor symptoms such as tremors, weakness, and walking difficulties.
This insight might alter how patients and clinicians approach the management of FND symptoms.
What the study looked at
Researchers analysed thousands of daily symptom entries recorded in a mobile symptom-tracking app used by people living with FND. Participants logged:
- Motor symptoms (such as tremor, weakness, dystonia and gait problems)
- Emotional states (including anxiety, frustration, sadness and calmness)
- Possible triggers
- Overall symptom severity on a 0–10 scale
In total, 4,757 daily logs were analysed, with 3,486 containing motor symptoms.
The goal was simple – to understand which emotions were most strongly linked with symptom severity in real life.
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A surprising finding: sadness predicted the worst symptoms
The study confirmed that anxiety was the most frequently reported emotion on days when motor symptoms occurred. However, when researchers examined which emotions were linked to the most severe symptoms, the results differed.
Across all motor symptom types, sadness consistently predicted the highest symptom severity. For example:
- Tremor severity was highest when sadness was present
- Weakness was more severe on days with sadness
- Walking difficulties also worsened when sadness was reported
In other words, sadness wasn’t just present — it was strongly linked to how severe symptoms became.
Hopelessness may be an even stronger warning sign
Another important finding was the role of hopelessness.
Although it was reported less often than anxiety or frustration, hopelessness was associated with the highest overall symptom severity of any emotional state.
This suggests feelings such as:
- helplessness
- emotional exhaustion
- a sense that things will never improve
may act as “amplifiers” of neurological symptoms.
For many people living with long-term conditions, these emotions are understandable. But recognising them may also be an important step in symptom management.
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Positive emotions seemed to reduce symptom severity
The study also found something encouraging. When people reported positive emotional states such as:
- calmness
- contentment
- gratitude
their symptom severity was about 1–1.2 points lower on average. That might sound small, but in neurological conditions where symptoms fluctuate day to day, even modest reductions can make daily life easier.
Emotional triggers mattered more than physical ones
Another striking finding was that psychological triggers often predicted worse symptoms than physical triggers. The highest-severity triggers included:
- depression
- anger or frustration
- interpersonal conflict
- social isolation
By comparison, common physical triggers such as heat, noise or physical exertion tended to produce slightly lower symptom severity scores.
This highlights how closely the brain’s emotional systems and motor systems interact in FND.
What this means for people living with FND or chronic pain
This research doesn’t mean symptoms are “all in the mind”. Far from it. Functional neurological symptoms are very real neurological experiences involving complex brain networks that regulate movement, sensation and emotion.
The study suggests that emotional states may influence how strongly those brain networks express symptoms. For patients, that means approaches that support emotional wellbeing — such as:
- psychological therapies
- stress-management strategies
- pacing and self-care
- social support
may play an important role alongside physical rehabilitation.
A more complete way to understand symptoms
One of the most powerful messages from this research is that emotions and physical symptoms should not be seen as separate worlds. The brain systems involved in movement, pain and emotion are deeply connected.
For people living with FND, chronic pain or other complex neurological conditions, understanding that connection may help explain why symptoms can fluctuate so dramatically — and why a holistic approach to treatment is often the most effective.