Childhood trauma and dissociation in women with pseudoseizure-type conversion disorder

Özçetin, Adnan; Belli, Hasan; Ertem, Umit; Bahçebaşı, Talat; Ataoğlu, Ahmet; Canan, Fatih

doi:10.3109/08039480903029728

Cited by 32 publications

(15 citation statements)

References 21 publications

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“…66,100-103 A particular relationship between early-life childhood sexual abuse and PNES has been demonstrated in the literature, 101,104 and prior psychological trauma in PNES has also been linked to the development of other MUS. 102 In a large cohort of 176 subjects with definite PNES, prior sexual abuse was associated with early symptom onset, greater diagnostic delay, more severe spells typically of a “convulsive type,” emotionally triggered events, and flashbacks among other symptoms.…”

Section: Introductionmentioning

confidence: 96%

An Integrative Neurocircuit Perspective on Psychogenic Nonepileptic Seizures and Functional Movement Disorders

et al. 2014

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Functional Neurological Disorder (conversion disorder) is a neurobehavioral condition frequently encountered by neurologists. Psychogenic Non-Epileptic Seizure (PNES) and Functional Movement Disorder (FMD) patients present to epileptologists and movement disorder specialists respectively, yet neurologists lack a neurobiological perspective through which to understand these enigmatic groups. Observational research studies suggest that PNES and FMD may represent variants of similar (or the same) conditions given that both groups exhibit a female predominance, have increased prevalence of mood-anxiety disorders, frequently endorse prior abuse, and share phenotypic characteristics. In this perspective article, neuroimaging studies in PNES and FMD are reviewed, and discussed using studies of emotional dysregulation, dissociation and psychological trauma in the context of motor control. Convergent neuroimaging findings implicate alterations in brain circuits mediating emotional expression, regulation and awareness (anterior cingulate and ventromedial prefrontal cortices, insula, amygdala, vermis), cognitive control and motor inhibition (dorsal anterior cingulate, dorsolateral prefrontal, inferior frontal cortices), self-referential processing and perceptual awareness (posterior parietal cortex, temporoparietal junction), and motor planning and coordination (supplementary motor area, cerebellum). Striatal-thalamic components of prefrontal-parietal networks may also play a role in pathophysiology. Aberrant medial prefrontal and amygdalar neuroplastic changes mediated by chronic stress may facilitate the development of functional neurological symptoms in a subset of patients. Improved biological understanding of PNES and FMD will likely reduce stigma and aid the identification of neuroimaging biomarkers guiding treatment development, selection and prognosis. Additional research should investigate neurocircuit abnormalities within and across functional neurological disorder subtypes, as well as compare PNES and FMD to mood-anxiety-dissociative disorders.

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Section: Introductionmentioning

confidence: 96%

An Integrative Neurocircuit Perspective on Psychogenic Nonepileptic Seizures and Functional Movement Disorders

et al. 2014

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“…Dissociative disorders (DD), characterized amongst others by loss of sensations and control of bodily movements [1], are often related to traumatic experience like sexual abuse [2, 3], and emotional neglect or abuse [4, 5]. Hence, it has been discussed whether DD can be conceived of as trauma-related syndrome [6–9].…”

Section: Introductionmentioning

confidence: 99%

Somatoform dissociation and posttraumatic stress syndrome – two sides of the same medal? A comparison of symptom profiles, trauma history and altered affect regulation between patients with functional neurological symptoms and patients with PTSD

et al. 2017

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BackgroundHistory of traumatic experience is common in dissociative disorder (DD), and similarity of symptoms and characteristics between DD and posttraumatic stress disorder (PTSD) encouraged to consider DD as trauma-related disorder. However, conceptualization of DD as a trauma-related syndrome would critically affect diagnosis and treatment strategies. The present study addressed overlap and disparity of DD and PTSD by directly comparing correspondence of symptoms, adverse/traumatic experience, and altered affect regulation between patients diagnosed with dissociative disorder (characterized by negative functional neurological symptoms) and patients diagnosed with PTSD.MethodsSomatoform and psychoform dissociation, symptoms of posttraumatic stress, general childhood adversities and lifetime traumata, and alexithymia as index of altered affect regulation were screened with standardized questionnaires and semi-structured interviews in 60 patients with DD (ICD-codes F44.4, F44.6, F44.7), 39 patients with PTSD (ICD-code F43.1), and 40 healthy comparison participants (HC).ResultsDD and PTSD patients scored higher than HC on somatoform and psychoform dissociative symptom scales and alexithymia, and reported more childhood adversities and higher trauma load. PTSD patients reported higher symptom severity and more traumata than DD patients. Those 20 DD patients who met criteria of co-occuring PTSD did not differ from PTSD patients in the amount of reported symptoms of somatoform dissociation, physical and emotional childhood adversities and lifetime traumata, while emotional neglect/abuse in childhood distinguished DD patients with and without co-occuring PTSD (DD patients with co-occuring PTSD reporting more emotional maltreatment).ConclusionThe pattern of distinctive somatoform and psychoform dissociative symptom severity, type of childhood and lifetime traumata, and amount of alexithymia suggests that DD and PTSD are distinctive syndromes and, therefore, challenges the conceptualization of DD as trauma-related disorder. Together with the detected close correspondence of symptom and experience profiles in DD patients with co-occuring PTSD and PTSD patients, these findings suggest that adverse/traumatic experience may intensify dissociative symptoms, but are not a necessary condition in the generation of functional neurological symptoms. Still, diagnosis and treatment of DD need to consider this impact of traumata and post-traumatic stress symptoms.

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“…The presence of PNESs accounted for a significant variance (approximately 15%) of pathological dissociation. This may indicate that PNESs per se can be classified as a subtype of dissociative experiences as previously proposed [26][27][28]. Our findings can add another piece of evidence to the association between PNESs and dissociative experiences [12,13,15,[29][30][31].…”

Section: Discussionmentioning

confidence: 47%

Dissociative experiences in epilepsy: Effects of epilepsy-related factors on pathological dissociation

Hara

Adachi

Akanuma

et al. 2015

Epilepsy & Behavior

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Childhood trauma and dissociation in women with pseudoseizure-type conversion disorder

Cited by 32 publications

References 21 publications

An Integrative Neurocircuit Perspective on Psychogenic Nonepileptic Seizures and Functional Movement Disorders

An Integrative Neurocircuit Perspective on Psychogenic Nonepileptic Seizures and Functional Movement Disorders

Somatoform dissociation and posttraumatic stress syndrome – two sides of the same medal? A comparison of symptom profiles, trauma history and altered affect regulation between patients with functional neurological symptoms and patients with PTSD

Dissociative experiences in epilepsy: Effects of epilepsy-related factors on pathological dissociation

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