Three Categories That Get Collapsed Into One

When a teen has a seizure-like episode, there are actually three distinct categories that need to be distinguished — and collapsing them together causes real harm.

Epileptic seizures are caused by abnormal electrical activity in the brain. They are involuntary. Functional seizures are part of Functional Neurological Disorder (FND). They can involve shaking, convulsing, stiffening, falling, or unresponsiveness. They look like epileptic seizures, but they are not caused by epileptic electrical activity — and they are also involuntary. The person is not consciously making them happen.

Then there are intentionally produced symptoms — malingering (where someone consciously fakes or exaggerates symptoms for an external benefit) and factitious disorder (where symptoms are intentionally falsified without an obvious external reward). Functional seizures are neither of these.

The correct question is never "Is this real or fake?" The question is whether the episode is epileptic, functional, or intentionally produced. Those are very different situations.

Why "Pseudo Seizure" Needs to Be Retired

The term "pseudo seizure" is outdated — and not just a little outdated. Many people hear "pseudo" and assume it means fake. That assumption can be devastating for teens who are already scared, confused, and searching for someone to believe them.

What we often see is that this single word — pseudo — can derail a family's trust in the medical process before recovery even begins. The preferred terms today include functional seizures, non-epileptic seizures, dissociative seizures, or psychogenic non-epileptic seizures (PNES). For clarity and accuracy, "functional seizures" is the most straightforward.

Can You Diagnose Functional Seizures by Observation Alone?

Behavioral observations — like noticing how a symptom changes with attention, distraction, or the environment — can provide useful clinical information. But one observation is not enough to make a diagnosis, and a symptom changing does not prove that the person is consciously controlling it.

This is what makes FND confusing, even for clinicians. An involuntary symptom can still be influenced by attention. Think of a panic attack — no one chooses to have one, but hyperfocusing on every physical sensation can make it stronger. Shifting attention may help it settle. That doesn't mean the person was faking.

The same principle applies to functional seizures. Proper diagnosis requires a full history, understanding the pattern of a person's typical episodes, a neurological evaluation, and often recording an episode during video EEG monitoring. This is a neurological diagnosis — not something that can be determined from a short clip or a single bedside test.

What Parents Should Know About Responding During an Episode

When your child collapses or starts shaking, your instinct as a caring parent is to protect them — to hold them, to make it stop. That reaction is completely understandable, and it comes from a place of deep love.

But once functional seizures have been properly diagnosed, a panicked and highly physical response can become part of the cycle that maintains the episodes. What families I've worked with often discover is that the nervous system can learn that the episode is dangerous and requires rescue every time — and that learning happens without any conscious intent from the teen.

This is where reinforcement is often misunderstood. Reinforcement does not mean the teen is faking the symptom for attention. The symptom is involuntary — and it can still be shaped by what happens before, during, and after it. Attention can reinforce a symptom without the symptom being for attention.

Riding the Wave With a Safety Mindset

So what should the response look like? Here's what this process is built around:

• Maintain reasonable safety — you don't need a thousand pillows and bubble wrap

• Stay calm and reduce unnecessary stimulation

• Avoid crowding, shouting, or repeatedly asking questions like "Can you tell me who you are?"

• Do not restrain your teen unless immediate safety requires it

• Allow the episode to pass and support your teen in returning to normal activity as soon as reasonably possible

The message you're sending is: You're safe. I'm here. Your nervous system can move through this, and you are capable of handling it.

This does not mean ignoring, punishing, or abandoning your child. It means moving the whole family from fear and rescue toward safety and recovery. Parents often need coaching to respond this way — especially after months of believing every episode was a medical emergency. That fear becomes part of the pattern too, and there is some undoing to do.

Your Family Can Move Through This

Changing the family's response is really about helping everyone — teen and parents alike — shift from chaos to understanding, and from understanding to practice, and from practice to living life beyond FND.

If your family is navigating functional seizures and you're looking for a structured path forward, learn more about how Teen FND Academy helps families do exactly that at teenfndacademy.com.