Familiar Symptoms, New Symptoms, and Medical Change

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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 something feels different

You’re making lunch when your hand begins to shake.

“Oh, this again.”

You’ve experienced this before. Usually, the shaking settles after a while, and you know what helps you get through it.

But today, it’s lasting much longer.

Hmm. That’s different.

Is this still your usual FND? Or is something else going on?

That’s one of the tricky things about FND. Your symptoms might change quite a bit, even when nothing new is wrong.

So how do you know when a change is worth checking out?

You don’t have to figure out what’s causing it. That’s a job for your healthcare team.

But knowing what makes an experience different can help you explain what’s happening.

Familiar, changed, or new?

There are three terms worth knowing. They’re useful when you’re talking with a doctor.

A familiar symptom is something you’ve experienced before that fits a pattern your clinician has already assessed.

Maybe it comes and goes. Maybe some days are worse than others. It can still be familiar.

A changed symptom is one you recognise, but something important about it is different.

Remember that shaking hand? Perhaps it usually settles within a few minutes, but today it’s lasted much longer.

A new symptom is something that hasn’t been part of your previously assessed pattern.

It might turn out to be related to FND. It might have another explanation.

That’s what an assessment can help work out.

Illustration: Familiar, changed and new symptoms. These terms can help you explain what’s happening.

If you remember one thing

A familiar symptom can have a familiar response. Something new or meaningfully different may need a fresh medical look.

So, what’s different this time?

Let’s go back to your shaking hand.

You’ve had shaking before, but this time something has caught your attention.

Perhaps you’re thinking, “I know this symptom, but it doesn’t usually happen quite like this.”

That’s useful information.

When you’re talking with a clinician, a few details can help:

• The beginning: Did it start the way it usually does?
• The symptoms: Is it affecting the same parts of your body?
• The length: Is it lasting about as long as usual?
• The recovery: Are you recovering in your usual way?
• Anything else: Have you been ill, injured, or started or changed a medication?

You might remember only one or two of those things.

That’s still useful.

And if memory is giving you trouble, perhaps your symptom map has something that helps. Someone who was there might remember a detail, too.

The idea is to describe what stood out, rather than spend your day watching for every little change.

A symptom behaving differently doesn’t automatically mean something dangerous is happening.

It gives you something worth considering with your care team.

When everything gets blamed on FND

Here’s something that can be especially frustrating.

You develop a new problem, visit a doctor, and the conversation quickly turns to your FND.

But you’re sitting there thinking, “Hang on. Could we look at this new problem?”

There’s actually a medical term for what can sometimes happen.

It’s called diagnostic overshadowing.

That’s when an existing diagnosis gets so much attention that another possible health problem is overlooked.

One person in an online FND community described developing light sensitivity after being diagnosed with FND.

They eventually saw an eye doctor, who identified a pollen allergy and prescribed treatment.

The person wrote:

“He gave me steroid droplets … and since then my light sensitivity is gone.”

Figure 1. Individual lived experience: a comment from a now-deleted account in an FND community discussion. An omission is marked. [7]

For this person, getting their eyes checked led to treatment that helped.

Someone else’s light sensitivity could have a completely different explanation.

That’s the point, really.

You can have FND and another medical problem at the same time. We covered that in earlier lessons, but it’s especially important when something changes. [1][2]

But more medical treatment isn’t always better, either

Now let’s look at the other side.

Imagine someone who has familiar functional seizures.

Their episodes have been assessed. Their healthcare team knows what usually happens, and they’ve worked out what kind of help is useful.

Would it make sense to put that person through the same emergency tests and treatments every single time?

Sometimes an episode really does need emergency attention.

But when it’s a familiar, previously assessed event, an agreed response may be safer and more helpful than repeating treatments that aren’t needed.

Medical procedures and medications can have risks of their own. And repeated emergency visits can be exhausting.

This is where an individual safety plan comes in.

It’s guidance worked out with your clinicians about what helps during familiar symptoms, how to keep you safe, and when it’s time to get more medical help. [2][3][4]

You may already have one.

The Reference Library explains an individualized functional-seizure safety plan. A first or uncertain seizure-like event, abnormal breathing, or prolonged or repeated events without usual recovery need urgent medical help. If no usable plan is available, seek urgent advice rather than assume the event is familiar. [2][4]

If you haven’t, that’s something we’ll work toward in the next lesson.

Wait. Didn’t we just make a symptom map?

We did!

And the good news is that the work you put into it can help here, too.

Think of it this way:

Your symptom map describes what’s going on with your health.

Your safety plan explains what to do when help is needed.

The map can hold a short safety summary or point to the plan.

You certainly don’t need two enormous documents. There’s enough paperwork in life already!

In Lesson 13, we’ll look at turning the useful information you’ve gathered into a safety plan with your care team.

Then, in Lesson 14, we’ll see how to use it.

When is it time to get more help?

Sometimes a change can be discussed with your regular healthcare team.

Other times, getting help quickly is important.

For example, sudden symptoms that could be a stroke, such as new one-sided weakness, facial drooping or difficulty speaking, need emergency assessment. Severe breathing problems, serious injuries or other immediate dangers also call for emergency help.

When something could be a medical emergency, seek emergency care right away.

For changes that aren’t emergencies, your healthcare team can help decide what needs checking.

Maybe it’s a conversation and an examination. Maybe some tests would be useful.

You can start with something as simple as:

“I’ve had this symptom before, but this time something feels different. Could we check it out?”

You don’t have to walk in with a theory about what’s wrong.

A good description of what’s happening is a great place to start.

Something to think about

Think of a symptom or episode you’ve experienced before.

What makes it familiar to you?

Now imagine something important about it changes.

Would you know who to ask for medical advice?

If you’re unsure, that’s a useful question to bring to your next appointment.

One small thing you can do

Remember your symptom map?

If you’d like, choose one familiar, medically assessed symptom and add a short description of what usually happens.

For example:

“My usual episodes involve shaking and difficulty speaking. Afterwards, I generally need some quiet time to recover.”

Already have something like that written down? Great. You can leave it as it is.

You could also ask your clinician which changes would mean getting more medical help.

And if writing or remembering feels like too much today, this activity can wait.

The idea is to make getting care easier, not give yourself another chore.

Next, we’ll use what you’ve learned to help prepare your individual safety plan.

Optional crossword

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

Optional colouring activity

Open the Lesson 12 colouring PDF (new tab), or browse the colouring collection.

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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

When what you’re seeing doesn’t quite add up

Imagine someone you care about is struggling to move their arm.

They reach for a cup, but their hand barely moves.

A little later, they’re laughing at something on television and reach for their phone without much trouble.

Hang on. How does that work?

It’s the sort of thing that can leave a supporter scratching their head.

Perhaps you’ve seen something similar with walking, speaking, shaking, memory or another symptom.

And sometimes the changes seem to happen when someone mentions the symptom or draws attention to it.

It’s understandable to have questions. You might even wonder whether the person has some control over what’s happening.

That’s where everything you’ve learned about FND so far becomes useful.

Remember what we’ve learned about FND?

Earlier lessons introduced the roles of attention, prediction and the way the brain processes information.

You also learned that symptoms can change depending on the situation.

For some people with FND, movement or another ability may become easier when their attention shifts. A symptom might also change in response to a suggestion.

That can look pretty strange from the outside.

But here’s the important part.

Real, involuntary symptoms can change with attention or suggestion.

These changes can be part of how real, involuntary functional symptoms behave.

Clinicians may even use certain changes during examination as positive diagnostic signs—findings that help them recognise FND.

Of course, the way a symptom behaves in one moment isn’t enough for a supporter to diagnose it.

And this is where you can give someone something especially valuable.

You can believe what they’re experiencing, even when you don’t fully understand how it’s happening.

You might still have questions. That’s okay.

Being curious and being supportive can go together.

Those little details you’ve been noticing

Over the previous lessons, we’ve introduced several terms that help make sense of symptoms.

Let’s bring a few of them together.

Imagine someone with FND is having a particularly difficult afternoon.

They’ve been in a noisy environment for a while. Then they notice a familiar strange feeling. Shortly afterwards, one of their usual episodes begins.

When it’s over, they’re exhausted.

There’s quite a bit of information in that little story.

The noise might have been a trigger—something that contributed to making the episode more likely.

That strange feeling might have been a warning sign, something the person noticed as the episode was approaching or beginning.

And the exhaustion afterwards? That could be a consequence of the episode, although other things may contribute to it too.

Notice the word might.

Seeing two things happen close together gives you a clue. It doesn’t necessarily tell you what caused what.

Some people have episodes without an obvious trigger or warning.

Others experience persistent symptoms that stay with them for much of the day, perhaps becoming better or worse at different times.

An episode, by comparison, has a recognisable period of symptoms, although recovery may take longer.

Why are these distinctions useful?

Because describing what happened is often more helpful to a clinician than trying to explain why it happened.

And that takes some pressure off you.

You can be a helpful observer without having to become a neurologist.

What if you remember it differently?

Here’s another situation that can get complicated.

Perhaps you remember an episode happening on Tuesday.

The person you’re supporting is certain it happened weeks earlier.

Or you remember a long period when they couldn’t speak, while they recall only a few moments.

It can feel strange when two people who were there remember the same event differently.

Earlier in the course, we talked about functional cognitive disorder (FCD) and the way thinking and memory can become unreliable. Memory differences can have several explanations, including fatigue, sleep, other health conditions and ordinary differences in recall. New cognitive changes deserve assessment on their own merits. [8]

Someone may genuinely remember an event differently from the way you do.

And, of course, supporters can forget details as well. Our memory isn’t exactly a perfect filing cabinet.

Sometimes two people are also noticing different parts of an experience.

One person may remember the fear or confusion they felt during an episode. The other may remember how long it lasted or what was happening around them.

Both perspectives can provide useful information.

When memory differences become frustrating, a shared note can sometimes help.

For instance, you might agree to record an important medical event together while the details are still reasonably fresh.

The symptom map from Lesson 11 can hold the information that matters.

A parent supporting a teenager with FND described why another person’s observations could help:

“A diary is good idea and think anyone who witnesses might be good too as he doesn’t remember what happens.”

Figure 2. A parent’s perspective in an FND community discussion. The account concerns memory around episodes; it does not establish an FCD diagnosis. [9]

The aim is to build a clearer shared picture, rather than decide whose memory wins.

And when someone finds it difficult to remember their own experiences, being listened to with patience can make an enormous difference.

What if something really has changed?

Remember the difference between familiar, changed and new symptoms from the Person section of this lesson?

Supporters can sometimes notice changes that the person experiencing the symptoms hasn’t recognised.

Perhaps an episode begins differently.

Maybe recovery is taking much longer than the pattern their clinician has assessed.

Or perhaps there’s been an injury or an entirely unfamiliar symptom.

These observations may help the healthcare team decide what needs attention.

A known FND diagnosis can explain familiar symptoms while another medical problem may still need assessment.

And some situations, such as serious injury, severe breathing difficulty or sudden signs of a possible stroke, require emergency care.

The important thing is recognising when the situation deserves medical attention, rather than feeling responsible for deciding the diagnosis yourself.

You can help describe what’s different and seek appropriate assistance when needed.

Listening is part of keeping someone safe

Something interesting happens when supporters become better at observing.

They may start recognising patterns the person with FND hasn’t noticed.

That can be helpful.

But the person experiencing the symptoms also has information that nobody else can see.

Perhaps a particular sensation tells them an episode may be approaching.

Maybe they know that certain kinds of help make things easier, while others make recovery more difficult.

Or perhaps they need a different kind of support than the one you’ve been offering.

That’s why being receptive matters.

You bring what you’ve noticed.

They bring what they’ve experienced.

And together, you may discover something neither of you had understood quite as clearly before.

Of course, conversations about symptoms can sometimes become tiring, especially when both people have already had a difficult day.

There’s room to choose when a conversation would be useful and when it’s better to leave it for another time.

Good observation helps you understand someone. Good listening helps you use that understanding in a way that respects them.

Something to think about

Has there been a time when a symptom surprised you because it looked different from what you expected?

How might what you’ve learned about FND change the way you understand that experience?

And is there something the person you support has told you about their symptoms that you’d like to understand better?

One small thing you can try

The next time the person you’re supporting describes a symptom, try giving their explanation a little room.

Perhaps there’s something they’d like you to notice, or a detail that could help their healthcare team.

If you both think it’s useful, that information can find a place on the symptom map you learned about in Lesson 11.

There’s no need to turn everyday life into a constant observation exercise.

The goal is to understand one another a little better, so that when help is needed, it fits the person and the situation.

Coming up next

You’ve spent quite a few lessons learning about FND and the different ways it can affect someone’s life.

Now we’re going to put that understanding to work.

In the next lesson, we’ll explore how two people can turn what they’ve learned into practical arrangements that make everyday life safer and easier.

That includes something just as important as understanding the person with FND:

Understanding what the supporter needs, too.

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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

When the diagnosis is right, but the explanation is incomplete

An 18-year-old woman has an established diagnosis of functional neurological disorder.

Her presentation includes functional weakness and seizures, supported by neurological examination and previous video-EEG assessment.

The diagnostic evidence is meaningful.

Yet an important part of her illness remains unexplained.

Standing makes her lightheaded. Her legs become increasingly heavy. Lying down brings relief.

Earlier standing measurements were brief and nondiagnostic.

Her orthostatic symptoms have largely been attributed to FND, anxiety or deconditioning.

The question is no longer simply whether the patient has FND.

How much of her presentation does the established diagnosis actually explain?

This exercise follows a published case reported by Das, Yerraballa and Shekhawat (2026). The clinical findings and outcome come from the case report; the questions and reasoning commentary are educational additions. (5)

First, consider the clinical pattern

There are two potentially important observations.

The patient has positive evidence supporting FND.

She also describes symptoms that repeatedly worsen with standing and improve when supine.

What weight should each finding carry?

Does the existing neurological examination adequately explain the positional pattern?

And how much confidence should be placed in brief orthostatic measurements that failed to establish a diagnosis?

The previous measurements have left a question unresolved. They haven’t established that autonomic dysfunction is absent.

The symptom pattern provides a reason to investigate a specific physiological possibility.

This is an important distinction in FND care.

A positive diagnosis can remain secure while the clinical formulation expands to account for additional findings.

What the treating team found

On reassessment, positive functional motor signs were still present.

That matters because the investigation of another condition did not require abandoning the established FND diagnosis.

The team quantified the patient’s autonomic symptoms, reviewed medications and considered alternative explanations before arranging formal autonomic testing.

The tilt-table findings were striking.

Autonomic testing	Reported finding
Initial heart rate	95 beats/min
Heart rate during tilt	144 beats/min
Change within ten minutes	+49 beats/min
Additional findings	Symptoms reproduced; no orthostatic hypotension; elevated blood pressure

Findings reported in the published case, not a general diagnostic protocol. (5)

Before considering the authors’ conclusion, what does this result add?

How would medication effects, cardiac rhythm abnormalities and other causes of orthostatic tachycardia affect its interpretation?

And which of the patient’s symptoms would still require a separate explanation?

Evidence changes the formulation

After considering the clinical presentation, autonomic findings, laboratory results, rhythm assessment and alternatives, the authors diagnosed coexisting postural orthostatic tachycardia syndrome (POTS).

The orthostatic tachycardia and reproduced symptoms provided objective evidence supporting the additional diagnosis in its clinical context.

The positive functional motor findings remained relevant.

So did the previously established functional seizures.

The result was a more complete formulation: FND and POTS coexisted.

This is the central lesson of the case.

New evidence can clarify what an established diagnosis explains and where another explanation is needed.

This is particularly valuable when symptoms overlap.

Leg heaviness, fatigue, dizziness and difficulty remaining upright can influence functional ability through more than one mechanism.

A patient may experience several of these problems together.

The clinical task is to determine which mechanisms the evidence supports and how they interact, while retaining uncertainty where the evidence remains incomplete.

Why the distinction matters

The consequences extend beyond diagnostic accuracy.

Consider a patient whose orthostatic difficulties have repeatedly been attributed to anxiety, deconditioning or FND.

Further rehabilitation may still be appropriate.

But an unrecognised autonomic disorder can change how clinicians interpret activity intolerance, select interventions and judge treatment tolerance.

In the published case, POTS-directed management was introduced alongside continuing FND care.

Mobility subsequently improved.

The authors could not determine how much improvement resulted from any one intervention, and the additional diagnosis did not explain every symptom.

That limitation matters.

The case supports the value of identifying a coexisting condition. It does not establish that treating POTS caused the observed improvement or that the same pathway applies to every patient with FND. (5)

A contrasting case: when the original diagnosis needs revision

The distinction becomes clearer when compared with a different published account.

Berry and Wiethoff (2020) described a 62-year-old woman initially diagnosed with a functional voice disorder.

Her presentation included progressive voice problems, difficulty opening her eyes and falls.

As symptoms progressed, repeated examinations and further investigations supported a clinical diagnosis of progressive supranuclear palsy.

The authors also considered that functional symptoms probably remained alongside the neurodegenerative disorder.

An interesting detail emerged: indoor sunglasses, previously interpreted as supporting a functional explanation, helped reduce aggravation of blepharospasm. Sunglasses alone are not a diagnostic sign of FND; their meaning depends on the wider clinical assessment.

This case raises a different question.

When does additional evidence justify expanding a diagnosis, and when does it require revising the original formulation?

In the first case, evidence supported FND alongside POTS.

In the second, progression and further assessment led clinicians to reconsider an earlier functional diagnosis.

Both illustrate the importance of allowing the current clinical evidence to shape the formulation.

They are different diagnostic situations, and neither establishes that FND generally predicts an overlooked neurological condition. (6)

Applying this reasoning in practice

The symptom map introduced in Lesson 11 can help distinguish different patterns without prematurely assigning them a common cause.

In the primary case, the clinically useful distinctions include functional seizures, functional weakness and symptoms specifically associated with standing.

Documenting these patterns separately makes it easier to identify unresolved questions and communicate the evidence supporting each diagnosis.

This also creates an opportunity to make clinical reasoning more transparent.

For example, the record might distinguish an established positive functional diagnosis from a newly confirmed autonomic disorder, noting which symptoms remain uncertain and who will reassess them.

That clarity can reduce fragmented care.

It also makes subsequent clinical decisions easier to understand for patients, supporters and professionals.

Where this leaves the care team

The first case raises a practical question beyond diagnosis.

Once a second condition is recognised, what should change?

The answer may involve rehabilitation goals, symptom-specific treatment, activity planning, safety arrangements and coordination between professionals.

The existing symptom map provides a starting point.

In Lesson 13, we’ll examine how to translate that information into a practical safety plan, including when occupational therapy, physiotherapy, medical specialists or other professionals should contribute.

We’ll also consider the costs of fragmented care and the potential benefits of choosing interventions that address clearly identified needs.

The strongest clinical formulation is one that remains accurate as new evidence emerges—and leads to care that better fits the person.

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

Further reading

• Memory supports
• Functional-seizure safety planning

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Research and Sources

The clinical exercise is based on two published case reports. The emergency-department and iatrogenic-harm reviews give broader context for reassessment and proportionate intervention. Case reports illustrate clinical reasoning but cannot establish how often an additional diagnosis occurs or attribute treatment effects. The Das report also describes hypermobility/hEDS and incomplete medication chronology; this exercise selects findings relevant to its teaching question. The community account illustrates one person’s experience. Ball and colleagues inform the distinction between cognitive symptoms and a positive FCD diagnosis. [2][3][4][5][6]

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]	—	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
[3]	—	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
[4]	—	Anderson JR, Nakhate V, Stephen CD, Perez DL. Functional (psychogenic) neurological disorders: assessment and acute management in the emergency department. Seminars in Neurology. 2019;39(1):102–114. FND-CIT-0070. https://doi.org/10.1055/s-0038-1676844
[5]	—	Das S, Yerraballa SRN, Shekhawat P. Coexisting postural orthostatic tachycardia syndrome on autonomic reflex testing in functional neurologic disorder. American Journal of Case Reports. 2026;27:e953323. https://doi.org/10.12659/AJCR.953323 FND-CIT-0293.
[6]	—	Berry AJ, Wiethoff S. Revising a diagnosis of functional neurological disorder—a case report. Oxford Medical Case Reports. 2020;2020(9):omaa073. https://doi.org/10.1093/omcr/omaa073 FND-CIT-0294.
[7]	Figure 1	Public Reddit comment, now-deleted account, in “Sharing my success story.” r/FND. Original comment. Verified October 25, 2026. Individual lived experience. FND-CIT-0295.
[8]	—	Ball HA, McWhirter L, Ballard C, Bhome R, Blackburn DJ, Edwards MJ, et al. Functional cognitive disorder: dementia’s blind spot. Brain. 2020;143(10):2895–2903. https://doi.org/10.1093/brain/awaa224 FND-CIT-0071.
[9]	Figure 2	Public parent contribution in “Teenage son diagnosed, any helpful advice/support?” r/FND. Original discussion. Quotation checked in the October 25, 2026 caregiver quotation bank. Individual lived experience; memory surrounding episodes is not a confirmed FCD diagnosis. FND-CIT-0299.

This page still needs review by people with FND, supporters, emergency clinicians and neurologists.

Initial draft: September 4, 2026 · Evidence audit and approved corrections: October 25, 2026 · Editorial Audit 2: October 25, 2026 · Independent clinical review pending