Cluster analysis of normal personality traits in patients with psychogenic nonepileptic seizures

Cragar, Dona E.; Berry, David T. R.; Schmitt, Frederick A.; Fakhoury, Toufic

doi:10.1016/j.yebeh.2005.03.007

Cited by 91 publications

(81 citation statements)

References 26 publications

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“…• Account of semiology and phenomenology seems to imply deliberate simulation/deceit • Unclear whether it can account for PNES that arise in the absence of obvious seizure models and that have changed little over time • Cannot explain why very similar PNES-behaviours have been observed across different cultures • It is often difficult to identify reinforcers/gains for PNES, making it difficult to explain symptom onset and resistance to extinction compared to controls with epilepsy and the other which does not (Brown et al, 2013;Cragar, Berry, Schmitt, & Fakhoury, 2005;Reuber, Pukrop, Bauer, Derfuss, & Elger, 2004;Uliaszek, Prensky, & Baslet, 2012). Taken together, these findings suggest that many people with PNES experience elevated physical arousal but do not recognize or describe themselves as anxious (Goldstein & Mellers, 2006;Dimaro et al, 2014).…”

Section: Anxiety and Dissociation During Pnesmentioning

confidence: 99%

Towards an integrative theory of psychogenic non-epileptic seizures (PNES)

Brown

Reuber

2016

Clinical Psychology Review

194

208

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Current models of PNES can account for some but not all of the available data.• Automatic activation of seizure representations in memory may be a unifying process.• Suppression of arousal and distress are typical maintaining factors for PNES.• Inhibitory dysfunction, often arising from chronic stress, is a key vulnerability. • Trauma exposure is common but neither necessary nor sufficient for PNES to occur. a b s t r a c tPsychogenic Nonepileptic Seizures (PNES) superficially resemble epileptic seizures but are thought to have a psychological rather than epileptic basis. Patients with PNES vary widely in terms of background, personality profiles, comorbidities, response to treatment and outcomes. Previous accounts interpreting these seizures as the activation of dissociated material, a physical manifestation of emotional distress, hard-wired reflex responses, or learned behaviours cannot explain key features of the phenomenon. Drawing on a brief review of the literature on etiology, correlates and phenomenology of PNES, this paper integrates existing approaches and data within a novel explanatory framework that applies to all PNES patients with subjectively involuntary seizures. Following the Integrative Cognitive Model of medically unexplained symptoms, we suggest that the central feature of all PNES is the automatic activation of a mental representation of seizures (the "seizure scaffold") in the context of a high level inhibitory processing dysfunction. This often arises in response to elevated autonomic arousal, and may disrupt the individual's awareness of distressing material, but can become divorced from abnormal autonomic and emotional activity. This model accounts both for existing findings and the heterogeneity of patients with PNES, whilst leading to a number of novel hypotheses against which it can be evaluated.

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Section: Anxiety and Dissociation During Pnesmentioning

confidence: 99%

Towards an integrative theory of psychogenic non-epileptic seizures (PNES)

Brown

Reuber

2016

Clinical Psychology Review

194

208

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“…Indeed, while psychodynamic, cognitive, behavioral, and systemic psychological theories offer dif-ferent accounts of PNESs [3], all recognize the patient's response to anxiety as a significant contributing factor and suggest that PNESs may reflect an inability, failure, or unwillingness to actively engage with anxiety. This recognition is supported by evidence that patients with PNESs generally report a greater preference for avoidant coping strategies and are more likely to somaticize their distress compared with those with epilepsy [4][5][6][7][8][9][10]. Nevertheless, relatively little research has specifically addressed avoidance in PNESs despite its key role in many psychological theories about the etiology of PNESs.…”

Section: Anxiety and Avoidance In Psychogenic Nonepileptic Seizuresmentioning

confidence: 99%

Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety

Dimaro

Dawson

Roberts

et al. 2014

Epilepsy & Behavior

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This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit-explicit anxiety discrepancies were only identified in patients with PNESs (p b .001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r = .63, p b .01) and frequency of seizures (r = .67, p b .01); implicit anxiety correlated with frequency of seizures only (r =.56,p b .01). Our findings demonstrate the role of implicit anxiety in PNESs and provide addi-tional support for the contribution of explicit anxiety and experiential avoidance to this disorder.

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“…Abnormal neuropsychological performance in patients with PNES was associated with the degree of psychopathology as measured by the MMPI-2 in one study (Cragar et al 2005). PNES patients who were relatively normal or who had somatoform abnormalities on the MMPI-2 had better neuropsychological performance than patients with emotional problems as measured by MMPI-2.…”

Section: %mentioning

confidence: 96%

“…Nonepileptic seizure of psychogenic origin patients may have cognitive impairment because of developmental problems including low intelligence or specific learning disabilities; comorbid neurological conditions, especially ES; or psychiatric conditions, but many if not most PNES patients who pass symptom validity testing will perform normally. The findings relating degree of emotional and personality disturbance to the likelihood of neuropsychological abnormality (Cragar et al 2005) are interesting and are in need of replication.…”

Section: Implications For Forensic Neuropsychological Practicementioning

confidence: 99%