“Your Symptoms Are Real”: Understanding an FNSD Diagnosis
Receiving a diagnosis of functional neurological symptom disorder (FNSD), often called functional neurological disorder (FND), can bring relief, confusion, or both. Having a name for your symptoms may help. Yet you may still wonder what the diagnosis means, why certain tests were normal, or whether your healthcare team believes you.
FNSD symptoms are real and involuntary. They can disrupt movement, sensation, and everyday life. A diagnosis does not mean you are choosing your symptoms or pretending to be ill (Gilmour et al., 2020). Springer Nature Link
Understanding the Diagnosis
FNSD involves changes in how the nervous system functions. Symptoms may include weakness, tremor, walking difficulties, altered sensation, or functional seizures. These experiences can be disabling even when routine investigations do not reveal structural damage that explains them (Gilmour et al., 2020).
A diagnosis should rest on positive clinical evidence: recognizable examination findings or features of episodes that support FNSD. Normal imaging alone is not enough to establish the diagnosis. A clinician with expertise in neurological diagnosis should explain which findings support it in your case (Bennett et al., 2021). Springer Nature Link
You deserve more than a label. A useful explanation connects the diagnosis to what you experience and allows you to ask questions.
Why Feeling Dismissed Matters
Perhaps you have heard, “Nothing is wrong,” or “It is just stress.” Those statements can leave you wondering how to explain symptoms that interrupt your work, relationships, or independence. When an explanation does not match the seriousness of your experience, it can be difficult to trust the next recommendation.
Research documents these concerns. McLoughlin et al. (2024) explored patients’ experiences and described stigma arising through healthcare encounters, everyday interactions, the experience of symptoms, and patients’ own developing beliefs about themselves. The burden can extend beyond symptoms to the feeling that other people doubt your credibility. PubMed
These findings do not mean every person with FNSD has the same experience. They do show why listening and respectful communication belong at the center of care. You should be able to discuss feeling dismissed without that concern being treated as resistance to treatment.
When Stigma Becomes Self-Doubt
Repeated experiences of disbelief may lead you to question yourself: Am I exaggerating? Why can’t I control this? Will anyone take me seriously?
In a qualitative study of 15 people accessing psychological services, Staton et al. (2024) identified internalized stigma, self-doubt, and concerns about disclosing information to professionals. Participants also described the importance of trust and an attuned therapeutic relationship. PubMed
If these questions sound familiar, bring them into the conversation with your clinician. For example:
“I want to understand the diagnosis, but I am worried you think I am causing this deliberately.”
Naming that concern allows your provider to address it directly.
Does the Diagnosis Mean Trauma Caused It?
Stressful experiences and trauma can be relevant for some people with FNSD, but they are not required for the diagnosis. Your history should be explored with care, without assuming there must be a hidden psychological explanation. Risk factors are not the same as a proven cause in a person (Gilmour et al., 2020). Springer Nature Link
Why Psychotherapy May Be Recommended
A psychotherapy referral can feel confusing after seeking help for physical symptoms, particularly if previous providers have minimized your experience.
Treatment should be tailored to your symptoms and needs. Depending on the presentation, care may include neurological follow-up, specialized physical rehabilitation, and psychological treatment. Psychotherapy may address symptom-related distress, relevant patterns affecting symptoms, and coexisting mental health concerns. It should be explained as part of a coordinated plan, with goals you understand (Bennett et al., 2021; Gilmour et al., 2020). University of Edinburgh Research Explorer
The therapeutic relationship matters, too. Staton et al. (2024) found that positive relationships with professionals were perceived to lessen barriers associated with stigma. You should have room to ask how a proposed treatment applies to your experience. PubMed
Questions to Bring to Your Next Appointment
Consider writing down a few questions:
- What clinical findings support my FNSD diagnosis?
- Can you explain what those findings mean in everyday language?
- What is each recommended treatment intended to help with?
- Who will coordinate my care and follow-up?
- How will we measure progress toward activities that matter to me?
- What should I do if my symptoms change?
Clear communication and coordinated care are central recommendations in FND management (Bennett et al., 2021). Asking for clarification is a reasonable part of participating in your care. University of Edinburgh Research Explorer
Moving Forward With Support
Understanding a diagnosis can take more than one conversation. You may need time to process it, revisit questions, and decide what support would help you participate in treatment.
I help patients seeking support for the emotional impact of living with FNSD, including feeling misunderstood, navigating uncertainty, and discussing your treatment goals. Your experience deserves careful attention, and your questions deserve thoughtful answers.
Dan Powell, MA., LMFT, BCBA
References
Bennett, K., Diamond, C., Hoeritzauer, I., Gardiner, P., McWhirter, L., Carson, A., & Stone, J. (2021). A practical review of functional neurological disorder (FND) for the general physician. Clinical Medicine, 21(1), 28–36. https://doi.org/10.7861/clinmed.2020-0987
Gilmour, G. S., Nielsen, G., Teodoro, T., Yogarajah, M., Coebergh, J. A., Dilley, M. D., Martino, D., & Edwards, M. J. (2020). Management of functional neurological disorder. Journal of Neurology, 267(7), 2164–2172. https://doi.org/10.1007/s00415-020-09772-w
McLoughlin, C., McGhie-Fraser, B., Carson, A., Olde Hartman, T., & Stone, J. (2024). How stigma unfolds for patients with functional neurological disorder. Journal of Psychosomatic Research, 181, Article 111667. https://doi.org/10.1016/j.jpsychores.2024.111667
Staton, A., Dawson, D., Merdian, H., Tickle, A., & Walker, T. (2024). Functional neurological disorder: A qualitative study exploring individuals’ experiences of psychological services. Psychology and Psychotherapy: Theory, Research and Practice, 97(1), 138–156. https://doi.org/10.1111/papt.12504
