Prevalence of alexithymia in patients with psychogenic non-epileptic seizures and epileptic seizures and predictors in psychogenic non-epileptic seizures

Myers, Lorna; Matzner, Barbara; Perrine, Kenneth; Lancman, Marcelo E.

doi:10.1016/j.yebeh.2012.11.054

Cited by 56 publications

(42 citation statements)

References 27 publications

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“…However, the rate of alexithymia in patients with PNES is largely comparable to that seen in patients with epilepsy and other medical outpatients (Tojek et al, 2000;Myers et al, 2013;Taylor, Bagby, & Parker, 1997). Several studies have found higher levels of physically and/or emotionally avoidant behaviour in patients with PNES compared to healthy controls (Bakvis, Spinhoven, Zitman, & Roelofs, 2011;Cronje & Pretorius, 2013;Dimaro et al, 2014;Frances, Baker, & Appleton, 1999;Goldstein et al, 2000) and epilepsy (Goldstein & Mellers, 2006;Novakova, Howlett, Baker, & Reuber, 2015;cf.…”

Section: Somatization and Emotional Processingmentioning

confidence: 79%

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

Brown

Reuber

2016

Clinical Psychology Review

217

208

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Current models of PNES can account for some but not all of the available data.• Automatic activation of seizure representations in memory may be a unifying process.• Suppression of arousal and distress are typical maintaining factors for PNES.• Inhibitory dysfunction, often arising from chronic stress, is a key vulnerability. • Trauma exposure is common but neither necessary nor sufficient for PNES to occur. a b s t r a c tPsychogenic Nonepileptic Seizures (PNES) superficially resemble epileptic seizures but are thought to have a psychological rather than epileptic basis. Patients with PNES vary widely in terms of background, personality profiles, comorbidities, response to treatment and outcomes. Previous accounts interpreting these seizures as the activation of dissociated material, a physical manifestation of emotional distress, hard-wired reflex responses, or learned behaviours cannot explain key features of the phenomenon. Drawing on a brief review of the literature on etiology, correlates and phenomenology of PNES, this paper integrates existing approaches and data within a novel explanatory framework that applies to all PNES patients with subjectively involuntary seizures. Following the Integrative Cognitive Model of medically unexplained symptoms, we suggest that the central feature of all PNES is the automatic activation of a mental representation of seizures (the "seizure scaffold") in the context of a high level inhibitory processing dysfunction. This often arises in response to elevated autonomic arousal, and may disrupt the individual's awareness of distressing material, but can become divorced from abnormal autonomic and emotional activity. This model accounts both for existing findings and the heterogeneity of patients with PNES, whilst leading to a number of novel hypotheses against which it can be evaluated.

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Section: Somatization and Emotional Processingmentioning

confidence: 79%

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

Brown

Reuber

2016

Clinical Psychology Review

217

208

View full text Add to dashboard Cite

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“…For example, in Stalder et al [61], cortisol, heart rate and HRV were not associated with self-reported measures of either perceived stress or emotional regulation in a group of psychology students. Furthermore, both patients with epilepsy and patients with PNES tend to have relatively high levels of alexithymia (i.e., difficulty in identifying, understanding and describing own emotions), which may cause further inaccuracies in their self-reports [64][65][66]. This highlights the complexity of the experience of stress and the difficulty of its assessment in patients with seizures, as patients' subjective perceptions may not match or reliably reflect underlying physiological processes.…”

Section: Discussionmentioning

confidence: 99%

Diurnal patterns and relationships between physiological and self-reported stress in patients with epilepsy and psychogenic non-epileptic seizures

Nováková

Harris

Reuber

2017

Epilepsy & Behavior

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“…The present study, therefore, is consistent with the idea that experiential avoidance (perhaps as an "overlearned" or practiced response style) may be a risk factor for the development of PNESs. Similarly, Myers and colleagues [69] found that reports of alexithymia, which refers to a lack of emo-tional awareness and expression, did not differ between PNESs and epilepsy but that within the group with PNESs, alexithymia was associ-ated with anxious arousal and avoidance.…”

Section: Experiential Avoidancementioning

confidence: 91%

“…Consequently, those with PNESs may explicitly report anxiety while failing to "internalize" anxiety as part of their self-concept. Such a "protective" function of PNESs could also help explain the observation that patients with PNESs report more negative life events compared with those with epilepsy but fail to make a link be-tween these life events and their seizures [4] or that a large subgroup of patients with PNESs are limited in their emotional and psychological awareness [69].…”

Section: Anxietymentioning

confidence: 99%

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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Prevalence of alexithymia in patients with psychogenic non-epileptic seizures and epileptic seizures and predictors in psychogenic non-epileptic seizures

Cited by 56 publications

References 27 publications

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

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

Diurnal patterns and relationships between physiological and self-reported stress in patients with epilepsy and psychogenic non-epileptic seizures

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

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