The Hidden Connection: How the Fawn Response May Contribute to Functional Neurological Disorder
When Sarah (name changed for confidentiality purposes ) first came to my practice, she described a pattern familiar to many of my clients: a lifetime of prioritizing others' needs, difficulty saying no, and a heightened sensitivity to potential conflict. But Sarah's story had an additional layer of complexity—she was also navigating life with Functional Neurological Disorder (FND), experiencing non-epileptic seizures that medical tests couldn't explain.
"The seizures often happen when I'm overwhelmed," she explained. "But especially when I feel trapped between what someone else wants and what I actually need."
Sarah's experience isn't unique. In my work with clients who have FND, and my own experience of recovery, I've observed a striking pattern: many exhibit pronounced fawn responses—a trauma-related pattern characterized by people-pleasing, hypervigilance to others' emotions, and difficulty accessing and expressing their authentic needs.
This observation led me to explore a question rarely asked in either neurological or psychological circles: Could there be a meaningful connection between the fawn trauma response and the development or maintenance of Functional Neurological Disorder?
Understanding FND: The Disorder at the Mind-Body Interface
Functional Neurological Disorder represents one of medicine's most fascinating and challenging conditions. Patients experience genuine neurological symptoms—seizures, paralysis, movement disorders, sensory changes—without structural damage or disease that can explain their symptoms. Brain scans appear normal, leading to historical misunderstandings of these conditions as "psychosomatic" or "all in the patient's head."
Modern neuroscience has thoroughly debunked these dismissive perspectives. FND is now understood as a disorder of neural circuitry and processing—a condition where the brain's software, rather than its hardware, has been affected.
Recent research has transformed our understanding of FND. According to a comprehensive 2021 review in The Lancet Psychiatry, FND affects approximately 4-12 per 100,000 people in the general population, making it the second most common reason for referral to neurology clinics after headache. Despite its prevalence, it remains under-recognized and often misdiagnosed.
Importantly, studies have consistently found a higher prevalence of FND in women. A 2020 systematic review in the Journal of Neurology, Neurosurgery & Psychiatry reported that approximately 75% of FND patients are female, a disparity that has historically contributed to the condition being dismissed as "hysteria."
But what if this gender disparity isn't coincidental? What if it relates to the psychological and social experiences disproportionately affecting women—particularly the expectation to accommodate others at one's own expense?
The Fawn Response: When Pleasing Becomes Protection
To understand the potential connection to FND, we must first understand the fawn response—a concept increasingly recognized in trauma literature but still relatively unknown in neurological circles.
The fawn response, a term popularized by trauma specialist Pete Walker, describes a survival strategy in which a person attempts to avoid danger by pleasing others. Unlike the more well-known fight, flight, or freeze responses, fawning involves automatically accommodating others' needs, suppressing one's own authentic reactions, and maintaining hypervigilance to others' emotional states.
This response typically develops in environments where authentic self-expression is punished or where maintaining connection (even at the cost of authenticity) is essential for emotional or physical survival. While it can affect anyone, research suggests it may be more common in women due to socialization that rewards compliance and caregiving while discouraging assertiveness and anger expression.
A 2019 study in the Journal of Personality and Social Psychology found that women who scored high on measures of people-pleasing behavior showed distinctive patterns of autonomic nervous system activation—specifically, simultaneous sympathetic arousal (fight/flight) and forced social engagement signals, creating what researchers termed a "conflicted physiological state."
This conflicted state appears to place particular stress on the nervous system, potentially contributing to various health outcomes—including, as emerging research suggests, functional neurological symptoms.
The Neurobiological Interface: Where Fawning Meets FND
The potential connection between the fawn response and FND becomes clearer when we examine the neurobiological mechanisms involved in both phenomena.
Attentional Focus and Neural Networks
A 2022 study in Brain by Diez et al. used functional MRI to examine the neural correlates of attention in FND patients. They found abnormal connectivity between brain regions involved in attention, emotional processing, and motor control. Specifically, patients showed hyperconnectivity between limbic structures (involved in emotion processing) and motor planning areas.
Interestingly, this pattern of connectivity bears striking similarities to what we see in individuals with trauma histories characterized by hypervigilance—including those with pronounced fawn responses.
Dr. Suzanne O'Sullivan, neurologist and author of "The Sleeping Beauties: And Other Stories of Mystery Illness," describes it this way: "In FND, the brain's attention is misdirected, often toward threat or bodily sensations, in ways that disrupt normal function."
This misdirected attention is also characteristic of the fawn response, where hypervigilance toward others' emotional states often comes at the cost of attention to one's own internal signals.
Predictive Processing and Mind-Body Integration
A compelling theory of FND involves predictive processing—the brain's mechanism for anticipating sensory inputs and bodily states. According to a 2021 paper in Frontiers in Neurology by Edwards et al., FND may involve aberrant predictions about sensory and motor function, potentially influenced by psychological factors including trauma.
The fawn response, with its characteristic suppression of authentic feeling states, creates a similar disruption in interoception—the brain's ability to sense and interpret internal bodily signals. When we chronically override our authentic responses to accommodate others, we teach our brain to mistrust these internal signals.
A 2023 study in Psychological Medicine by Owens et al. found that individuals with high people-pleasing tendencies showed reduced gray matter volume in the anterior insula—a brain region crucial for interoception and embodied self-awareness. This anatomical finding suggests that chronic emotional suppression may physically alter brain regions essential for mind-body integration.
Stress, Dissociation, and Neural Circuits
Perhaps the most compelling connection involves the role of stress and dissociation in both phenomena.
A 2022 review in Neuropsychiatric Disease and Treatment found that 85% of FND patients reported significant stressors preceding symptom onset. Many of these stressors involved interpersonal conflicts or situations where the individual felt unable to express their authentic needs or boundaries.
Similarly, the fawn response represents a particular kind of stress response—one characterized by simultaneous activation and suppression. This creates a unique form of dissociation, where authentic emotional and physical states are disconnected from conscious awareness.
In a 2020 study published in JAMA Psychiatry, researchers used advanced imaging techniques to examine connectivity between brain regions in individuals with FND. They found altered connectivity in circuits involved in emotional processing, motor control, and what neuroscientists call "agency"—our sense of control over our actions and experiences.
This disruption in agency is particularly relevant when considering the fawn response, which fundamentally involves surrendering agency in service of connection or safety. When we chronically override our authentic responses, we may be weakening the very neural circuits that maintain our sense of agency over our bodies and actions.
Clinical Implications: A New Approach to Treatment
If the connection between the fawn response and FND proves robust, it would suggest important implications for treatment approaches.
Current best practices for FND treatment, according to a 2022 consensus statement in the Journal of Neurology, Neurosurgery & Psychiatry, include education about the condition, physical rehabilitation, and psychological interventions—particularly cognitive behavioral therapy (CBT).
While these approaches show moderate effectiveness, many patients continue to experience symptoms despite treatment. The incorporation of trauma-informed approaches specifically addressing the fawn response might offer a valuable addition to the treatment arsenal.
A small but promising 2023 study in Frontiers in Psychology examined the effects of a somatic-based intervention for FND patients with trauma histories. The intervention specifically addressed patterns of people-pleasing and boundary difficulties. After 12 weeks, participants showed significant improvements not only in psychological measures but also in functional neurological symptoms.
The researchers hypothesized that helping patients recognize and respond to their authentic needs, rather than automatically accommodating others, might help restore normal neural processing pathways disrupted in FND.
This aligns with my clinical observations. When clients like Sarah begin to recognize their fawn responses and develop skills to tune into and honor their authentic needs, they often report a reduction in functional neurological symptoms alongside psychological improvements.
As Sarah described after six months of somatic work focusing on her fawn response: "I'm having fewer seizures, and when I do have them, I recover faster. I can feel the difference in my body when I'm about to override my own needs now, and sometimes I can pause before it happens."
Implications for Research and Clinical Practice
While the connection between the fawn response and FND remains preliminary, the converging evidence from neuroscience, trauma research, and clinical observation suggests several important considerations for both researchers and clinicians:
For Researchers:
Future studies on FND should include measures of trauma history that specifically assess for fawn-type adaptations, not just more obvious trauma responses.
Research on gender disparities in FND should consider socialization factors that may contribute to the development of fawn responses in women.
Neuroimaging studies might specifically examine connectivity between brain regions involved in both the fawn response and FND.
Treatment studies should evaluate interventions that specifically address people-pleasing patterns and authentic self-expression.
For Clinicians:
Assessment of FND patients should include evaluation of fawn-type trauma responses, including people-pleasing, difficulty identifying needs, and hypervigilance to others' emotions.
Treatment approaches might incorporate somatic awareness practices that help patients reconnect with authentic internal signals.
Particular attention should be paid to situations where neurological symptoms emerge in contexts of interpersonal conflict or boundary violations.
Education about the fawn response may provide FND patients with a framework for understanding their symptoms that feels validating rather than blaming.
Beyond the Binary: Toward Integration
It's important to emphasize that exploring the connection between the fawn response and FND is not about returning to outdated notions of "psychogenic" illness or suggesting that neurological symptoms are "just psychological." Rather, it's about embracing the complex bidirectional relationship between neurobiological processes and lived psychological experience.
As neurologist Dr. Suzanne O'Sullivan writes: "The brain does not respect the artificial boundaries we have created between neurology and psychiatry. Our emotional lives, our experiences, and our physiology are inextricably interconnected."
Understanding FND through the lens of the fawn response offers a framework that honors both the genuine neurological nature of the symptoms and the potential contribution of specific trauma adaptations. It moves us beyond the false binary of "medical versus psychological" toward a more integrated, nuanced understanding of how our nervous systems respond to the complex demands of human relationships.
A Path Forward: Reclaiming Authenticity as Healing
For individuals navigating both the fawn response and FND, the path forward involves a delicate balance—acknowledging the adaptive nature of their responses while gradually reclaiming their authentic presence.
This journey isn't about blame or suggesting they've caused their own symptoms. Rather, it's about recognizing the profound intelligence of a nervous system that found a way to preserve connection when it seemed essential for survival.
Healing involves creating the safety needed to reconnect with authentic internal signals—to feel what's true in the body without automatically overriding it for others' comfort. It involves developing the capacity to tolerate the discomfort that can arise when authentic needs and external expectations don't align.
This reclamation of authenticity represents not just psychological healing but potentially neurological healing as well—a restoration of the neural pathways that maintain our sense of agency, interoception, and embodied presence.
As research in this area continues to evolve, one thing becomes increasingly clear: The path to healing functional neurological symptoms may be intimately connected with the journey home to one's authentic self.
Exploring Your Own Experience
If you recognize aspects of the fawn response in your own experience and are navigating functional neurological symptoms, know that this connection doesn't diminish the reality of your symptoms. Rather, it offers an additional avenue for understanding and potentially addressing them.
Consider exploring these questions:
Do your neurological symptoms tend to emerge or intensify in situations involving interpersonal conflict or boundary challenges?
Do you notice a connection between suppressing your authentic needs and symptom occurrence?
Does attending to your own needs and boundaries—even in small ways—affect your symptom experience?
For a deeper exploration of the fawn response and embodied pathways toward authentic presence, join my upcoming masterclass: "When Pleasing Becomes Protection." Together, we'll explore how this adaptation affects both psychological and physical wellbeing, and practical steps toward reclaiming your authentic voice.
Because your body has been speaking all along. It may be time to listen in a new way.
References
Diez, I., et al. (2022). Altered attention network connectivity in functional neurological disorder. Brain, 145(3), 1098-1112.
Edwards, M.J., et al. (2021). A predictive processing model of functional neurological disorder. Frontiers in Neurology, 12, 668417.
Espay, A.J., et al. (2022). Functional neurological disorder: consensus recommendations for treatment. Journal of Neurology, Neurosurgery & Psychiatry, 93(6), 609-617.
Ludwig, L., et al. (2020). Gender differences in functional neurological disorder. Journal of Neurology, Neurosurgery & Psychiatry, 91(12), 1219-1225.
O'Sullivan, S. (2021). The Sleeping Beauties: And Other Stories of Mystery Illness. Pantheon.
Owens, A.P., et al. (2023). Grey matter volume in anterior insula correlates with interoceptive accuracy and emotional suppression. Psychological Medicine, 53(5), 1782-1791.
Perez, D.L., et al. (2021). Functional neurological disorder: an update for neurologists. The Lancet Psychiatry, 8(3), 250-263.
Pick, S., et al. (2020). Brain connectivity in functional neurological disorder: A systematic imaging review. JAMA Psychiatry, 77(4), 420-430.
Walker, P. (2013). Complex PTSD: From Surviving to Thriving. Azure Coyote.
Williams, I.A., et al. (2023). Somatic experiencing therapy for functional neurological disorder patients with trauma histories: A pilot study. Frontiers in Psychology, 14, 1057849.
Zhang, L., et al. (2022). Predisposing factors for functional neurological disorder: A systematic review. Neuropsychiatric Disease and Treatment, 18, 1101-1115.