Maladaptive emotional regulation in patients diagnosed with psychogenic non-epileptic seizures (PNES) compared with healthy volunteers

Abstract

The term PNES refers to a conversion disorder that mimics epileptic seizures but has a psychological etiology. Recent studies report that in patients with PNES, there is reduced understanding of emotions, impulse control difficulties, and limited access to emotional regulation strategies. The aim of this study was to compare patients diagnosed with PNES with healthy volunteers on the presence of maladaptive emotional regulation. Method: Patients (N = 64 F:M 52:12; mean age 35.5 years; duration ≥ 2 years) were assessed while inpatients at the Epilepsy Center, Na Homolce Hospital, Prague. PNES diagnosis was based on normal EEG findings, habitual seizure capture, suggestive seizure provocation, neuropsychological assessment and patients´history. The clinical sample was compared with healthy volunteers (N = 64 F:M 52:12; mean age 35.8 years). The presence of maladaptive emotional regulation was assessed through the Czech research version of the ASQ and DERS. Results: Compared with a healthy sample, patients with PNES had greater emotion regulation impairments across nearly all dimensions of the DERS -Nonacceptance = 17.0 (M = 14.5), p = 0.006, Goals = 16.0 (M = 11.5), p < 0.001, Impulse control = 13.8 (M = 11.5), p = 0.005, Awareness = 16.4 (M = 15.3), p = 0.183, Strategies = 17.9 (M = 13.0), p < 0.001, Clarity = 11.8 (M = 9.5), p < 0.001 and the total score of the DERS = 92.9 (M = 75.3), p < 0.001. Similar results were found in ASQ questionnaire scales -Concealing = 24.5 (M = 21.0), p = 0.002, and Adjusting = 20.9 (M = 22.8), p = 0.076 but not on the Tolerating Scale = 14.5 (M = 14.7), p = 0.873. Conclusion:Our results highlight that maladaptive emotional regulation is a key psychological mechanism in PNES. Emotional dysregulation may represent an important target when designing psychoeducational and psychotherapeutic approaches for patients with PNES.

Shame in patients with psychogenic nonepileptic seizure: A narrative review

“…Traditional ideas of conversion and dissociation and more recent explanatory models based on emotion processing have linked Psychogenic Nonepileptic Seizures (PNES) closely with emotions [4]. In support of these theories, experimental studies have demonstrated abnormalities of emotion sensitivity, intensity, perception, tolerance, regulation and baseline arousal when comparing patients with PNES to those with epilepsy, healthy controls, or control groups with similar levels of trauma [5][6][7][8]. Clinical research has highlighted the overlap of manifestations of PNES with symptoms of arousal [9], and documented high levels of correlation of anxiety and avoidance as well as avoidance and seizure frequency in patients with PNES [10].…”

Neuropsychological performance and effort in patients diagnosed with psychogenic nonepileptic seizures – Descriptive study of a Czech sample

“…Increased F scale is also indicator of aggravation of psychological and somatic complaints. A previous manuscript reported that many patients evaluated at our Epilepsy center had a history of trauma, experienced a variety of stressors, and comorbidities (described in detail in [21]).…”

“…A social introvert is uncomfortable with social interactions and typically withdraws from such whenever possible, may have limited social skills, or simply prefer to be alone or with a small group of friends. This scale has 69 items[19,21].…”

Case report on psychogenic nonepileptic seizures: A series of unfortunate events

“…PNES is theorized to be a maladaptive response to stress or emotional dysregulation. 22 It, therefore, falls within the so-called neuroticism domain, which describes a tendency to experience stressful events with a perceptive hyperacuity. 5 Although arguably subjective, the patient exhibited a disproportionate emotional response to external stressors.…”

“…PNES is theorized to be a maladaptive response to stress or emotional dysregulation 22 . It, therefore, falls within the so‐called neuroticism domain, which describes a tendency to experience stressful events with a perceptive hyperacuity 5 .…”