Stress-Induced Seizures, Trauma-Induced Seizures, and PNES: Understanding Functional Neurological Disorder 

Stress-induced seizures, trauma-induced seizures, pseudo-seizures, functional seizures, psychogenic non-epileptic seizures (PNES)—these symptoms go by many different names. One thing is certain: they are often confusing and frightening for clients and frequently misunderstood by clinicians. 

PNES is most associated with Functional Neurological Disorder (FND), which is classified under Somatic Symptom and Related Disorders in the DSM-5-TR. 

What Is Functional Neurological Disorder (FND)? 

Functional Neurological Disorder (FND) is a condition in which a person experiences neurological symptoms that are not caused by an identifiable medical or neurological disease, despite the symptoms being very real and often debilitating. 

Before FND can be diagnosed, a thorough medical and neurological evaluation must be completed to rule out organic causes. FND is a diagnosis of inclusion, not exclusion, and requires careful interdisciplinary collaboration. 

Common Symptoms of FND 

Motor Symptoms 

• Weakness or paralysis 

• Abnormal movements (e.g., tremor, dystonia, myoclonus) 

• Gait abnormalities 

• Limb heaviness 

• Difficulty swallowing 

• Speech disturbances (e.g., aphonia, slurred speech) 

• Seizure-like episodes (PNES) 

Sensory Symptoms 

• Altered or absent skin sensation 

• Numbness or tingling 

• Visual disturbances (e.g., blindness, double vision) 

• Hearing disturbances 

• Fainting or collapse episodes 

• Non-epileptic seizures 

Can Someone with FND Also Have a Dissociative Disorder? 

Yes. Research consistently shows a high prevalence of PTSD, complex trauma histories, and dissociative symptoms in individuals diagnosed with FND (Davies et al., 2025; Mavroudis et al., 2025; Gray et al., 2020). Dissociative disorders and FND frequently co-occur, particularly in clients with early, chronic, or relational trauma. 

Can PNES Occur within the Dissociative Disorders? 

Yes. Individuals with dissociative disorders may experience single or recurrent episodes of PNES. 

If seizure-like activity is new or changing, it is critical that clients receive appropriate medical assessments to rule out any organic causes. Many medical conditions can mimic PNES, and the gold standard for diagnosing PNES is video EEG monitoring. 

Unfortunately, clients with dissociative disorders are often dismissed or misdiagnosed due to the fluctuating nature of their symptoms. Clinicians must be careful not to assume symptoms are psychosomatic simply because dissociation is present. Medical causes must always be ruled out. 

People Think My Client Is “Faking or Seeking Attention.” How Should I Respond? 

PNES are subconscious, involuntary events. Clients are not faking, exaggerating, or intentionally seeking attention. 

Sadly, many individuals with PNES report being treated poorly in emergency or medical settings due to misunderstanding and stigma. A PNES episode represents a functional neurological response—one that serves a protective or regulatory purpose at a subconscious level. 

Therapy focuses on: 

• Identifying triggers and internal conflicts 

• Increasing awareness of bodily and emotional cues 

• Developing regulation and grounding skills 

• Gradually restoring a sense of agency and control 

With appropriate treatment, many clients experience reduced frequency and intensity of PNES episodes. 

What Questions Should I Ask a New Client With PNES? 

Establishing a clear baseline is essential. In addition to including the above listed motor and sensory symptoms into your intake, consider assessing: 

• Frequency, duration, and intensity of PNES episodes 

• Age of onset and progression over time 

• Known triggers or patterns 

• Whether symptoms began after trauma, illness, or major life stressors 

• Previous medical evaluations and findings 

It is also clinically appropriate to assess for both psychoform and somatoform dissociative symptoms, including: 

• Depersonalization and derealization 

• Dissociative amnesia 

• Identity confusion 

• Time loss 

Understanding the timeline, frequency, and severity of both neurological and dissociative symptoms supports accurate case conceptualization and treatment planning. Coming up in the next blog, we will illustrate how to use conceptualization to treatment plan and intervene. 

References 

Davies, S., Rafi, D., Rifkin-Zybutz, R., Heyland, S., & Jadhakhan, F. (2025). Prevalence and impact of comorbid PTSD, c-PTSD and EUPD on symptom severity in functional neurological disorder: protocol for a systematic review and meta-analysis. BMJ open, 15(10), e101122. https://doi.org/10.1136/bmjopen-2025-101122 

Gray, C., Calderbank, A., Adewusi, J., Hughes, R., & Reuber, M. (2020). Symptoms of posttraumatic stress disorder in patients with functional neurological symptom disorder. Journal of psychosomatic research, 129, 109907. https://doi.org/10.1016/j.jpsychores.2019.109907 

Mavroudis, I., Franekova, K., Petridis, F., Ciobîca, A., Gabriel, D., Anton, E., Ilea, C., Papagiannopoulos, S., & Kazis, D. (2025). Comorbidities Across Functional Neurological Disorder Subtypes: A Comprehensive Narrative Synthesis. Life (Basel, Switzerland),15(8), 1322. https://doi.org/10.3390/life15081322