Functional Neurological Disorder (FND): A Guide for Care Staff

Functional neurological disorder, usually shortened to FND, is one of the most common reasons people attend neurology clinics, yet it is still widely misunderstood. People with FND can have real and disabling symptoms such as weakness, tremor, seizures or loss of sensation, and they often tell stories of not being believed. For care and healthcare staff, understanding FND is a matter of both good practice and basic respect. This guide explains the condition and how to support people who have it.

It is general information, not clinical advice. Diagnosis and treatment are for specialists, and care plans should follow the person's individual assessment.

What is FND?

NHS information describes FND as a condition in which the brain has difficulty processing messages from the body, so that the nervous system does not work as it should. It is not caused by brain damage or by a disease of the nervous system, and it is not inherently dangerous, although injuries can occur as a result of symptoms such as falls. The symptoms are real and are not made up or under conscious control.

Common symptoms

FND can look different in every person. The NHS lists symptoms that include:

• Movement. Weakness in a limb, tremors, spasms, jerky movements and difficulties with walking.
• Sensation. Numbness, tingling, pain that is often on one side, loss of vision or double vision.
• Altered awareness. Non-epileptic seizures, blackouts and faints.
• Other symptoms. Chronic pain, fatigue, anxiety, problems with memory and disturbed sleep.

Symptoms often vary from day to day, and can worsen with stress, tiredness or pain. That variability is part of the condition, and should not be taken as evidence that the person is exaggerating.

How FND is diagnosed

NHS services state that diagnosis relies on positive signs and symptoms, not just on ruling out other conditions. A neurologist or other specialist normally makes the diagnosis, and getting there can take time. Many people have waited years and been told that nothing is wrong, which is why a clear explanation is so important once the diagnosis is made.

How FND is treated

There is no medicine that cures FND, because it is not caused by disease. NHS treatment pathways describe a staged approach that includes:

1. education, so that the person understands what FND is and how it works
2. strategies for managing symptoms, often with physiotherapy or occupational therapy input
3. psychological support for stress, anxiety and coping patterns, where appropriate

Many people improve with the right rehabilitation, but recovery is different for each person.

Non-epileptic seizures

Some people with FND have seizures that look like epileptic seizures but are not caused by abnormal electrical activity in the brain. It can be hard, even for professionals, to tell the two apart without specialist tests. Staff should follow the person's individual seizure plan, keep them safe, and call for emergency help if the seizure is a first one, if the person is injured, or if the plan or your training says to. If you are unsure, treat it as an emergency. Our epilepsy and seizure management guide gives more detail on seizure first aid and risks.

How staff can help

• Believe the person. Acknowledge that symptoms are real and distressing. Avoid phrases such as "it's all in your head."
• Be consistent. Use the same explanation as the clinical team, and avoid conflicting messages.
• Support independence. Encourage the person to use their rehabilitation strategies, and avoid taking over tasks they can do.
• Reduce triggers. Stress, pain and fatigue can all make symptoms worse, so plan rest and predictable routines.
• Keep the person safe. Think about falls risk, mobility aids and the environment.
• Record accurately. Describe what you see, including how long symptoms last and what happened beforehand.

Emotional wellbeing

For some people stress or past trauma may play a part, but not everyone has such a history, so staff should respond with care and curiosity, not assumptions. Our trauma-informed care guide explains approaches that help people feel safe and in control.

Work and everyday life

FND can affect work, education and relationships. Employers can help with changes such as flexible hours, rest breaks and adapted workstations. See our reasonable accommodations guide for ideas that apply to many long-term conditions.

Frequently asked questions

Is FND a psychiatric condition?

FND is diagnosed and managed by neurology and related services. It involves how the nervous system functions, not damage to it, and psychological factors may play a part for some people, but that does not make the symptoms any less real.

Can someone recover from FND?

Many people improve with education, rehabilitation and psychological support. Outcomes vary between individuals.

Should staff challenge the diagnosis?

No. Raise concerns with the clinical team, but do not tell the person their symptoms are not real.

Where can teams find training?

See the CPD hub for professional development options for care and healthcare teams.

Learnsignal will update this guide as national guidance develops.