Bridging the Mind and Body: Functional Neurologic Symptom Disorder Following Sexual Trauma in an Adolescent Girl

Functional neurologic symptom disorder (FNSD) is a multifaceted condition that can present with neurologic symptoms inconsistent with recognized neurological disease, often in the context of psychosocial stressors, though these are not required for diagnosis. We report the case of a 12-year-old Hispanic female who developed episodes of limb paralysis, motor unresponsiveness, and self-injurious behaviors following a history of sexual abuse by a family member. Despite the initial absence of depressive symptoms, the patient later met criteria for major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Her neurological symptoms lacked identifiable medical findings, following unremarkable results from comprehensive blood work, a brain CT scan, MRIs, and an EEG. She was ultimately diagnosed with FNSD. Her care involved multiple psychiatric hospitalizations and trials of selective serotonin reuptake inhibitors (SSRIs), with partial response, complicated by psychosocial instability and poor adherence. Trauma-focused cognitive behavioral therapy (CBT-TF) was initiated and continued alongside pharmacologic treatment. At follow-up, the patient showed modest improvement in mood and functioning. There was a considerable reduction in the frequency and duration of her episodes, and her mood improved, from being dysthymic and socially withdrawn to becoming more engaged and euthymic, which led to increased participation in school and family activities. This case emphasizes the need for individualized, trauma-informed, and developmentally sensitive approaches to reduce extensive medical work-ups and optimize care in pediatric FNSD.