Understanding the FND Diagnosis

Receiving a diagnosis of Functional Neurological Disorder can bring very different emotions.

For some people, it brings relief. There is finally a name for what has been happening. For others, it brings confusion, disbelief or anger. Sometimes all of these emotions arrive together.

You may have spent months or years moving between appointments, investigations and different specialists. You may have heard that your scans were “normal” while your body was clearly telling you that things were not normal. You may have started to wonder whether anyone believed you. In some cases, you may even have started to doubt yourself.

So before we go any further, I want to make one thing clear.

An FND diagnosis does not mean that nothing is wrong. It does not mean that the symptoms are imagined. It does not mean that you are producing them deliberately. FND symptoms are real, involuntary and capable of having a major impact on your life.

The diagnosis needs to be explained with care because the way it is given can influence what happens next.

“Your tests are normal” is not an explanation

In medical terminology, the letters NAD stand for “No Abnormality Detected”. They are often used when an examination or investigation has not revealed a problem. Usually this is intended to be reassuring. In FND, it can land very differently.

Imagine that you are struggling to walk, losing the use of an arm, experiencing tremors or having seizures. You undergo investigations and are then told that everything is normal. The professional may mean that no structural disease has been found. What you may hear is that there is no explanation for your experience—or worse, that you should not be experiencing it at all.

But the symptom remains. The distress remains. The impact on your life remains.

This is why I avoid writing “the MRI was normal” in my clinic letters. I prefer to say that the MRI scan did not reveal a problem with brain structure. This is more accurate. It also leaves room for the truth that a problem with functioning can be present even when the structure looks intact.

FND arises from a disruption in how the nervous system is functioning and communicating. Routine scans are designed mainly to show us structure. They can identify problems such as a tumour, a bleed, inflammation or damage caused by a stroke. They do not show every aspect of how the brain and nervous system are operating from moment to moment.

An unremarkable scan is therefore not evidence that your symptoms are unreal. It tells us something important about what has not been found. It does not erase what you are experiencing.

FND should not be a diagnosis of last resort

Historically, FND was often treated as a diagnosis of exclusion. A person would go through test after test and, when another explanation could not be found, the remaining possibility was assumed to be psychological.

Our understanding has moved on.

FND can be diagnosed through positive clinical signs. These are features seen during a neurological assessment that show how the symptom is functioning. The diagnosis should therefore be based on what the clinician observes and identifies—not simply on the absence of another disease.

The word positive matters here. It means that there is clinical evidence supporting the diagnosis. It does not mean that the clinician has failed to find anything else and has placed FND in the empty space.

This was an important shift within medicine. In 2013, the DSM-5 removed the requirement for a psychological stressor to be identified before a diagnosis could be made. It also placed greater emphasis on positive clinical signs rather than relying only on the exclusion of other diagnoses.

That change matters because not everyone with FND has a history of psychological trauma. Trauma can be a risk factor for some people, but it is not a compulsory part of the condition and it should not be searched for in a way that makes the diagnosis depend upon finding it.

What should happen during the diagnosis?

A good diagnostic conversation should help you understand why FND has been identified in your particular case.

The professional should be able to explain:

• which symptoms fit with FND;

• which positive clinical signs support the diagnosis;

• what the investigations have and have not shown;

• whether any other condition has also been identified;

• what treatment or support may be helpful;

• and what should happen if your symptoms change.

You should also have an opportunity to ask questions. This sounds obvious, but many people receive the diagnosis while feeling overwhelmed, tired or frightened. It can be hard to absorb new information in that state. Sometimes the words only begin to make sense after the appointment has ended.

If this happens, it does not mean that you have failed to understand. It means that you are human and your nervous system may already have been carrying a great deal.

Ask for the explanation again if you need it. Ask for information in writing. Take someone you trust to an appointment if that helps. A diagnosis as important as FND may need more than one conversation.

Can FND exist alongside another condition?

Yes.

Having FND does not protect you from developing another neurological or medical condition. It is possible to have FND alongside epilepsy, migraine, persistent pain, a neurological disease or another health difficulty. It is also possible for symptoms from different conditions to overlap and become hard to separate.

This is another reason why the diagnosis should not become a label that closes every future enquiry.

Once FND appears in a medical record, there can be a risk that every new symptom is viewed through that single lens. Professionals need to remain open and curious. Equally, repeating investigations without a clear clinical reason can increase uncertainty, anxiety and exhaustion. Finding the right balance requires thoughtful clinical judgement and a collaborative relationship.

If a symptom is new, substantially different or concerning, it deserves appropriate medical attention. FND should guide care; it should not become a reason to stop listening.

The words used around FND matter

FND has inherited difficult language from its history. Terms such as “hysteria” and “conversion disorder” have shaped attitudes for generations. Even when those words are no longer spoken, some of their meaning can remain in the way people are treated.

A diagnosis can become harmful when it is delivered with the suggestion that the symptoms are an exaggeration, a behaviour or a purely psychological reaction. It can also be harmful when a clinician gives the name but offers no meaningful explanation.

The professional may leave the room believing that a diagnosis has been communicated. The person receiving it may leave with a heavier burden than the one they carried in.

I have met many people whose distress did not come only from their symptoms. It also came from how those symptoms had been interpreted by others. They felt disbelieved, rejected or blamed. Some had encountered medical gaslighting. Some were made to feel responsible for symptoms that were outside their conscious control.

If this has been part of your journey, I am sorry. It should not be dismissed as an unfortunate side issue. These experiences can affect trust, engagement with treatment and the ability to feel safe with professionals.

You do not have to accept everything immediately

It can take time to make sense of an FND diagnosis.

You may have entered the appointment expecting to hear the name of a disease that would appear clearly on a scan. Instead, you were given an explanation based on functioning, networks and clinical signs. That can require a shift in how you understand illness itself.

You are allowed to need time.

You are allowed to ask how the diagnosis was reached.

You are allowed to seek another clinical opinion if important questions remain unanswered.

What I would encourage is curiosity. Try to avoid feeling that your only choices are to accept the diagnosis without question or reject it completely. There may be a middle ground where you can examine the explanation, notice what makes sense, identify what does not and continue the conversation.

A diagnosis works best when it is held collaboratively. The clinician brings medical knowledge and experience. You bring something equally important: the lived experience of your own body and your own life.

The diagnosis is a beginning

The words “Functional Neurological Disorder” are not, by themselves, a treatment plan. But a diagnosis that is clearly explained can create an important starting point.

It can help move the question from “Is this real?” to “What is happening within my nervous system?”

It can move the conversation from blame to understanding. It can help identify treatment approaches, useful connections and practical ways of working with the symptoms.

Most importantly, it can begin to restore agency.

You are not responsible for producing FND symptoms. They are not under your conscious control. You can, however, become an active participant in what happens next. Understanding your diagnosis, recognising patterns, asking questions and building a supportive clinical network can all become part of that process.

Understanding may not arrive in one appointment. It may develop slowly as you revisit the explanation and compare it with your own experience. That is perfectly acceptable. Your understanding belongs to you and it needs to make sense within the reality of your life.

The diagnosis should not reduce you to three letters. It should help you see FND as a condition you are experiencing rather than an identity that defines you.

You have FND. You are not FND.

And while receiving the diagnosis may feel like entering another part of the maze, a clear and compassionate explanation can also help you begin to find the way out.

This article provides general educational information and does not replace individual medical advice, diagnosis or treatment. If you experience new, substantially different or urgent symptoms, please seek appropriate medical assessment.