Implicit and explicit self-esteem discrepancies in people with psychogenic nonepileptic seizures

Abstract

Purpose: Self-esteem (SE), or one's sense of competence and worth, is reduced in many mental and physical\ud disorders. Low SE is associated with perceived stigma and disability and poor treatment outcomes. The present\ud study examined implicit and explicit SE (automatic and deliberate views about the self) in people with epilepsy\ud and people with psychogenic nonepileptic seizures (PNESs). Discrepancies between implicit SE and explicit SE\ud have been found to correlate with psychological distress in disorders often associated with PNESs but are\ud relatively unexplored in PNESs. We hypothesized that, compared with epilepsy, PNESs would be associated\ud with lower self-reported SE and greater discrepancies between implicit SE and explicit SE.\ud Methods: Thirty adults with PNESs, 25 adults with epilepsy, and 31 controls without a history of seizures were\ud asked to complete the Rosenberg Self-esteem Scale as a measure of explicit SE and an Implicit Relational\ud Assessment Procedure as a measure of implicit SE. The State–Trait Anxiety Inventory and Patient Health\ud Questionnaire—15 (a somatic symptom inventory) were also administered.\ud Results: We found significant group differences in explicit (p b 0.001) but not implicit SE. Patients with PNESs\ud reported lower SE than the other groups. No group differences were found in implicit SE. Implicit–explicit SE\ud discrepancies were larger in the group with PNESs than in the other groups (p b 0.001). Higher frequency of\ud PNESs (but not epileptic seizures) was associatedwith lower explicit SE (rs=−.83, p b 0.01) and greater SE discrepancies\ud (i.e., lower explicit relative to implicit SE; rs = .65, p b 0.01). These relationships remained significant\ud when controlling for anxiety and somatization.\ud Conclusion: Patients with PNESs had lower explicit SE than those with epilepsy or healthy controls. In keeping\ud with our expectations, there were greater discrepancies between implicit SE and explicit SE among patients\ud with PNESs than in the other groups. Our results, including the strong relationship between PNES frequency,\ud anxiety, and explicit–implicit SE discrepancies, support the interpretation that PNESs serve to reduce cognitive\ud dissonance, perhaps protecting patients' implicit SE

Emotion processing and psychogenic non-epileptic seizures: A cross-sectional comparison of patients and healthy controls

“…Dimaro et al found discrepancies between explicit and implicit anxiety and self-esteem measures in the PNES but not the other two participant groups. They interpreted their findings as indicating that PNES may serve a protective function: whilst patients with PNES (explicitly) self-reported high levels of anxiety and low levels self-esteem, the Implicit Relational Assessment Procedure (IRAP) measures suggested that their self-image was not characterised by elevated anxiety or reduced self-esteem [25,41].…”

Psychogenic Non-epileptic Seizures and Pseudo-Refractory Epilepsy, a Management Challenge

“…A wealth of studies has provided insights into the psychosocial features of PNES (8,41), but the biological underpinnings of the disorder have received much less attention and are still poorly understood. However, an emerging and growing body of evidence has finally started to unravel the neurobiological basis of PNES (42)(43)(44).…”

“…For a long time, PNES have been considered disorders generated in the absence of biological and organic substrates. Thus, most of the attention has been focused on the psychosocial correlates of the condition (8,9) and PNES patients have been mainly investigated and treated with psychoanalytic/psychodynamic approaches. The psychosocial origins of PNES have been largely endorsed by specialists as well as patients who often find it difficult to reconcile themselves with the idea of suffering from a disorder that lacks an organic basis (10,11).…”

Towards an integrative theory of psychogenic non-epileptic seizures (PNES)

“…In some circumstances, focusing on the physical aspects of one's experiences may constitute a highly adaptive response that enables the individual to retain a relatively normal sense of self and well-being in the face of on-going adversity (Dimaro et al, 2014(Dimaro et al, , 2015. Indeed, there is evidence that patients who do not experience subjective fear symptoms during their panic attacks are better adjusted than those who do (Chen, Tsuchiya, Kawakami, & Furukawa, 2009).…”