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

Abstract

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.

Neuropsychiatric Factors Linked to Adherence and Short-Term Outcome in a U.S. Functional Neurological Disorders Clinic: A Retrospective Cohort Study

“…45,[53][54][55][56] Although this unified, interdisciplinary approach may help streamline clinical and research activities, more subtle distinctions across subtypes are also relevant, including differences across subtypes related to dissociation and personality profiles. 55,57,58 This study has several limitations, including the retrospective design and the lack of utilization of objective functional status measurements (i.e., timed walk test) or standardized self-report measures (i.e., quality-of-life scales). However, outcome measures for FND have yet to be standardized, and existing functional movement disorder measures are not generalizable across semiologies.…”

The association of panic and hyperventilation with psychogenic non-epileptic seizures: A systematic review and meta-analysis

“…All of the included studies reported an association between panic and PNES, although the methods used and the reported rates of association varied widely. There were differences in methods of patient recruitment [22,23], methods and timing of psychological evaluation [23,24,27,29,30], and potential selection bias [8,[17][18][19][20]. Furthermore, panic attack symptoms were recorded retrospectively in all but one study [20].…”

“…A more recent study by Ekanayake et al studied several measures to distinguish between patients with PNES and those with Psychogenic Motor Disorders (PMD), and found panic disorder in eight out of 43 patients (19%) with PNES, significantly more than in patients with PMD (p = 0.0009) [29].…”

Shared demographics and comorbidities in different functional motor disorders

“…A small study in which functional paresis was compared to functional movement disorders has found relatively non-specific differences, like male predominance, lower psychiatric hospitalisation and higher incidence of head trauma in functional paresis [5]. When comparing patients with non-epileptic attacks to FMD, differences in risk factors, etiological background and psychological comorbidity were found [6,7]. A review paper comparing non-epileptic attacks and FMD however, concluded that similarities exceed the differences in terms of demographics and associated psychological and physical symptoms [8].…”