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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, 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]
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“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]
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“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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Reuber, M., & Kurthen, M. (2011) · Behavioural Neurology · doi:10.1155/2011/327654 · Cited by 28
Implicit attentional bias for facial emotion in dissociative seizures: Additional evidence
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Self-citationSaxena, A. R., Godena, E. J., Maggio, J., & Perez, D. L. (2020) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s247119 · Cited by 27
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Cole, R. H., Elmalem, M. S., & Petrochilos, P. (2023) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2023.120585 · Cited by 27
Dissociative seizures in the emergency room: room for improvement
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Metadata
- 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 › Clinical Neurology › Epilepsy research and treatment
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › 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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