Toward a Dynamical Systems Approach to Treating Functional Neurological Disorder

By Dr. Patty Gently on September 13, 2025

The FND Mind-Body

Bright Insight Support Network founder and president Dr. Patricia Gently supports gifted and twice-exceptional adults in their own autopsychotherapy through identity exploration, structured reflection, and alignment with inner values. A writer, educator, and 2e adult, Dr. Patty centers depth, integrity, and complexity in all aspects of her work.

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Response to Kluger, Allen, & Gross (2024), “Brain-Body States Embody Complex Temporal Dynamics”

Introduction

Functional neurological disorder (FND) often presents with disabling symptoms such as tremor, gait disturbance, or non-epileptic seizures that are real and disruptive, even without identifiable structural injuries or abnormalities (Espay et al., 2018; Edwards et al., 2013). Despite significant clinical advances, treatment often relies on fragmented approaches that address isolated domains rather than an integrated framework of brain-body dynamics.

Kluger, Allen, and Gross (2024) propose a computational model in which brain-body states are understood as trajectories constrained within low-dimensional manifolds shaped by interoception and nested timescales. In plain language, this means the brain and body move through repeating patterns that are limited to certain pathways, influenced by how we sense internal bodily signals, and by overlapping rhythms like breathing, heart rate, or circadian (sleep-wake) cycles. This framework has important implications for clinical implementation.

Here, I outline how Kluger et al.'s approach can inform novel strategies for treating FND, focusing on interventions that reconfigure constraining attractor states into more flexible trajectories. In doing so, I extend their framework by incorporating the concept of hyperneuroplasticity, which describes a systemic orientation toward rapid, deep, and whole-system neural reconfiguration. Hyperneuroplasticity magnifies both opportunity and risk within these trajectories, offering an explanatory bridge between theoretical models of brain-body states and the lived clinical realities of FND.

From the outset, I want to be clear that this article takes a neurodiversity-affirming stance: FND is not reduced to error or deficiency. In fact, It is instead understood as a set of emergent dynamics within a complex adaptive system. Treatment is therefore framed as supporting broader flexibility and agency, not enforcing normalization.

Reframing FND Through Dynamical Brain-Body States

Kluger et al. (2024) emphasize that complex neural and bodily processes can be reduced to a smaller set of “stiff dimensions” that strongly influence system behavior, while “sloppy” dimensions exert limited control. In plain terms, stiff dimensions are the few variables that matter most, whereas sloppy dimensions are many other variables that fluctuate but have less overall impact. For example, mood shifts in a single day or minor changes in diet might vary, but they don’t usually drive the whole system the way sleep, movement, or autonomic regulation can. These stiff dimensions create the backbone of the system’s dynamics. Within this structure, the specific constraining attractors in FND, such as heightened interoceptive threat monitoring, impaired movement initiation, and dysregulated autonomic rhythms, emerge. These attractors act like magnets that repeatedly pull the system toward narrowed ways of functioning, representing less adaptive state subspaces within the overall manifold (Perez et al., 2021).

This perspective reframes FND not as “misfiring” or “psychogenic,” but as the system becoming stuck in narrowed trajectories, deeply influenced by prior states, physiological coupling, and external context. Treatment, therefore, becomes an exercise in trajectory perturbation and redirection rather than correction of faulty circuits. When considered through the neurodiversity-affirming lens of hyperneuroplasticity, these less adaptive subspaces reflect an amplified sensitivity to both internal and external conditions. Additionally, this heightened responsiveness explains why FND symptoms can emerge suddenly and persistently, and it underscores the importance of interventions that carefully scaffold adaptive reorganization.

Treatment Implementation Strategies

1. Interoception as a Therapeutic Lever

Interoception is a person's ability to sense and interpret internal bodily signals, and functions as a primary control point in shaping brain-body states. In the case of functional neurological disorder (FND), shifts in interoceptive processing often fuel symptom cycles. For example, the perception of an increased heart rate may be interpreted as threatening or overwhelming, escalating autonomic arousal and reinforcing constrained brain-body trajectories (Perez et al., 2021). Because interoception both registers and regulates systemic dynamics, it offers a particularly powerful therapeutic lever.

Treatment can focus on retraining interoceptive awareness through interventions such as mindfulness-based practices, paced breathing, and interoceptive exposure, which allow individuals to gradually reinterpret bodily sensations as non-threatening. Closed-loop biofeedback techniques, such as monitoring heart rate variability (HRV), respiration, or neural activity, can provide real-time corrective feedback and support adaptive recalibration. Crucially, these approaches should be applied at moments of heightened malleability (times when monitoring indicates that the system is particularly receptive to change), aligning with Kluger and colleagues’ notion of state-dependent receptivity.

Hyperneuroplastic systems, in particular, may amplify the salience of interoceptive signals, making the careful timing and personalization of interventions even more critical. Importantly, these strategies should aim to broaden interoceptive flexibility in ways that affirm each individual’s unique patterns of embodiment. 

2. Reshaping State Histories Through Repetition

According to the dynamical framework proposed by Kluger et al., past trajectories strongly constrain the range of future states available to an individual. For patients with FND, entrenched symptom histories can narrow the system’s repertoire, making less adaptive subspaces more accessible than more adaptive ones. Treatment, therefore, must repeatedly expose the system to adaptive states in order to rewrite these histories (Nicholson et al., 2020).

Physiotherapy and motor retraining provide one avenue, as structured repetition of functional movement patterns helps the nervous system “rehearse” and embed alternative trajectories that gradually increase accessibility over time (Espay et al., 2018). Trauma-informed psychotherapies such as parts work, somatic therapies, EMDR, or psychodynamic approaches extend this principle into cognitive and emotional domains, reshaping past associations that bias the system toward constraint. In addition, rhythmic entrainment therapies, including practices involving music, coordinated movement, and breathing exercises, provide temporal scaffolding that stabilizes adaptive state transitions. By engaging multiple layers of the system simultaneously, these approaches create new state histories that support long-term functional accessibility. Hyperneuroplasticity magnifies the capacity for both narrowing and rapid relearning, meaning that repeated exposure to adaptive states can be particularly effective in shifting trajectories for these individuals.

3. Dimensionality Reduction for Personalized Intervention

The framework introduced by Kluger and colleagues underscores that while brain-body dynamics unfold across high-dimensional spaces, only a few “stiff dimensions” exert strong influence on overall system behavior. This insight is highly relevant for treatment, as it highlights the importance of identifying and targeting the dimensions that matter most for each patient. For one individual, sleep dysregulation may represent a key driver; for another, interoceptive bias or motor initiation may hold greater weight. Precision assessments using multimodal tools such as wearable devices, ecological momentary assessments, and patient diaries can help clinicians track which variables consistently constrain trajectories (Perez et al., 2021).

Rather than dispersing therapeutic energy across less consequential “sloppy” dimensions, interventions can be focused on these central drivers. Integrating these objective data streams with clinician observation and patient self-report enables the construction of individualized treatment maps. Such an approach ensures that therapeutic resources are directed toward the most influential parameters, increasing efficiency and the likelihood of meaningful change. For hyperneuroplastic individuals, where systemic responsiveness is heightened, targeting the most influential drivers becomes even more essential, as small perturbations can produce disproportionately large shifts in the overall trajectory.

4. Perturbation and Network Control

Kluger et al. highlight the relevance of network control theory, which emphasizes the possibility of shifting trajectories by applying targeted perturbations at moments of instability. In this framework, perturbations are carefully applied changes that destabilize limiting patterns and open opportunities for more adaptive states. This concept has direct implications for FND treatment. Neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), or vagus nerve stimulation can be deployed in a state-dependent fashion to disrupt constraining attractors and create openings for more functional dynamics (Espay et al., 2018). Similarly, somatic practices including yoga, tai chi, and somatic experiencing, offer embodied perturbations that gently reconfigure brain-body coupling and promote flexible state transitions.

Beyond individual practices, contextual interventions also serve as critical perturbations. Environmental restructuring, access to safe relational contexts, and the intentional use of social safety cues can shift the external forces shaping brain-body dynamics. In each case, the goal is not to “fix” broken circuits but to destabilize rigid patterns and create opportunities for the emergence of adaptive states. Hyperneuroplastic responsiveness makes these perturbations especially potent, as the system may reorganize more rapidly than in less plastic orientations. Framed within neurodiversity-affirming practice, these perturbations should be understood as expanding adaptive range and honoring individuality, not as enforcing conventional standards of normality.

Clinical Implications: Embodied Precision Neuroscience for FND

Applying this dynamical systems framework to FND moves treatment toward an embodied precision neuroscience model. Rather than relying on generalized protocols, interventions can be designed to match the unique state trajectories of each individual. Symptom relief is achieved not by erasing or invalidating existing states, but by expanding access to more adaptive subspaces and cultivating the flexibility to move between them (Stone et al., 2010).

Patients are reframed as dynamic systems learners, whose histories and bodily states shape but do not predetermine their future possibilities. This approach offers a biologically grounded yet neurodiversity-affirming paradigm, recognizing symptoms as emergent properties of constrained brain-body dynamics rather than markers of weakness or unreality. Importantly, the aim is not to normalize patients or force conformity to neurotypical standards. Instead, treatment seeks to broaden each person’s range of adaptive states and to honor the validity of their lived experience.

Treatment thus becomes a collaborative effort to gently nudge trajectories toward integration, coherence, and functional adaptability, while honoring the complexity of FND and providing practical avenues for change. From the perspective of hyperneuroplasticity, this model also emphasizes that individuals with amplified neural responsiveness require not only careful scaffolding but also recognition of their heightened potential for systemic reorganization. Precision interventions that align with their unique responsiveness may unlock both profound healing and expanded functional capacity.

References

Edwards, M. J., Bhatia, K. P., & Stone, J. (2013). Functional (psychogenic) movement disorders: Merging mind and brain. The Lancet Neurology, 12(3), 250–260. https://doi.org/10.1016/S1474-4422(12)70310-6

Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., … Stone, J. (2018). Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurology, 75(9), 1132–1141. https://doi.org/10.1001/jamaneurol.2018.1264

Kluger, D. S., Allen, M. G., & Gross, J. (2024). Brain–body states embody complex temporal dynamics. Trends in Cognitive Sciences, 28(8), 695–698. https://doi.org/10.1016/j.tics.2024.05.003

Nicholson, T. R., Aybek, S., Craig, T., Harris, T., Wojcik, W., David, A. S., & Kanaan, R. A. (2020). Life events and escape in conversion disorder. Psychological Medicine, 50(1), 36–45. https://doi.org/10.1017/S0033291718003994

Perez, D. L., Edwards, M. J., & Nielsen, G. (2021). Functional neurological disorder: An update for neuropsychiatrists. Journal of Neuropsychiatry and Clinical Neurosciences, 33(1), 14–26. https://doi.org/10.1176/appi.neuropsych.20090224

Stone, J., LaFrance, W. C., Levenson, J. L., & Sharpe, M. (2010). Issues for DSM-5: Conversion disorder. American Journal of Psychiatry, 167(6), 626–627. https://doi.org/10.1176/appi.ajp.2010.09101440