Making Sense of Your Symptoms and Questions

---

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For the Person With FND

When your health story gets complicated

Imagine sitting down with a new doctor.

They ask how you’ve been doing.

Well, where do you begin?

Maybe your walking has been difficult. You’ve had migraine attacks, too. And there’s that new symptom you’ve been meaning to ask about.

Some days have been better than others. A few details are important, but they’re hard to remember on the spot.

Before you know it, your thoughts are playing hide-and-seek.

There’s a way to make these conversations a little easier.

It’s called a personal symptom map.

Think of it as a short guide to your health. It helps you keep track of what has been diagnosed, what you’re still trying to understand and what makes everyday life more manageable.

You can use it when meeting a new clinician, talking with someone who supports you or deciding what to bring up at your next appointment.

It’s also useful when memory and concentration are difficult.

One person in the FND community described their experience this way:

“I can’t really tell the difference between whether something happened two weeks ago or four months ago.”

Figure 1. Individual lived experience of remembering when events happened. [9]

Read their community comment.

Imagine how helpful a short written record could be when dates and memories get mixed together.

And here’s the nice part: your map can be just one page.

You can add to it when something important changes. The aim is to make remembering easier, while leaving you free to get on with living your life.

A personal symptom map is a way of organizing your health information that we’ve introduced in this course. It can support conversations and decisions about care. Your healthcare team still provides the assessment needed to understand and diagnose symptoms. [2][3][5]

Giving everything its own place

Let’s imagine someone whose leg weakness has been diagnosed as functional.

They also have migraine.

Recently, they’ve started experiencing dizziness that feels different from anything they’ve had before.

All three experiences matter. But they tell us different things.

Their leg weakness has been identified as part of their FND.

If their migraine has been diagnosed, it belongs with their other health conditions. If they’re still being assessed for migraine, that question can stay open.

Doctors sometimes call conditions that occur alongside one another coexisting conditions or comorbidities.

And the new dizziness?

That belongs in a space marked still to be assessed.

An open question deserves attention. Writing it down helps keep it in view.

New, severe or substantially changed symptoms may need prompt medical assessment. If symptoms seem urgent, seek help straight away; your notes can wait. A clinician can help you plan for these situations, as we discuss in medical safety and individual plans.

The same approach works for many different experiences.

You might live with functional seizures, movement changes, speech difficulties, sensory symptoms or problems with thinking and memory. Perhaps you experience several of these, or something entirely different.

Your map is about your particular combination.

It can also have room for medication changes, side effects or symptoms that may be linked to another condition.

Each piece gets its own place until you and your care team know more. [1][4]

What happened before, during and after?

Sometimes understanding the order of events can be useful.

Imagine someone who experiences episodes of functional symptoms.

One night, they sleep poorly.

The following afternoon, they notice a familiar change in their speech. Shortly afterwards, one of their usual episodes begins.

When it’s over, they’re exhausted.

There are three different things happening here.

The poor sleep came before the episode. It might be a trigger — something that increases the chance of symptoms under certain circumstances.

The speech change appeared as the episode was beginning. It might be a warning sign, showing that something familiar is already happening.

The exhaustion came afterwards. It may be a consequence — something experienced as a result of the episode. Other influences, such as the poor sleep, may also help explain it.

The order tells us when things happened. Understanding how they are connected takes a closer look.

Perhaps poor sleep is connected with more difficult days for this person. We’d need more information to understand that connection.

For some people, episodes may occur without a recognizable trigger or warning. Other symptoms may be present for much of the time, rather than appearing as distinct episodes, although their intensity can still vary.

Your experiences may follow a different pattern, and your map can reflect that.

You may also hear clinicians mention a risk factor, which is linked with a greater chance of a condition, or a maintaining factor, which may contribute to symptoms continuing.

We explored these terms in Lesson 7. Here, we’re simply giving useful observations a place to live.

A small place to start

What would you most want a clinician to know about your health?

Perhaps it’s a symptom already diagnosed as FND, another health condition or a question that’s still open.

You can write just one line about it. That’s a useful beginning.

In Lesson 11, we’ll look at what helps, what remains possible and how to build those notes into a simple map.

Your health story is bigger than a page. The map helps you keep the important pieces within reach.

Optional crossword

Revisit the lesson with a crossword. The easy edition includes a word bank.

Optional colouring activity

Open the Lesson 10 colouring PDF (new tab), or browse the colouring collection.

---

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Family, Friends, and Other Supporters

Two people can know different parts of the same story

Living alongside someone with FND can teach you a great deal about their usual symptoms. You might recognize a familiar episode, notice when something has changed, or remember details from a difficult day.

The person living with FND knows something equally important: what the experience feels like from the inside. They may recognize a change in pain, sensation, thinking or awareness that nobody else can see.

Those two perspectives can work together. The person describes their experience and what matters to them. A supporter, when invited, can add what they observed and help communicate it. A clinician’s role is to assess and diagnose, using medical history, examination and other tests when needed.

Each role brings something different to the conversation.

And many people with FND manage their care without a supporter. These same questions are for them, too. They can explain what they experience, ask clinicians for clear answers and request accessible ways to communicate.

Having the right words helps

In Lesson 10, we’ve been separating things that are known from things that are still being investigated. A few terms make those conversations more precise.

A symptom diagnosed as FND has been identified by a clinician, using positive clinical evidence appropriate to the symptom. This may include characteristic features in the history and examination.

A coexisting condition, also called a comorbidity, is another condition the person has been diagnosed with. Migraine, for example, can exist alongside FND.

An associated symptom occurs alongside the condition but may have more than one possible explanation. An unresolved symptom still needs to be understood or assessed.

These are useful distinctions because a familiar FND diagnosis tells us something important about some symptoms. Other questions about the person’s health still deserve consideration. [1][4]

Suppose the person says, “This feels different from my usual symptoms.” A supporter might say, “I’ve noticed a change, too.”

Together, they’ve given the clinician a useful starting point for assessment.

Sharing observations without deciding the cause

Supporters may see things a person has difficulty remembering, particularly around an episode. With permission, they can describe what happened before, during and after.

This is where familiar words from Lesson 7 help.

Something that may make an episode more likely is a possible trigger. A change that appears as an episode begins may be a warning sign. Something that results from an episode is a consequence. A change noticed afterwards is a possible consequence, with its explanation still to be explored.

You might also hear about a risk factor or a maintaining factor. These describe possible influences, rather than something a supporter is expected to identify or prove.

An observation such as “Their speech changed before the episode” tells the care team what happened. Whether the speech change was part of that episode is a different question.

The person might add, “I felt confused before I could speak.” Both accounts can be valuable, even when they describe different parts of the experience.

And sometimes symptoms occur without a recognizable trigger or warning. That’s useful information as well.

When is a medical visit worth the cost?

For some people with FND, getting medical care is exhausting. The journey, bright lights, noise, waiting, pain or interruptions to rest can worsen symptoms. An emergency department can be particularly difficult.

That creates a real balancing act. A visit might answer an important question, but getting there can take a heavy toll. And because FND itself can cause such striking symptoms, it isn’t always obvious when something else needs attention.

Imagine someone who has lived with familiar functional episodes for years. After one episode, they experience a new kind of severe pain. The FND is already well known, so it becomes the focus of the conversation. Only later is a separate physical injury recognized.

This example is adapted with permission from patient correspondence, with personal details left out. It illustrates a risk called diagnostic overshadowing: when one familiar diagnosis draws attention away from another possible explanation. The account has not been independently verified. [10]

Think of a folder labelled FND. The label tells us something important about the pages already inside. Each new page still deserves a look of its own.

An established FND diagnosis can remain valid while another condition is present. Each new pain, symptom or change deserves consideration on its own merits and may need its own assessment. [7][8]

So how does someone decide whether a medical visit is worth the effort?

Often the answer lies in what has changed, how serious it seems, and how quickly an answer is needed. A familiar fluctuation may already be covered by the person’s care plan. A mild, non-urgent concern might be discussed by phone or at a planned appointment. Other changes—such as a serious injury, sudden stroke-like symptoms, concerning chest pain or difficulty breathing—can make prompt or emergency assessment important despite the burden of getting there.

These differences are worth talking through with a clinician before the next difficult day. Understanding which changes can wait, which call for advice and which need urgent care can reduce some of the guesswork. [7]

Making both perspectives count

The person with FND may be the first to notice, “This feels different.” A supporter, if one is involved, might remember how the person’s usual episodes look or notice something new afterwards.

Together, those observations can make a useful distinction: “The episode seemed familiar, but this part is new.”

That simple sentence may help a clinician consider both the established FND and another possible cause. It’s a way of making room for more than one explanation, rather than trying to decide the diagnosis at home.

Medical care can also be made more manageable. Sometimes a phone appointment, a written account, quieter surroundings or less repeated questioning can help the person’s concerns reach a clinician without so much added strain.

In Lesson 11, we’ll look at how a short personal symptom map can help keep those important details ready when they’re needed.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Clinicians and the Care Team

What does a positive FND diagnosis establish?

The clinical strength of an FND diagnosis lies in positive evidence appropriate to the presenting symptom. An examination finding that supports functional limb weakness can explain that presentation. A later pain syndrome, a new bladder problem or a changed episode calls for its own clinical reasoning.

Bennett et al. (2021) and Espay et al. (2018) describe a positive, phenotype-specific diagnostic approach. This allows clinicians to be confident about what has been demonstrated while retaining appropriate uncertainty about other findings. [1][6]

In practice, an established diagnosis and an unresolved symptom can sit side by side. Both can remain part of the working formulation.

When the familiar story changes

Consider this anonymized account, adapted with permission from a person’s contemporaneous correspondence about emergency care. It describes their experience and concerns; it is not an independently reviewed medical record or a determination of clinical fault. [10]

The person had an established diagnosis of FND and functional seizures. Their usual episodes had been relatively infrequent. Over a short period, that pattern changed to dozens of episodes a day. They also described speech disturbance and chest pain during an initial emergency presentation.

During subsequent travel, an episode was followed by a fall. Afterwards, they reported new loss of leg function and bladder or bowel difficulties. Later imaging was reported to identify spinal disc herniations.

In their account, the familiar FND diagnosis became the main explanation offered for the new weakness and bladder difficulty. They also described being lifted into a standing position and released despite their inability to support themselves, resulting in a fall.

There are several distinct clinical questions here. The sharp rise in episode frequency deserves its own interpretation. So do chest pain, new neurological deficits, sphincter symptoms and possible injury after a fall. Each question deserves assessment alongside the person’s established functional episodes.

The broken-arm analogy

The same patient used a simple comparison: imagine someone who already has paraplegia arriving with a broken arm.

Their paralysis matters. It affects how they move, transfer and receive care.

But the broken arm is still a new injury. Explaining that injury solely through the existing paralysis would confuse the background condition with the presenting problem.

FND presents a similar risk when an established diagnosis becomes the answer before the changed presentation has been examined.

The clinical error to avoid is diagnostic overshadowing: allowing a familiar diagnosis to narrow attention prematurely. A well-supported FND diagnosis and another medical problem can coexist. Both can be true. [1][7][8]

What evidence would change the formulation?

This is where clinical reasoning becomes most useful to patients.

A change in seizure frequency is an observation. Understanding why it changed takes further assessment.

A history of FND is relevant background. Attributing a new weakness, bladder disturbance or pain to FND requires positive evidence appropriate to that presentation.

Likewise, investigations that address one urgent differential—for example, an initial assessment for stroke or a cardiac event—answer the questions those investigations were designed to address. Other persistent or evolving findings may still need their own explanation.

New neurological or bladder/bowel dysfunction after injury can raise time-sensitive concerns about spinal or other pathology. Which examinations and investigations are warranted depends on the actual findings, time course and clinical risk. The reason for investigating, observing or deferring investigation should follow from the new presentation and its clinical context. [7]

The difference between two hospital assessments brings this reasoning into focus. According to the patient’s account, one hospital attributed the newly reported leg and bladder difficulties to FND and discharged them. At the next hospital, clinicians pursued spinal imaging and identified disc herniations, including at T6–T7.

The imaging provided additional evidence relevant to a problem that still needed explaining. Its clinical meaning depends on how well it fits the symptoms, examination and other findings. An established FND diagnosis may remain valid while a new presentation calls for its own assessment. The full clinical decisions at either hospital cannot be judged from the correspondence alone.

Why examination methods matter

Positive functional signs are valuable when they are appropriate to the symptom, elicited safely and interpreted in context.

A useful examination uses validated signs safely and in context. When weight-bearing is unreliable, supporting the person and preventing a fall are part of gathering trustworthy findings.

This brings diagnostic reasoning and physical safety together. The purpose of an examination is to gather interpretable evidence while protecting the person being examined. [8]

Balancing missed illness against harm from care

A careful assessment has two sides.

One risk is missing an additional condition because the existing FND diagnosis seems to explain everything.

The other is exposing someone with a well-characterized presentation to repeated low-yield investigations, treatments or hospital visits that may add significant physical and sensory burden.

Mcloughlin et al. (2025) discuss iatrogenic harm—harm associated with healthcare—in FND. That literature supports taking the consequences of medical intervention seriously, while emergency-care reviews emphasize continued attention to clinically important change. [7][8]

The balance depends on urgency, uncertainty, potential benefit and the cost of delay. A familiar event covered by an agreed plan differs substantially from a new injury or a potentially serious acute deficit.

This is proportionate assessment. It offers an evidence-based reason for both the investigations that are undertaken and those that can appropriately be deferred.

Make the explanation visible

Patients may hear only a conclusion: “This is FND.”

A more informative explanation separates the questions:

“These findings support FND for the symptoms we’ve already assessed.”

“Your new weakness and bladder changes raise additional questions, particularly after a fall.”

“Here is what we have evaluated, what remains uncertain and why this next step is appropriate.”

The patient can describe the experience from within. An invited supporter may add observations from outside. Clinical interpretation remains the clinician’s responsibility.

When the reasoning is visible, an FND diagnosis can remain both credible and appropriately limited. That protects the value of positive diagnosis while allowing new problems to receive their own assessment.

In Lesson 11, we turn to preserving that reasoning in a concise, practical symptom map.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

Further reading in the Reference Library: Positive diagnosis · Tests, investigations and what findings mean

Research and Sources

How to read this evidence

Bennett and Espay describe an approach to FND diagnosis based on positive clinical evidence, interpreted in the context of the individual presentation. Butler’s survey documents associated symptoms and comorbidity in a selected respondent population. The cause of a particular person’s new symptom requires individual assessment. [1][4][6]

Finkelstein’s emergency-department review discusses coexisting conditions and changed presentations, while Mcloughlin’s review examines harm associated with medical interventions. Together these sources support careful, proportionate clinical reasoning. Testing and urgency still depend on the individual presentation; these reviews provide neither a fixed testing schedule nor a validated triage rule. [7][8]

The course’s symptom map is an educational communication aid. The community quotation and anonymized clinical scenario share individual experiences. The correspondence illustrates a reasoning hazard; its clinical details, symptom causes and care decisions have not been independently verified. [9][10]

Citation table

Citation	Figure	Full citation
[1]	—	Bennett K, Diamond C, Hoeritzauer I, Gardiner P, McWhirter L, Carson A, Stone J. A practical review of functional neurological disorder (FND) for the general physician. Clinical Medicine. 2021;21(1):28–36. FND-CIT-0001. https://doi.org/10.7861/clinmed.2020-0987
[2]	—	Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. Journal of Neurology, Neurosurgery & Psychiatry. 2020;91(10):1037–1045. FND-CIT-0011. https://doi.org/10.1136/jnnp-2019-322281
[3]	—	Rutten S, Bradley-Westguard A, Nicholson TR, et al. Outcome measurement in functional neurological disorder: a qualitative study on the views of patients, caregivers and healthcare professionals. Journal of Neurology. 2025;272:189. FND-CIT-0012. https://doi.org/10.1007/s00415-025-12912-9
[4]	—	Butler M, Shipston-Sharman O, Seynaeve M, et al. International online survey of 1048 individuals with functional neurological disorder. European Journal of Neurology. 2021;28(11):3591–3602. FND-CIT-0014. https://doi.org/10.1111/ene.15018
[5]	—	Pick S, Anderson DG, Asadi-Pooya AA, et al. Outcome measurement in functional neurological disorder: a systematic review and recommendations. Journal of Neurology, Neurosurgery & Psychiatry. 2020;91(6):638–649. FND-CIT-0067. https://doi.org/10.1136/jnnp-2019-322180
[6]	—	Espay AJ, Aybek S, Carson A, et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurology. 2018;75(9):1132–1141. FND-CIT-0002. https://doi.org/10.1001/jamaneurol.2018.1264
[7]	—	Finkelstein SA, Cortel-LeBlanc MA, Cortel-LeBlanc A, Stone J. Functional neurological disorder in the emergency department. Academic Emergency Medicine. 2021;28(6):685–696. FND-CIT-0068. https://doi.org/10.1111/acem.14263
[8]	—	Mcloughlin C, Lee WH, Carson A, Stone J. Iatrogenic harm in functional neurological disorder. Brain. 2025;148(1):27–38. FND-CIT-0069. https://doi.org/10.1093/brain/awae283
[9]	Figure 1	Public community comment by lia_bean in “DAE have functional cognitive disorder?” Reddit, r/FND. Original comment. Quotation verified October 22, 2026. Individual lived experience. FND-CIT-0288.
[10]	—	Anonymous patient correspondence about emergency care, supplied for lesson development and adapted with permission. Individual lived experience; not independently verified. Original correspondence and identifying details remain private. FND-CIT-0289.

Human editorial review and the project’s evidence and editorial audits of Lesson 10 are complete. Independent clinical review remains pending.

Initial draft: September 4, 2026 · Human-authored revision completed: October 22, 2026 · Audit 1 and Audit 2 completed: October 22, 2026 · Clinical review pending