Epilepsy Information

American Epilepsy Society Poster (Abst. 1.334)

A new perspective in the assessment of the psychological composition of patients with psychological non-epileptic seizure disorder

Authors: Lorna Myers, M. Lancman, J. Kanter and C. Zaroff

Significant advances have been made in the diagnosis of psychological non-epileptic seizures (PNES). However, knowledge about underlying psychological characteristics, and distinct sub-classifications is still limited. The Minnesota Multiphasic Personality Inventory (MMPI) has been the most utilized tool in the assessment of psychological structure: depression, hypochondriasis and hysteria scores form the classic triad in these patients. Since 2008, we added to our standard battery a set of measures that assess a supplementary series of psychological factors including anger expression, stress coping mechanisms, alexithymia, trauma symptomatology and quality of life.


Our standard battery for patients diagnosed with PNES includes the Trauma Symptom Inventory (TSI), Toronto Alexithymia Scale (TAS), State Trait Anger Expression Inventory (STAXI), Quality of Life in Epilepsy Inventory (QOLIE-31), Coping Inventory for Stressful Situations (CISS), Minnesota Multiphasic Personality Inventory-2 (MMPI-2) along with a comprehensive cognitive assessment. Diagnosis of PNES was made by epileptologists through review of video-EEG monitoring. Neuropsychological testing was conducted on an outpatient or inpatient basis on all patients who were referred.

Sixty-four patients completed the PNES battery in its entirety or major portions of it. Seven were males and fifty-seven were females. Mean age was 35.7 years. Mean education was 13.7 years. More than half of patients carried a diagnosis of PNES for over 2 years. Forty (63%) were in mental health treatment and 39 (60%) were receiving psychiatric medication at the time the assessment was conducted. Twelve (19%) had suicide attempts and a psychiatric hospitalization in their past. Seventeen (27%) were employed although of those several were “underemployed” based on their educational attainment. Clinically significant scores were defined as > 1.5 standard deviations from the mean. The following number of patients earned significant scores on the TSI scales: Anxious Arousal (18/42; 45%), Depression (16/42; 39%), Dissociation (15/42; 36.6%), Defensive Avoidance (15/42; 36.6%) and Intrusive Experiences (13/42; 31.20%). Alexithymia was endorsed by 17 out of 46 patients (37%). Fifteen of 47 patients (32%) reported that they tend not to address stressful situations using task-oriented strategies. Twenty-eight patients out of 50 (56%) reported clinically relevant scores on the total Anger Index of the STAXI. Seventeen of 33 patients reported impoverished overall quality of life.

These findings highlight discrete psychological factors in PNES patients that add to the clinical understanding provided by current standard psychological batteries. These factors are key in treatment planning and treatment target designation including anger management, implementation of anxiety reduction techniques and treatment of the trauma triad (arousal, avoidance, intrusion).