The results underscore the importance of incorporating onset-specific considerations into clinical care and support strategies. Future studies should aim to gain a deeper understanding of the psychosocial burden of FA across the lifespan. By considering the unique pathways of patients in different life stages, researchers can tailor interventions to address differing illness perceptions across various age at onset. Comparative studies across different hereditary ataxias, such as spinocerebellar ataxias, could clarify whether the onset-dependent patterns we observed are specific to FA or represent broader features of progressive ataxic disorders. Moreover, qualitative approaches should complement quantitative measures to deepen insight into patients’ lived experiences, particularly regarding interpersonal challenges and the use of assistive devices. Finally, future intervention studies should include targeted psychosocial support, counselling, or stigma-reduction strategies can mitigate the adverse impact of relationship-related life events and improve mental wellbeing in FA, especially for those with pediatric onset.