Summary:Purpose: This study tests the hypothesis that trauma histories, including histories of physical and sexual abuse, and posttraumatic stress disorder (PTSD) are more prevalent in psychogenic non-epileptic seizure (NES) patients than in epilepsy patients.Methods: Thirty-five inpatients with intractable seizures were evaluated for trauma history and PTSD. After these assessments, patients were diagnosed as having either epileptic or nonepileptic seizures through EEG monitoring.Results: NES diagnosis correlated with PTSD and total number of lifetime traumas, adult traumas, and abuse traumas. Contrary to previous hypotheses, reported childhood sexual abuse (CSA) did not correlate significantly with NES diagnosis. However, CSA predicted PTSD in a discriminant analysis.Conclusions: We found evidence for the hypothesized relations between trauma, abuse, PTSD, and NES diagnosis. However, elevated levels in both seizure-disorder groups suggest that routine assessment for abuse, trauma, and PTSD might facilitate medical care and treatment for all intractable seizure patients. Key Words: PTSD-Trauma-NES-EpilepsyAbuse.The purpose of this study was to compare prevalence of trauma exposure, sexual and physical abuse, and posttraurnatic stress disorder (PTSD) in two seizure-disorder populations. We tested the hypothesis that trauma histories, including histories of physical and sexual abuse, and PTSD are more prevalent in psychogenic non-epileptic seizure (NES) patients than in epilepsy patients.Psychogenic nonepileptic seizures are by far the most frequent nonepileptic conditions seen in epilepsy centers, NES patients accounting for approximately half of inpatient and one fifth of outpatient epilepsy visits (1,2). NESs can be defined as behavioral events that resemble epileptiform seizures but are without identifiable physiological cause. Historically, many hypotheses have been put forth to link the NES syndrome to comorbid psychiAccepted October 20, 1999. Address correspondence and reprint requests to H. J. Rosenberg at Dartmouth-Hitchcock Medical Center, One Medical Center Drive, atric disorders or particular psychological profiles. Although there has been no confirmation of a specific diagnostic link, many researchers have focused on the relation of trauma exposure and abuse history to NES symptoms. Female patients constitute 75 to 85% of diagnosed NES patients (3), and a number of recent studies have reported high rates of severe psychological trauma (particularly sexual and physical abuse traumas) in women with NES (1,[3][4][5][6][7][8][9][10]. Although fewer data are available on trauma in men with NES, there also are reports suggesting higher rates of abuse than for men in the general population (1 1). Several influential writers have hypothesized that NESs represent a particular form of psychological response to abuse (e.g., a type of dissociation or a conversion reaction) (1,5,6,9,12). Nash (12) stated that NESs should be properly thought of as dissociative phenomena generated by childhood trauma. Bowman (1) al...