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Am J Psychiatry 1996; 153:57-63
Copyright © 1996 by American Psychiatric Association
Psychodynamics and psychiatric diagnoses of pseudoseizure subjects
ES Bowman and ON Markand
Department of Psychiatry, Indiana University School of Medicine, Indianapolis 46202, USA.
OBJECTIVE: The goal of this study was to determine current and lifetime
rates of DSM-III-R disorders in patients with pseudoseizures and to
ascertain whether trauma is associated with the occurrence of
pseudoseizures. METHODS: Adult pseudoseizure patients (N = 45) were
interviewed regarding seizure course and life events, and they were given
the Structured Clinical Interview for DSM-III-R--Patient Version, the
Structured Clinical Interview for DSM-III-R Dissociative Disorders, the
Dissociative Experiences Scale, and the Personality Diagnostic
Questionnaire--Revised. The pseudoseizures were diagnosed in a tertiary-
care video-EEG facility. Most of the subjects (78%) were female, and the
mean age of the overall patient group was 37.5 years (SD = 9.7). RESULTS:
The mean duration of the subjects' seizure history was 8.3 years (SD =
8.0). Common current psychiatric diagnoses included somatoform disorders
(89%), dissociative disorders (91%), affective disorders (64%), personality
disorders (62%), posttraumatic stress disorder (PTSD) (49%), and other
anxiety disorders (47%). The lifetime occurrence of nonseizure conversion
disorders was 82%. The mean Dissociative Experiences Scale score was 20.2
(SD = 18.2). Trauma was reported by 84% of the subjects: sexual abuse by
67%, physical abuse by 67%, and other traumas by 73%. CONCLUSIONS:
Pseudoseizure subjects have high rates of the psychiatric disorders found
in traumatized groups; they closely resemble patients with dissociative
disorders. Reclassification of conversion seizures with the dissociative
disorders should be considered. Pseudoseizures often appear to express
distress related to abuse reports. Clinicians should screen pseudoseizure
patients for adult and childhood trauma, dissociative disorders,
depression, and PTSD.
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