What POTS Actually Is — And Why It Sounds So Familiar

POTS stands for postural orthostatic tachycardia syndrome. In plain language, when your teen stands up, their heart rate spikes far more than it should. The result? Dizziness, lightheadedness, brain fog, fatigue, nausea, and sometimes fainting.

The gold standard for confirming a POTS diagnosis is the tilt table test. Your teen lies flat on a table that tilts upward to a near-standing position while heart rate and blood pressure are monitored. In adolescents, a heart rate increase of 40 beats per minute or more within the first 10 minutes confirms the diagnosis — as long as blood pressure stays relatively stable.

Here's the part that matters most: the heart itself is structurally fine. All the tests for structural damage come back normal. The problem isn't the hardware — it's how the system is functioning.

If that sounds familiar, it should. It's the same framework used to understand FND. Not a broken structure, but a nervous system running a pattern it shouldn't be running.

Why POTS and FND Are Not Two Separate Problems

Dr. Thomas Chelimsky, a neurologist at Virginia Commonwealth University who has spent his career studying functional autonomic disorders, describes it this way: when you run a diagnostic on a computer and the hard drive comes back fine, the problem isn't the hardware — it's the software.

POTS is a software problem. FND is a software problem. And when both show up in the same teen at the same time, it's likely because the same nervous system is dysregulated.

This isn't a coincidence. What we often see is that these conditions travel together precisely because they share a common root: a nervous system that has lost its ability to regulate properly and is stuck in a threat response.

Why Conventional POTS Treatment Keeps Missing the Real Driver

The traditional approach to POTS focuses on managing symptoms from the outside in. Salt and fluid loading to increase blood volume. Compression socks to prevent blood pooling. Graded exercise through physical therapy. And for some teens, medication on top of it all.

These tools are not wrong. For many families, they provide real, meaningful relief. But they're all aimed at peripheral symptoms — heart rate, blood pressure, blood volume — while nobody asks why the nervous system is generating these signals in the first place.

When the conventional approach plateaus, most families hit a wall. More medication adjustments, more PT, more symptom management. But the underlying system driving the symptoms stays completely untouched.

What the 2026 Research Changes

This is where the research by Crouch, Chelimsky, and colleagues becomes critically important. Their 2026 study in Clinical Autonomic Research argues that POTS is better understood as a central nervous system disorder — not primarily a cardiovascular disease.

In plain English: the persistent symptoms of POTS may be driven by a nervous system stuck in a threat response. The brain has essentially learned to treat the act of standing up as dangerous, so it triggers an alarm that keeps firing even when no real danger exists.

Based on this framework, the team developed POTS Reprocessing Therapy (PORT), adapted from Pain Reprocessing Therapy (PRT), an evidence-based approach for centralized chronic pain. The core of PORT is teaching the nervous system that the symptoms are not the emergency the brain thinks they are.

This is early research — the full trial is still underway — but the direction it points is significant. It mirrors the same mechanism at the heart of FND recovery: retraining the brain's threat response rather than just managing what that response produces.

What Happens When Both Conditions Go Unconnected

Families I've worked with describe a pattern that repeats itself. A teen gets diagnosed with POTS. Treatment starts and things feel somewhat manageable. But then new symptoms emerge — tremors, legs giving out, stretches of exhaustion lasting days or weeks. School attendance drops. The world gets smaller.

Eventually a second diagnosis arrives: FND. And suddenly it feels like starting from zero.

But these families aren't starting from zero. Nobody gave them the framework to see that both conditions were part of the same picture. The POTS treatment managed some symptoms, but the underlying nervous system was still running a threat response — and over time, that expanded into more and more symptoms.

What a Whole-Nervous-System Approach Looks Like

Chasing each diagnosis separately — with the cardiologist managing POTS and the neurologist managing FND — will likely keep your family stuck longer. Each specialist is doing their best within their lane, but nobody is working from a single framework that addresses the system underneath both conditions.

That shared mechanism — a nervous system that learned to stay in a threat state and can't find its way out — is what needs to be addressed. And this process is built to work with the whole family, not just the teen, and not symptom by symptom.

Medication and physical therapy are not wrong. They actually work best when the family is also addressing the nervous system piece. Without that, you're putting out individual flames while the house keeps burning.

If your teen has both diagnoses, or if you're watching POTS symptoms expand into something that looks more like FND, there is a reason that happens — and there is a framework for addressing both together. To learn how families are navigating this and helping their teens move toward recovery, visit teenfndacademy.com.

References

• Crouch, T. B., Nguyen, M., Wells, M., Redman, T., Ashar, Y., Schubiner, H., Westcott, G., Kinser, P., Maxwell, M., Chelimsky, G., & Chelimsky, T. (2026). An alternative "Port"? Rationale and development process for POts Reprocessing Therapy (PORT), a brain-body therapy for postural tachycardic syndrome (POTS). Clinical Autonomic Research, 36, 373-385. View study