Emotional dysregulation, alexithymia, and attachment in psychogenic nonepileptic seizures

Brown, Richard J.; Bouska, Julia F.; Frow, Anna; Kirkby, Antonia; Baker, Gus A.; Kemp, Steven; Burness, Christine; Reuber, Markus

doi:10.1016/j.yebeh.2013.07.019

Cited by 96 publications

(85 citation statements)

References 36 publications

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“…[15][16][17][18] In a study where the patients with CD were clustered according to psychological items, the group including patients with CD had significantly higher somatization than the patients with epilepsy. [19] In our study; although somatization is significantly different in all three sample groups, somatic amplification did not reveal such a difference. Although Barsky et al also reported that the somatic amplification is a central predisposing factor in somatization and hypochondriazis; [16,17] our results suggest a discrepancy between the presence of somatization and the severity of somatic amplification in patients with epilepsy.…”

Section: Resultscontrasting

confidence: 66%

Comparison Of Psychiatric Features Between Conversion Disorder And Epilepsy Patients With Non-Intractable Seizure

Özkorumak¹,

Gazioğlu²,

Ti̇ryaki̇³

et al. 2014

Epilepsi

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Amaç: Epilepsi hastalarının ruhsal durumu birçok çalışmada değerlendirilmiştir. Epilepsi hastalarında psikiyatrik eştanılar sıktır. Bu çalışmanın amacı konversiyon bozukluğu olan kadın hastaların, epilepsi hastalarının sağlıklı kontrollerle psikopatolojik özellikler açısından karşılaştırılmasıdır. Gereç ve Yöntem:Örneklem üçüncü basamak bir merkezde bulunana psikiyatri ve nöroloji klniklerine ayaktan başvuran hastalar arasından oluşturulmuştur. Çalışma evrenini benzer yaş ve eğitimde olan 32 Konversiyon Bozukluğu olan 32 kadın, epilepsisi olan 30 kadın ve sağlıklı 31 oluşturmaktadır. Psikopatolojik durum kısa semptom envanteri, somatoduyusal abartma ölçeği ve sosyodemografik bilgi formu ile değerlendirilmiştir.Bulgular: Sosyodemeografik özellikler üç grup arasında farklılık göstermemiştir. Kısa semptom envanterinin alt ölçekleri konversiyon bozukluğu olan hastalarda epilepsi hastalarından yüksek ve epilepsi hastalarında sağlıklı kontrollerden yüksek bulunmuştur. Fakat somatoduyusal abartma ölçeği yalnız konversiyon bozukluğu olan hastalarla ile sağlıklı kontroller arasında fark göstermiştir.Sonuç: Üç grubun psikopatolojik özellikleri birçok maddede farklılıklar göstermektedir. Bu epilepsi hastalarının ruhsal durumunun nöbetle ilişkili klinik özelliklerden farklı etmenlerle belirlendiğini gösterir. SummaryObjectives: Mental state of the patients with epilepsy has been evaluated in various studies. Psychiatric comorbidities are known to be relatively frequent in patients with epilepsy. The aim of this study was to compare the psychopathological features of female patients with conversion disorder (CD) and epilepsy with nonintractable seizures with healthy controls. Methods:The sample recruited from psychiatry and neurology outpatient clinics in a tertiary care center. The study population consisted of 32 female patients with CD, 30 female patients with epilepsy and 31 female healthy controls with similar age and education levels. The psychopathological state was assessed by clinical measures including Brief Symptom Inventory, Somatosensory Amplification Scale and a sociodemographic data form. Results: Sociodemographic features did not differ between the groups. The subscales of Brief Symptom Inventory were significantly higher in patients with conversion disorder than epilepsy, and in patients with epilepsy than the healthy control. But Somatosensory Amplification Scale differ significantly only between patients with conversion disorder and healthy control. Conclusion:The psychopathological features of three groups differed in most of the items. More severe psychopathological symptoms in epileptic patients than the healthy control but milder than Conversion Disorder may imply that mental state of patients with epilepsy is determined by different factors other than the clinical factors related with seizure.

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Section: Resultscontrasting

confidence: 66%

Comparison Of Psychiatric Features Between Conversion Disorder And Epilepsy Patients With Non-Intractable Seizure

Özkorumak¹,

Gazioğlu²,

Ti̇ryaki̇³

et al. 2014

Epilepsi

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“…It is possible that this finding reflects the psycho-pathological heterogeneity of PNESs: previous studies have identified at least two major groups characterized by low and high levels of emo-tional dysregulation [70]. Psychogenic nonepileptic seizures may be linked to implicit anxiety in some and explicit anxiety in other patients.…”

Section: Anxietymentioning

confidence: 89%

Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety

Dimaro

Dawson

Roberts

et al. 2014

Epilepsy & Behavior

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This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit-explicit anxiety discrepancies were only identified in patients with PNESs (p b .001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r = .63, p b .01) and frequency of seizures (r = .67, p b .01); implicit anxiety correlated with frequency of seizures only (r =.56,p b .01). Our findings demonstrate the role of implicit anxiety in PNESs and provide addi-tional support for the contribution of explicit anxiety and experiential avoidance to this disorder.

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“…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. 18 This study differs from ours in several important ways: they grouped together all types of functional neurological disorder, they used a single comparison group of healthy controls and they did not assess comorbidities.…”

Section: Discussion Alexithymiamentioning

confidence: 99%

The role of alexithymia in the development of functional motor symptoms (conversion disorder)

Demartini

Petrochilos

Ricciardi

et al. 2014

J Neurol Neurosurg Psychiatry

113

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BackgroundThe mechanisms leading to the development of functional motor symptoms (FMS) are of pathophysiological and clinical relevance, yet are poorly understood.AimThe aim of the present study was to evaluate whether impaired emotional processing at the cognitive level (alexithymia) is present in patients affected by FMS. We conducted a cross-sectional study in a population of patients with FMS and in two control groups (patients with organic movement disorders (OMD) and healthy volunteers).Methods55 patients with FMS, 33 patients affected by OMD and 34 healthy volunteers were recruited. The assessment included the 20-item Toronto Alexithymia Scale (TAS-20), the Montgomery-Asberg Depression Rating Scale, the Reading the Mind in the Eyes’ Test and the Structured Clinical Interview for Personality Disorders.ResultsAlexithymia was present in 34.5% of patients with FMS, 9.1% with OMD and 5.9% of the healthy volunteers, which was significantly higher in the FMS group (χ2 (2)=14.129, p<0.001), even after controlling for the severity of symptoms of depression. Group differences in mean scores were observed on both the difficulty identifying feelings and difficulty describing feelings dimensions of the TAS-20, whereas the externally orientated thinking subscale score was similar across the three groups. Regarding personality disorder, χ2 analysis showed a significantly higher prominence of obsessive-compulsive personality disorder (OCPD) in the FMS group (χ2 (2)=16.217, p<0.001) and 71.4% of those with OCPD also reached threshold criteria for alexithymia.ConclusionsBecause alexithymia is a mental state denoting the inability to identify emotions at a cognitive level, one hypothesis is that some patients misattribute autonomic symptoms of anxiety, for example, tremor, paraesthesiae, paralysis, to that of a physical illness. Further work is required to understand the contribution of OCPD to the development of FMS.

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Emotional dysregulation, alexithymia, and attachment in psychogenic nonepileptic seizures

Cited by 96 publications

References 36 publications

Comparison Of Psychiatric Features Between Conversion Disorder And Epilepsy Patients With Non-Intractable Seizure

Comparison Of Psychiatric Features Between Conversion Disorder And Epilepsy Patients With Non-Intractable Seizure

Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety

The role of alexithymia in the development of functional motor symptoms (conversion disorder)

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