The Nervous System in State: Reconsidering the Emotional Phenotypes of Functional Neurological Disorder Through an Autonomic Lens

Samenvatting

Recent digital phenotyping research identified seven emotional phenotypes in Functional Neurological Disorder (FND), by testing the traditional binary distress-resilience model (Painter et al., 2025).  This commentary proposes these phenotypes reflect underlying autonomic states specifically, the fight, flight, and freeze responses of stress physiology/ three F responses (Cannon, 1932). This paper suggests that FND symptoms are not simply different emotional experiences but also involve unique patterns of problems with the autonomic nervous system, which can affect how they should be treated. The concept of a regulatory setpoint is introduced as a system for understanding state persistence and intervention resistance. Clinicians are invited to consider assessment approaches that go beyond symptomatic subtyping to incorporate the autonomic context in which symptoms arise.