Ictal symptoms of anxiety, avoidance behaviour, and dissociation in patients with dissociative seizures
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OBJECTIVE: To examine anxiety related seizure symptoms and avoidance behaviour in adults with dissociative (psychogenic non-epileptic) seizures (DS) in comparison with a group suffering from partial epilepsy. METHODS: 25 DS and 19 epilepsy patients completed an attack symptom measure, the hospital anxiety and depression scale, the dissociative experiences scale, and the fear questionnaire. RESULTS: DS patients reported the presence of significantly greater numbers of somatic symptoms of anxiety during their attacks than the epilepsy group, despite not reporting subjectively higher levels of anxiety. The DS patients also reported higher levels of agoraphobic-type avoidance behaviour than the epilepsy group. Measures of dissociation were higher in the DS group, who also reported greater symptoms of depression. CONCLUSIONS: The findings support a model whereby DS occur as a paroxysmal, dissociative response to heightened arousal in the absence of raised general anxiety levels. The model has practical implications for clinical assessment and treatment: in clinical practice, inquiry about these symptoms may help in the diagnosis of DS; with respect to treatment, the anxiety related symptoms and avoidance behaviour prevalent in DS are a potential focus for a cognitive behavioural approach analogous to that used in the treatment of other anxiety disorders.
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In FND populations, elevated dissociation has been related to anxiety levels, lower interoceptive accuracy, maternal disfunction, other psychiatric comorbidities and childhood trauma.
“In FND populations, elevated dissociation has been related to anxiety levels, 21 lower interoceptive accuracy, 184,191 maternal disfunction, 192 other psychiatric comorbidities 169 and childhood trauma.169”
From A new science of emotion: implications for functional neurological disorder (2022) · cites this paper as [21]
The Discussion (page unavailable) describes dissociative seizures as a response to acute anxiety and heightened arousal, supporting a link between dissociation and attack-related anxiety. But the study found no raised general anxiety levels in the dissociative-seizure group, so it does not support an unqualified association with anxiety levels. This citation is attached only to the anxiety part of the sentence, not the other listed factors. (LLM, conf=0.85)
Experimental — accuracy not yet measuredLoss of consciousness and memory are not specific for PNES, since they can also occur in other paroxysmal conditions (e.g., syncope).
“loss of consciousness and memory are not specific for PNES, since they can also occur in other paroxysmal conditions (e.g., syncope) (98).”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [98]
The seizure-semiology table (section labeled DISCUSSION; page unavailable) reports loss of awareness or unresponsiveness in patients with dissociative seizures and lists complex partial seizures in the epilepsy comparison group, supporting the broader point that altered awareness is not unique to PNES. The paper does not establish the claim about memory loss or say that these symptoms occur in syncope. (LLM, conf=0.82)
Experimental — accuracy not yet measuredHyperarousal is common in FND, exemplified by the observation of panic attack without panic in people with functional seizures, as well as increased sympathetic tone and abnormal startle responses in FND populations.
“Hyperarousal is common in FND; this is exemplified by the observation of 'panic attack without panic' in people with functional seizures, as well as increased sympathetic tone and abnormal startle responses in FND populations.21,46,164,165”
From A new science of emotion: implications for functional neurological disorder (2022) · cites this paper as [21]
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- Authors
- Goldstein, L. H.
- Affiliations
- King's College London (GB)
- Corresponding author
- Goldstein, L H
- ORCID
- Goldstein, L H
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2006-05-01
- Volume
- 77
- Issue
- 5
- Pages
- 616-621
- ISSN
- 0022-3050 (ISSN-L)
- PMC
- PMC2117432
- OpenAlex
- W2134244149
- Semantic Scholar
- c7b45c28e499465a317ced25eb5fafc3406a1d9e
- Cited by
- 224
- References
- 46
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 15 · 2023: 12 · 2022: 13 · 2021: 11 · 2020: 17 · 2019: 12 · 2018: 12 · 2017: 9 · 2016: 19 · 2015: 12 · 2014: 10 · 2013: 17 · 2012: 11
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- psychogenic non-epileptic seizures, avoidance behavior, agoraphobic avoidance, dissociation, focal epilepsy, somatic anxiety, depression, cognitive-behavioral intervention
- MeSH terms
- Adult, Agoraphobia, Anxiety, Anxiety Disorders, Avoidance Learning, Conversion Disorder, Depressive Disorder, Diagnosis, Differential, Dissociative Disorders, Electroencephalography, Epilepsies, Partial, Female, Humans, Male, Middle Aged, Personality Inventory, Seizures, Somatoform Disorders
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