Comparisons of childhood trauma, alexithymia, and defensive styles in patients with psychogenic non-epileptic seizures vs. epilepsy: Implications for the etiology of conversion disorder

Kaplan, Meg S.; Dwivedi, Alok; Privitera, Michael; Isaacs, Kelly; Hughes, Cynthia; Bowman, Michelle R.

doi:10.1016/j.jpsychores.2013.06.005

Cited by 94 publications

(63 citation statements)

References 29 publications

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“…In our study, mean scores for PNES (mean = 56.6) were in the moderate range, which were significantly different from patients with PMD who reported low scores (mean 43.1; p=0.0002). These differences in our study are consistent with Kaplan et al (2013) (51) who also found that for every one-point rise in total TAS-20 score, the odds ratio for being affected by PNES was augmented by 1.028, with patients with PNES having higher levels of alexithymia than those with PMD (see Supplementary Table S1). Brown et al (2013) (52) identified two different groups of patients with PNES: one of these groups had trouble describing and expressing their emotions, while the other group did not have difficulty with alexithymia.…”

Section: Discussionsupporting

confidence: 92%

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Personality traits in psychogenic nonepileptic seizures (PNES) and psychogenic movement disorder (PMD): Neuroticism and perfectionism

Ekanayake

Kranick

LaFaver

et al. 2017

Journal of Psychosomatic Research

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Objective Psychogenic movement disorder (PMD) and psychogenic non-epileptic seizures (PNES) are two subtypes of conversion disorder (CD). In this case-control study, we asked whether these subtypes varied as a function of personality and history of childhood abuse, using the NEO Personality Inventory Revised (NEO PI-R). Methods Fifty-nine patients with PMD from the Human Motor Control Section Clinic at the National Institutes of Health, 43 patients with PNES from the Rhode Island Hospital Neuropsychiatry and Behavioral Neurology Division, and 26 healthy volunteers (HC) received a battery of neurological, psychiatric and psychological assessments. Results One-way ANOVA between the three groups indicated significant differences in overall domains of Neuroticism (p=0.001) and Conscientiousness (p=0.009): Patients with PNES reported significantly greater levels of Neuroticism (p=0.002) and lower levels of Conscientiousness (p=0.023) than patients with PMD. Levels of Neuroticism remained significantly higher in both PMD and PNES than HC following correction for multiple comparisons. Patients with PNES reported greater levels of depressive and anxiety symptoms, overall psychopathology, greater history of sexual abuse, greater levels of alexithymia, higher levels of dissociative symptoms, and an earlier age at which they experienced their most distressing traumatic event than patients with PMD. Conclusions These findings suggest that personality traits, type of abuse and age of onset of trauma varies as a function of CD subtype. Patients with PNES rated greater Neuroticism and lower Conscientiousness than patients with PMD. These differing psychological profiles may inform differing treatment approaches such as psychological therapies for PNES and physiotherapy (with/without psychotherapy) for PMD.

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Section: Discussionsupporting

confidence: 92%

“…Kaplan et al (2013) (51) note that a score of at least 61 indicates high levels of alexithymia, while a score of 51 or below indicates low levels of alexithymia. In our study, mean scores for PNES (mean = 56.6) were in the moderate range, which were significantly different from patients with PMD who reported low scores (mean 43.1; p=0.0002).…”

Section: Discussionmentioning

confidence: 99%

Personality traits in psychogenic nonepileptic seizures (PNES) and psychogenic movement disorder (PMD): Neuroticism and perfectionism

Ekanayake

Kranick

LaFaver

et al. 2017

Journal of Psychosomatic Research

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“…A tendency to suppress affect was identified by Novakova et al (2015) and Gul and Ahmad (2014), whereas problems with emotional regulation were found by Roberts et al (2012). In contrast, other studies have found no evidence for disproportionate denial (Kaplan et al, 2013;Testa & Brandt, 2010;Testa, Krauss, Lesser, & Brandt, 2012) or emotional suppression (Testa et al, 2012) in this group. As before, these variable findings probably reflect the heterogeneity of patients with PNES: Reuber et al (2004), Uliaszek et al (2012) and Brown et al (2013) all found emotion regulation problems in only a sub-set of patients with PNES, alongside elevated psychopathology more generally.…”

Section: Somatization and Emotional Processingcontrasting

confidence: 56%

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

Brown

Reuber

2016

Clinical Psychology Review

210

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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“…As additional evidence for this interpretation, patients with FMS were not significantly different from controls In the last few years, several studies have examined the relationship between alexithymia and functional neurological symptoms, mainly focusing on NESs. The most common finding is that patients with NESs are no more likely to have alexithymia than patients with epileptic seizures; [16][17][18][19][20][21][22][23][24][25][26][27] one study has found an increased prevalence in NES, 28 although another suggests that emotional dysregulation, including alexithymia, may pertain to a small subgroup. 29 Only one study has assessed alexithymia in other functional disorders.…”

Section: Discussion Alexithymiamentioning

confidence: 99%

The Role of Alexithymia in the Development of Functional Motor Symptoms (Conversion Disorder)

Demartini

Petrochilos

Ricciardi

et al. 2014

Journal of Neurology, Neurosurgery & Psychiatry

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Comparisons of childhood trauma, alexithymia, and defensive styles in patients with psychogenic non-epileptic seizures vs. epilepsy: Implications for the etiology of conversion disorder

Cited by 94 publications

References 29 publications

Personality traits in psychogenic nonepileptic seizures (PNES) and psychogenic movement disorder (PMD): Neuroticism and perfectionism

Personality traits in psychogenic nonepileptic seizures (PNES) and psychogenic movement disorder (PMD): Neuroticism and perfectionism

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

The Role of Alexithymia in the Development of Functional Motor Symptoms (Conversion Disorder)

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