Demographic and Seizure Variables, But Not Hypnotizability or Dissociation, Differentiated Psychogenic from Organic Seizures

Abstract

ABSTRACT. Early detection and differential diagnosis of psychogenic non-epileptic seizures (PNES) and epileptic seizures (ES) is a major clinical issue in comprehensive epilepsy centers. Using blind conditions with patients with PNES (N = 10) and ES (N = 31) before diagnosis, we tested the hypotheses that individuals with PNES would exhibit significantly greater dissociativity, hypnotizability, absorption, and history of early abuse than ES patients. Although PNES patients tended to show greater dissociative phenomena, only the last of our hypotheses was fully supported. Although absorption did not discriminate between the two diagnostic groups, it was significantly higher among those reporting early abuse. A logistic regression analysis using scores on dissociation, hypnotizability and absorption showed them to be poor predictors of diagnosis; however, other analyses revealed that female gender, reports of multiple trauma incidents lasting months or years, initial seizure onset in late teens or twenties, and daily seizure attacks significantly differentiated PNES from ES patients. Thus, demographic and seizure variables proved to be much better predictors of diagnosis Richard Litwin is in Private Practice, Cleveland, OH.

Hypnotizability and Somatic Complaints:A Gender-Specific Phenomenon

“…Only a few scientific papers have been published on the association of hypnotizability and somatoform disorders (Kuyk, Spinhoven, & van Dyck, 1999;Roelofs et al, 2002). These studies are congruent with earlier clinical observations in that somatoform disorder patients are more hypnotizable than matched patient controls, although this relation is equivocal (Litwin & Cardeña, 2000;Moene, Spinhoven, Hoogduin, Sandyck, & Roelofs, 2001). These studies further show a positive correlation between hypnotizability and the number of conversion complaints in a patient sample.…”

Neurophysiology of hypnosis

“…Some studies have reported higher rates of hypnotizability in patients with conversion disorders as compared to controls or patients with other pathological states (e.g. affective disorders) [6,35,53], while others have shown no difference in both hypnotizability and absorption (defined as the tendency to become fully involved in a perceptual, imaginative, or ideational experience) between patients with conversion disorders and controls [37]. A last study showed higher level of absorption in control subjects as compared to patients [23].…”

“…The level of hypnotizability was shown to correlate with the number of conversion symptoms presented by patients [53]. For example, pseudo-epileptic patients (defined by the demonstration of paroxysmal involuntary behavior patterns mimicking epileptic events) were shown to present more dissociative symptoms as compared to epileptic patients [23,37]. Some studies have reported higher rates of hypnotizability in patients with conversion disorders as compared to controls or patients with other pathological states (e.g.…”

Dissociative tendencies and individual differences in high hypnotic suggestibility

“…This and related work on acute stress and post-traumatic stress disorders led to the refined hypothesis that high hypnotic suggestibility is a predisposing factor for dissociative psychopathology (Butler, Duran, Jasiukaitis, Koopman, & Spiegel, 1996). Attempts to test the hypothesized relationship between dissociative tendencies and hypnotic suggestibility in non-clinical samples have been mixed (e.g., Butler & Bryant, 1997;Dienes, Brown, Hutton, Kirsch, Mazzoni, & Wright, 2009), whereas patients reporting dissociative symptomatology have consistently displayed higher hypnotic suggestibility than control samples (Bryant, Guthrie, & Moulds, 2001;Roelofs, Hoogduin, Keijsers, Naring, Moene, & Sandijck, 2002;Spiegel, Hunt, & Dondershine, 1988; but see Litwin & Cardeña, 2000). These disparities may reflect the circuitous route by which dissociative tendencies influence hypnotic responding.…”