POTS Misdiagnosis: Why Doctors Label Brain Injuries as Functional Neurological Disorder

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Dr. Joseph Schneider brings over 35 years of experience as a functional neurologist to one of medicine's most controversial diagnostic battles. Along with fellow neurologist Dr Adam Klotzek, who has spent 25 years investigating complex neurological cases, In this episode of the My POTS Podcast, Dr. Schneider shares a disturbing trend that he has witnessed, POTS patients with clear neurological dysfunction are being dismissed with functional neurological disorder (FND) diagnoses. This psychiatric labeling occurs despite measurable autonomic dysfunction and often follows identifiable brain injuries, leaving patients trapped in a medical system that treats their symptoms as psychological rather than neurological.

The misdiagnosis crisis has reached alarming proportions, with recent medical literature confirming that autonomic disorders like POTS are frequently mislabeled as functional disorders. When patients receive FND diagnoses, they often struggle to obtain proper diagnostic testing and therapeutic interventions because medical professionals attribute their ongoing symptoms to psychological causes. This diagnostic dead-end prevents patients from accessing the neurological rehabilitation that could restore their autonomic function and return them to normal life.

The Shocking Reality of POTS Misdiagnosis  

POTS represents a symptom of underlying neurological dysfunction, not a standalone condition that appears without cause. Dr. Schneider explains that POTS reflects a breakdown in the regulatory circuits that control blood pressure, heart rate, and the coordination between these systems when changing positions. Something has damaged these neural pathways, whether through concussion, toxic exposure, infection, or other trauma, yet the medical system consistently fails to investigate and address these root causes.

The case of a 26-year-old commercial pilot illustrates this diagnostic failure. After three severe car accidents, he developed hands that leak water like faucets, requiring him to constantly drink fluids to replace what he loses through his palms. Despite visible muscle twitching and obvious neurological symptoms that began after his accidents, doctors labeled him with functional neurological disorder and suggested his condition was psychological. This represents medical gaslighting at its most destructive, where clear physical symptoms following documented trauma get dismissed as mental health issues.

Why Traditional Medicine Gets POTS Wrong  

Current POTS treatment approaches focus on symptom management rather than addressing the underlying neurological dysfunction that creates the autonomic problems. Patients receive medications to regulate heart rate, supplements for hydration and electrolytes, and lifestyle modifications to manage their symptoms, but these interventions don't repair the damaged neural circuits causing their condition. This management-based approach keeps patients dependent on medications while their underlying neurological dysfunction continues unchecked.

The fundamental problem lies in medicine's segmented approach to POTS evaluation. Cardiologists focus on the heart, psychiatrists address the mental health aspects, and primary care physicians manage the general symptoms, but no specialty takes responsibility for the neurological circuits that coordinate all these systems. Functional neurologists understand that the brain controls autonomic function through specific neural pathways, and when these pathways are damaged, the entire system becomes dysregulated in predictable ways.

The Hidden Neurological Circuits Behind POTS Symptoms  

Heat intolerance serves as a perfect example of how POTS symptoms reflect neurological dysfunction rather than psychological issues. Patients who cannot tolerate hot showers or warm environments aren't experiencing anxiety about heat; they're dealing with damaged temperature regulation circuits in their brainstem and hypothalamus. The same neural pathways that control blood pressure and heart rate also manage temperature regulation, explaining why these symptoms cluster together in POTS patients.

Dr. Schneider traces this dysfunction to specific neurological mechanisms involving sympathetic nervous system dysregulations. When you stand up, your nervous system should automatically increase blood pressure to maintain proper circulation to your brain. In POTS patients, this automatic response fails because the neural circuits coordinating this process have been damaged. Taking a hot shower compounds this problem because heat causes blood vessels to dilate, further challenging a system that already struggles to maintain proper circulation.

Key signs that POTS represents neurological rather than psychological dysfunction include:

• Measurable changes in heart rate and blood pressure with position changes

• Temperature regulation problems that correlate with other autonomic symptoms

• Symptoms that began after identifiable brain trauma or illness

• Physical signs like excessive sweating or muscle twitching

• Improvement with targeted neurological therapies

Revolutionary Neurological Approaches That Actually Work  

The breakthrough in POTS treatment comes from understanding that damaged neural circuits can be retrained through targeted neurological rehabilitation. When Dr. Adam Klotzek performed cerebellar stimulation on the pilot with sweaty palms; the excessive sweating decreased by 50% in a single session. This dramatic improvement demonstrates that the symptoms stem from specific neurological dysfunction that responds to appropriate intervention, not psychological issues requiring psychiatric treatment.

Effective POTS treatment requires identifying the highest level of neurological dysfunction that explains the patient's symptoms. Rather than chasing individual complaints, functional neurologists locate the central area of dysfunction and design rehabilitation protocols that retrain these damaged circuits. This approach might combine cerebellar stimulation, vagus nerve therapy, oxygen protocols, and other interventions that target the specific neural pathways causing the autonomic dysfunction.

Psychiatric Labels for Neurological Conditions  

The medical system's tendency to label unexplained symptoms as functional disorders represents a fundamental failure of diagnostic reasoning. When doctors cannot identify the cause of a patient's symptoms, the appropriate response involves further investigation and consultation with specialists who understand complex neurological conditions, not psychiatric labeling that ends the diagnostic process. Patients with POTS deserve neurological evaluation that maps their autonomic dysfunction and identifies the underlying causes.

POTS patients experiencing medical gaslighting should seek evaluation from functional neurologists who specialize in autonomic disorders and understand the complex neural circuits that control these systems. Look for practitioners who offer comprehensive neurological testing, understand the connection between brain trauma and autonomic dysfunction, and provide targeted rehabilitation rather than just symptom management. The key is finding medical professionals who treat POTS as a neurological condition requiring specific intervention, not a psychological disorder requiring psychiatric treatment.

To learn more about the neurological causes of POTS and why misdiagnosis with functional neurological disorder is harming patients, listen to the full My POTS Podcast episode and visit HopeBrainCenter.com for resources on proper POTS evaluation and treatment. Understanding the real neurological basis of your symptoms is the first step toward getting the appropriate care you deserve.

Connect with Dr. Joseph Schneider:
Website: Hope Brain and Body Recovery Center; Hope Regeneration Center

Podcast: MyPOTSPodcast.com

LinkedIn: Joseph Schneider

YouTube: HopeBrainBodyRecoveryCenter

Instagram: @HopeBrainCenter_

Facebook: Hope Brain and Body Recovery Center  

Connect with Dr. Adam Klotzek:

LinkedIn: Adam-Klotzek-DC-MS-DACNB-FICC