as 'spooning'. depression, ptsd, sleep disorders, and anxiety disorders can also perpetuate functional disorders and should be identified and treated where they are present. side effects or withdrawal effects of medication often need to be considered. iatrogenic factors such as lack of a clear diagnosis, not feeling believed or not taken seriously by a healthcare professional, multiple (invasive) diagnostic procedures, ineffective treatments and not getting an explanation for symptoms can increase worry and unhelpful illness behaviours. stigmatising medical attitudes and unnecessary medical interventions (tests, surgeries or drugs) can also cause harm and worsen symptoms. treatment functional disorders can be treated successfully and are considered reversible conditions. treatment strategies should integrate biological, psychological and social perspectives. the body of research around evidence-based treatment in functional disorders is growing. with regard to self-management, there are many basic things that can be done to optimise recovery. learning about and understanding the condition is helpful in itself. many people are able to use bodily complaints as a signal to slow down and reassess their balance between exertion and recovery. bodily complaints can be used as a signal to begin incorporating stress reduction and balanced lifestyle measures (routine, regular activity and relaxation, diet, social engagement) that can help reduce symptoms and are central to improving quality of life. mindfulness practice can be helpful for some people. family members or friends can also be helpful in supporting recovery. most affected people benefit from support and encouragement in this process, ideally through a multi-disciplinary team with expertise in treating functional disorders. family members or friends may also be helpful in supporting recovery. the aim of treatment overall is to first create the conditions necessary for recovery, and then plan a programme of rehabilitation to re-train mind-body connections making use of the body’s ability to change. particular strategies can be taught to manage bowel symptoms, pain or seizures. though medication alone should not be considered curative in functional disorders, medication to reduce symptoms might be indicated in some instances, for example where mood or pain is a significant issue, preventing adequate engagement in rehabilitation. it is important to address accompanying factors such as sleep disorders, pain, depression and anxiety, and concentration difficulties. physiotherapy may be relevant for exercise and activation programs, or when weakness or pain is a problem. psychotherapy might be helpful to explore a pattern of thoughts, actions and behaviours that could be driving a negative cycle – for example tackling illness expectations or preoccupations about symptoms. some existing evidence-based treatments include cognitive behavioural therapy (cbt) for functional neurological disorder; and dietary modification or gut targeting agents for irritable bowel syndrome. for some patients, especially those who have lived with a functional disorder for many years, realistic treatment includes a focus on management of symptoms and improvements in quality of life. acceptance of symptoms and the limitations they cause can be important in these situations, and most people are able to see some improvement in their condition. supportive relationships with the healthcare team are key to this. controversies/stigma despite some progress in the last decade, people with functional disorders continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. stigma is a common experience for individuals who present with functional symptoms and is often driven by historical narratives and factual inaccuracies. given that functional disorders do not usually have specific biomarkers or findings on structural imaging that are typically undertaken in routine clinical practice, this leads to potential for symptoms to be misunderstood, invalidated, or dismissed, leading to adverse experiences when individuals are seeking help. part of this stigma is also driven by theories around “mind body dualism”, which frequently surfaces as an area of importance for patients, researchers and clinicians in the realm of functional disorders. artificial separation of the mind/brain/body (for example the use of phrases such as; “physical versus psychological” or “organic versus non-organic”) furthers misunderstanding and misconceptions around these disorders, and only serves to hinder progress in scientific domain and for patients seeking treatment. some patient groups have fought to have their illnesses not classified as functional disorders, because in some insurance based health-care systems these have attracted lower insurance payments. current research is moving away from dualistic theories, and recognising the importance of the whole person, both mind and body, in diagnosis and treatment of these conditions. people with functional disorders frequently describe experiences of doubt, blame, and of being seen as less ‘genuine’ than those with other disorders. some clinicians perceive those individuals with functional disorders are imagining their symptoms, are malingering, or doubt the level of voluntary control they have over their symptoms. as a result, individuals with these disorders often wait long periods of time to be seen by specialists and receive appropriate treatment. currently, there is a lack of specialised treatment services for functional disorders in many countries. however, research is growing in this area, and it is hoped that the implementation of the increased scientific understanding of functional disorders and their treatment will allow effective clinical services supporting individuals with functional disorders to develop. patient membership organisations/advocate groups have been instrumental in gaining recognition for individuals with these disorders. further research directions for research involve understanding more about the processes underlying functional disorders, identifying what leads to symptom persistence and improving integrated care/treatment pathways for patients. research into the biological mechanisms which underpin functional disorders is ongoing. understanding how stress effects the body over a lifetime, for example via the immune endocrine and autonomic nervous systems, is important ying-chih et.al 2020, tak et. al. 2011, nater et al. 2011). subtle dysfunctions of these systems, for example through low grade chronic inflammation, or dysfunctional breathing patterns, are increasingly thought to underlie functional disorders and their treatment. however, more research is needed before these theoretical mechanisms can be used clinically to guide treatment for an individual patient.