What is FND?

If you are reading this because you have been diagnosed with Functional Neurological Disorder, I want to begin with the most important point.

Your symptoms are real.

Let that sink in first. I will say it again: your symptoms are real. They are not fake, they are not made up and they are not imagined. They are not “just in your head”.

FND is short for Functional Neurological Disorder. It is a condition that affects the functioning of the nervous system. It can lead to symptoms such as functional seizures, weakness in an arm or leg, tremors, changes in sensation, difficulties with walking, loss of voice, visual symptoms and problems with memory or concentration. The experience is different for everyone. Even two people with similar symptoms may find that FND affects their lives in very different ways.

A problem with function, not fabrication

Our nervous system is as complicated as it is marvellous. It allows us to move, speak, feel, think and respond to the world around us. It also plays a central role in keeping us safe.

In many neurological conditions, doctors are able to identify damage to the structure of the nervous system. A stroke, for example, may damage an area of the brain. A scan can sometimes show where the damage has occurred and a clinical examination can help establish which functions have been affected.

FND is different. The difficulty is not usually caused by damage to the structure of the brain in the same way. The problem lies in how the brain networks and the nervous system are functioning and communicating. The structure may appear intact on a routine scan, but the system is not working as it should.

One way to think about this is to consider the difference between the physical structure of a system and the way that system operates. Something does not need to be broken in its structure for its functioning to become disrupted. In FND, messages within the nervous system are not being carried and coordinated in the usual way. The resulting symptoms can be disabling, frightening and completely involuntary.

This is why the word “normal” can be so unhelpful when it is used without care. A person may be told that their MRI scan is normal while they are still unable to walk, still having seizures or still struggling to speak. The scan may not show a problem with brain structure, but that does not mean that nothing is wrong. The symptom remains. The distress remains. The impact on the person’s life remains.

In my own clinic letters, I prefer to say that a scan “did not reveal a problem with brain structure”. I think this is more accurate and less likely to dismiss the reality of what the person is experiencing.

FND is not a made-up illness

Historically, FND has carried the baggage of terms such as “hysteria” and “conversion disorder”. Although our understanding has moved forward, old ideas can remain alive in professional language and behaviour for a long time.

Some people with FND have been made to feel that they are exaggerating their symptoms, producing them deliberately or seeking attention. If this has happened to you, I am sorry for the invalidation and injustice you have experienced.

Many years ago, I read the words “attention seeking” in the clinical notes of a person who was repeatedly attending hospital with seizures. I remember feeling deeply disturbed by it. I have never met an attention-seeking patient. I have met people seeking care, comfort, reassurance, understanding and safety.

FND symptoms are outside conscious control. A functional seizure is not a performance. Functional weakness is not laziness. A loss of voice is not a refusal to speak. These are real expressions of a nervous system that is struggling.

Is FND psychological or physical?

I do not think this question serves us particularly well because it keeps us trapped in an old mind-body split.

FND is a whole-body condition and a full-system problem. It can involve a number of different risk factors, and the combination will differ from one person to another. Psychological factors may be relevant for some people. Physical illness, pain, injury, exhaustion, trauma, relationships, repeated stress and other pressures may also form part of the picture. For some people, there is no obvious precipitating event at all.

Trauma is one possible risk factor. It is not a requirement for developing FND. An explanation that insists there must be hidden or repressed trauma can be as invalidating as an explanation that ignores trauma completely.

My job as a clinician is to remain open and curious. The explanation needs to make sense for the person living with the condition. Sometimes the most honest thing a professional can say is, “I don’t know exactly why this has happened, but I believe your symptoms and we can begin to understand them together.”

All medical conditions have physical and psychological aspects because human beings do not arrive in separate pieces. The mind does not live independently from the body, and the body does not operate independently from our experiences, relationships and surroundings. FND sits at an interface that medicine has historically found difficult to navigate. That difficulty belongs to the limitations of our models. It does not make the condition less real.

How is FND diagnosed?

FND should not simply be diagnosed because every test has come back without an explanation. It is not merely a diagnosis of exclusion.

A neurologist can identify positive clinical signs showing that a symptom has the characteristics of FND. The assessment may also involve investigations to look for other neurological conditions, because FND can sometimes exist alongside another diagnosis.

Receiving the diagnosis well matters. A good explanation can begin to reduce fear and confusion. A poor explanation can deepen both.

You deserve to be told what FND is, why the diagnosis has been made and what the possible next steps are. You also deserve the opportunity to ask questions.

Understanding cannot be rushed, particularly if you have spent months or years being passed between services or being told that tests are “normal”.

What do the symptoms mean?

I think it can be helpful to view a neurological symptom as an expression of the nervous system. It is communicating that something within the system is not functioning well.

This does not mean that every symptom contains a hidden psychological message waiting to be decoded. It means that the symptom has an impact and a meaning within your life. What does weakness mean for your independence? What does an unpredictable seizure mean for your sense of safety? What does losing your voice mean for how you connect with other people?

The answers will be unique to you. Nobody else can decide what your symptoms mean in the context of your life.

The symptom is part of your experience, but it is not the whole of who you are. When FND persists, it can gradually merge with identity. You may begin to lose trust in your body, your abilities and yourself. Part of healing involves gently creating some separation between the condition you are experiencing and your core sense of self.

You have FND. You are not FND.

Can people recover from FND?

Yes, recovery and improvement are possible. The path, however, will not look the same for everyone.

Treatment may involve neurological care, physiotherapy, occupational therapy, psychological therapy, psychiatry, pain management or rehabilitation, depending on the symptoms and circumstances. It often involves developing a better understanding of the condition, recognising patterns, rebuilding movement and confidence, managing energy and finding relationships in which you feel believed and supported.

Recovery cannot be forced. We can only work at the pace the nervous system is able to manage. For some people, progress happens steadily. For others, the journey includes periods of stability, flare-ups and relapse. Recovery is not a straight line.

If you have FND, you may understandably feel stuck in a maze. You may be searching for validation, comfort, solutions and relief. The first exit from that maze is often a clearer understanding of what is happening.

Awareness leads to understanding, and understanding leads to healing.

You are not responsible for producing your symptoms. You are not to blame for what has happened. But with the right support, information and tools, you can begin to take responsibility for what comes next. This is not about blame. It is about restoring agency.

There is hope. Your symptoms are real. You can be understood. And there is a way forward.

This article provides general educational information and does not replace individual medical advice, diagnosis or treatment. Please speak with an appropriately qualified healthcare professional about your circumstances.