When Your Body Feels Like the Enemy: How Somatic Therapy Can Help People Living with FND
Imagine waking up and not knowing whether your legs will carry you properly today. Perhaps your hands will tremble, your body will feel disconnected, or you'll experience pain, fatigue or sensations that are difficult to explain.
For people living with Functional Neurological Disorder (FND), the body can become an unpredictable and sometimes frightening place to live.
And when we can't trust our bodies, it's understandable that we might begin monitoring them constantly, anticipating the next symptom or avoiding activities because we're frightened of what might happen.
But what if part of our therapeutic work involved helping people develop a different relationship with their bodies?
This is where I believe somatic approaches can offer something valuable.
Understanding FND and the nervous system
FND is a genuine neurological condition involving changes in how the brain and nervous system function, rather than symptoms being explained by structural neurological damage.
It can affect movement, sensation, awareness and other bodily functions.
We increasingly understand FND through changes in the functioning and interaction of brain networks involved in attention, movement, emotion, sensation and the sense of agency.
Importantly, FND is not necessarily caused by psychological trauma, and symptoms are not imagined or consciously produced.
However, the nervous system's responses to threat, uncertainty and bodily sensations can sometimes interact with symptoms.
And this is one area where somatic therapy may be helpful.
What do we mean by somatic therapy?
Somatic approaches invite us to become curious about our bodily experiences rather than focusing exclusively on thoughts, memories or emotions.
They can involve noticing sensations, exploring movement, recognising changes in physiological arousal and developing a greater sense of choice in how we respond.
In my clinical work, I draw on Somatic Experiencing, Polyvagal Theory, EMDR, breathwork and other approaches, adapting them to the needs of each individual.
But with FND, I think we need to be particularly thoughtful about how we invite someone to pay attention to their body.
For some people, focusing internally can increase distress, dissociation or symptom awareness.
So rather than beginning with a traditional body scan, I might invite someone to notice the room around them.
The light coming through the window.
The colours they can see.
The support of the chair beneath them, if that feels comfortable.
We are not asking the body to perform or change.
We are simply exploring whether there is an experience that feels neutral, manageable or perhaps even pleasant.
Starting with safety, not symptoms
One of the concepts I find particularly useful from Somatic Experiencing is titration.
This means working in small, manageable amounts rather than overwhelming someone with too much sensation or activation.
Another concept is pendulation, gently moving attention between experiences that feel challenging and those that feel more manageable.
With FND, I might adapt this further.
For example, someone experiencing functional leg weakness might feel frightened or disconnected when thinking about their legs.
Rather than immediately directing their attention towards the weakness, we could begin by noticing something entirely different.
Perhaps the warmth of their hands.
The sensation of a soft blanket.
Or the feeling of being supported by the chair.
If appropriate, we might briefly acknowledge the more difficult experience before returning attention to something neutral.
There is no requirement to remain with an uncomfortable sensation.
And sometimes we wouldn't approach the symptom at all.
The aim is not to push through discomfort but to help the person experience greater flexibility and choice in where their attention goes.
Exploring movement without pressure
Movement is another interesting area.
People living with FND can experience difficulties with movements that would ordinarily happen automatically.
Consciously trying harder to make a movement happen can sometimes make that movement more difficult.
This is why I think somatic work needs to be carefully integrated with FND-informed physiotherapy and rehabilitation.
Rather than repeatedly asking someone to perform a difficult movement, we might explore comfortable, familiar movements, external rhythms or activities that encourage automatic movement.
Perhaps a gentle shift of posture, moving to music, or noticing the experience of a movement that already feels accessible.
The focus isn't on correcting the body through effort.
It's on creating opportunities for movement, curiosity and confidence without reinforcing a sense of failure.
The importance of agency
One of the things I am particularly interested in is the experience of agency.
When someone develops FND, they may feel that their body has stopped responding to them.
This loss of control can be deeply distressing.
Somatic work can offer opportunities to explore choice.
Can I decide whether to move my attention towards or away from a sensation?
Can I choose to open my eyes?
Can I change my position?
Can I stop an exercise when I want to?
These may sound like small things, but experiencing choice can be important when someone feels that their body has become unpredictable.
And perhaps the therapeutic question becomes less about how do we make this symptom stop? and more about how can we help this person experience greater confidence, flexibility and agency?
Where does EMDR fit?
As an EMDR therapist, I am also interested in how bodily experiences connect with memories, beliefs and emotional responses.
For some people with FND, there may be experiences of illness, medical procedures, frightening symptoms, accidents or other events that have left a lasting emotional impact.
Someone might develop beliefs such as:
"My body isn't safe."
"I have no control."
"I can't trust myself."
"Something terrible is going to happen."
Where clinically appropriate, EMDR may help process distressing memories and associated beliefs.
But I don't believe we should assume that trauma processing is necessary for everyone with FND.
Sometimes the most useful work may involve helping someone feel more comfortable with sensations, building confidence in movement or developing practical strategies for managing symptoms.
And sometimes somatic approaches can help us prepare for EMDR processing, providing opportunities for grounding, resourcing and managing activation.
Rebuilding a relationship with the body
I think one of the most difficult aspects of living with FND is the way it can change someone's relationship with their own body.
The body can begin to feel like an enemy.
Something to fear, monitor, battle against or constantly try to fix.
Somatic approaches may help us gently challenge that relationship.
Not by telling someone that their symptoms are simply stress.
Not by asking them to relax their symptoms away.
And certainly not by suggesting they are responsible for creating them.
But by exploring experiences of comfort, connection, movement, agency and safety in ways that are meaningful to them.
The evidence for specific somatic therapies as treatments for FND is still developing. These approaches are best understood as potentially helpful components of individualised, multidisciplinary care rather than established standalone cures.
For me, the aim is not necessarily to teach someone to love every sensation their body produces.
It is to help them discover that, even when symptoms are present, there may still be moments of connection, choice and confidence.
And sometimes, those small moments can become the beginning of a different relationship with the body.
Kate J Chartres
Trauma Therapist, EMDR Consultant and Clinical Supervisor