Sudden, Medically Unexplained Changes in Speech, Voice or Swallowing - Understanding Functional Neurological Disorder (FND)

29 Apr

Have you experienced a sudden change in speech, voice, or swallowing, but been told that test results are “normal”? Maybe you’ve felt dismissed, or you’re stuck in limbo waiting for answers. It might feel like your body is working against you, even though nothing specific has shown up on scans.

If any of this feels familiar, it’s possible that a ‘functional’ component, such as Functional Neurological Disorder (FND), could be playing a role. Whether you’ve received a FND diagnosis or are still searching for answers, you don’t have to face it alone.

This blog post explores what FND is, how it can impact communication and swallowing, and how we can help. Support is available, and recovery is possible.

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What is Functional Neurological Disorder (FND)?

FND affects how the brain sends and processes signals to the body. It causes neurological symptoms that may look very similar to those caused by stroke, brain injury, or other conditions - but without any structural damage to the brain or nerves.

You can think of it like a train that’s temporarily come off the tracks - the system is still there, but it’s not running as expected. Or like a software glitch rather than a hardware failure - the brain isn’t damaged, but the messages it’s sending are getting scrambled or misdirected.

These symptoms are real and genuinely experienced. They arise from a problem in how the nervous system is functioning - not from anything being imagined or “put on.”

In Speech and Language Therapy, we most often see people with FND presenting with:

Sudden-onset of stammering/stuttering or slurred speech
Complete or partial voice loss
Muscle tension or fatigue during speaking
Difficulty swallowing or a feeling of a lump in the throat (‘globus’ sensation)
Communication and/or swallowing difficulties that worsen under stress

These symptoms often arise suddenly, sometimes following an illness, injury, or emotionally stressful period, but they can also come on completely ‘out of the blue.’

Understanding FND Symptoms Holistically

We approach FND using a ‘biopsychosocial framework’, which means we look at the full picture of what might be contributing to your symptoms - not just the body or brain in isolation.

This includes:

Biological factors – such as previous illness, injury, or nervous system patterns like tension or shallow breathing
Psychological factors – including stress, emotional suppression, perfectionism, or trauma

Social factors – like work pressures, relationship dynamics, or lack of support

This approach helps reduce confusion and blame. It recognises that the mind and body are deeply connected, and that multiple factors often combine to trigger and maintain symptoms.

We often also help clients explore their personal “3 Ps”:

Predisposing factors: life experiences or traits that may have made you more vulnerable to FND symptoms - such as a history of trauma, perfectionism, or always putting others first. Research and our clinical experience also suggest that FND can be more common in people who are neurodivergent, including those with autism or sensory processing differences.
Precipitating factors: triggers that often happen shortly before symptoms appear - like a head injury, illness, surgery, or periods of emotional stress. For some people though, there may be no obvious trigger event.
Perpetuating factors: things that keep symptoms going - such as fear, anxiety, overthinking, self-critical thoughts, avoidance of speaking or eating, fatigue and muscle tension.

This framework also helps us understand why symptoms may have developed, and more importantly, how we can support recovery and prevent relapse.

Understanding these patterns helps many people feel more in control and more hopeful that change is possible.

How We Can Help at TalkCoach

Our approach to FND is based on both current clinical research and years of experience.

We combine practical symptom support with space to understand and work through what's going on beneath the surface.

Supporting You to Understand What’s Happening

We start by helping you understand what FND is and how it may be affecting you. Many people find it reassuring to have a clear explanation - especially if they’ve previously felt dismissed or misunderstood. We always validate your experience - your symptoms are real and not imagined.

Specific Techniques to Support Your Voice, Swallow and Speech

We’ll might also work together on:

Reducing physical tension in your voice and speech muscles
Improving breath support and control, often using gentle tools like Lax Vox or straw-based exercises
Building smooth, fluent speech through techniques such as ‘easy onset’ and guided practice
Supporting safe and confident swallowing, using strategies based on your needs
Practising real-life speaking tasks, using a step-by-step approach

Therapy is always tailored to your individual symptoms, goals and comfort levels.

Building Confidence in a Manageable Way

Many people with FND start avoiding conversations, phone calls, meals, or social events out of fear or frustration.

We’ll work with you to gently rebuild confidence - starting small, at your own pace. With our support, you'll learn how to manage those tricky situations and reduce avoidance without feeling overwhelmed.

Psychological Support for Communication Challenges

We recognise that communication isn’t just a physical skill - it’s tied to emotions, thoughts and self-beliefs. Our work might involve supporting you to:

Notice and challenge self-critical thoughts
Understand how stress and emotion affect your symptoms
Develop self-compassion and assertiveness
Explore ways to look after your energy and reduce overwhelm

Some clients also work with a psychologist or psychotherapist alongside speech therapy if deeper psychological support is required, particularly if you have a history of trauma. We’re happy to work as part of your wider support network.

Real-Life Examples of FND Recovery

Here are some examples of how we’ve supported people with FND-related communication and swallowing difficulties (names have been changed for anonymity):

Rebuilding Speech After Sudden-Onset Stammering

Sam, a 21-year-old man, woke up one day with such a severe stammer that he couldn’t get a single word out. He had never experienced any speech difficulties before and was understandably frightened and confused.

We used strategies to help him learn to speak again, starting with simple sounds, progressing to words and sentences, and eventually supporting fluent conversations. As his confidence grew, we introduced graded exposure tasks to help him return to speaking on the phone - essential for his job in a call centre. We also explored contributing factors and developed a personalised plan to help prevent relapse. With the right support, Sam was soon back at work, handling phone calls with confidence.

Reclaiming Communication Identity

Nancy, a 60-year-old woman, developed a significant stammer immediately after a head injury. She was later diagnosed with FND. Her speech symptoms were life-altering - she went from being confident and sociable to avoiding conversations and social situations entirely.

We supported Nancy to understand her diagnosis, reduce physical tension, improve breath control, and rebuild fluent, relaxed speech. Just as important, we helped her explore emotional patterns and perfectionist tendencies that contributed to ongoing tension and avoidance.

By the end of therapy, she had returned to part-time work, was re-engaging with her art classes, and shared:

“I feel finally feel like me again - I feel comfortable in my own skin and able to express my voice”.

When the Voice Disappears

Laura, in her early 30s, came to us after completely losing her voice following a highly stressful family event. She could whisper, but no sound came out when she tried to speak aloud. Medical investigations found no damage to her vocal cords.

We supported her through a step-by-step process to restore her voice - beginning with gentle airflow and sound production techniques, gradually reintroducing pitch, volume and confidence. We also explored the emotional context behind the voice loss, helping her connect with her needs and boundaries. Her voice returned fully after a short block of therapy, and she was able to return to work and social activities.

From Soup to Solid Foods

James, a man in his 50s, developed intense anxiety around swallowing after a minor viral illness. Although all his swallow assessments came back normal, he became convinced that eating solid food wasn’t safe. He lived on soup for over six months, losing weight and confidence. Using a structured but compassionate approach, we helped James rebuild trust in his swallow. This included education, safe swallow strategies, graded exposure to different textures, and practical coaching during mealtimes. We also supported him in addressing the fear that was keeping the cycle going. Over time, James resumed a full and varied diet and began enjoying social meals again, without fear.

Is Online Speech and Language Therapy for FND Effective?

Yes - and it’s often the most convenient option. You can attend from home or work, without needing to travel or take time out of your day. Many people also feel more comfortable being able to attend from their home environment.

We’ve written more about why online speech therapy works so well in this blog post, but in short: it’s just as effective, more flexible, and easy to access wherever you are.

All you need is a quiet space and a device with a camera - we’ll guide the rest.

What’s Next?

FND symptoms can feel confusing, scary, and isolating, but you don’t need to navigate this alone. If you’re living with sudden changes in communication or swallowing, and you’re not sure where to turn, please know there is support available.

At TalkCoach, we work with many people who are still waiting for a clear diagnosis - or who have been told there’s “nothing wrong” even though their day-to-day life has been deeply affected by these unexplained symptoms. Whether your symptoms relate to FND or not, and whether you have a confirmed diagnosis or not, we’ll meet you where you are, and work with you to move forward.