title: Ictal symptoms of anxiety, avoidance behaviour, and dissociation in patients with dissociative seizures.
abstract: OBJECTIVE
  To examine anxiety related seizure symptoms and avoidance behaviour in adults with dissociative (psychogenic non-epileptic) seizures (DS) in comparison with a group suffering from partial epilepsy.
  
  
  METHODS
  25 DS and 19 epilepsy patients completed an attack symptom measure, the hospital anxiety and depression scale, the dissociative experiences scale, and the fear questionnaire.
  
  
  RESULTS
  DS patients reported the presence of significantly greater numbers of somatic symptoms of anxiety during their attacks than the epilepsy group, despite not reporting subjectively higher levels of anxiety. The DS patients also reported higher levels of agoraphobic-type avoidance behaviour than the epilepsy group. Measures of dissociation were higher in the DS group, who also reported greater symptoms of depression.
  
  
  CONCLUSIONS
  The findings support a model whereby DS occur as a paroxysmal, dissociative response to heightened arousal in the absence of raised general anxiety levels. The model has practical implications for clinical assessment and treatment: in clinical practice, inquiry about these symptoms may help in the diagnosis of DS; with respect to treatment, the anxiety related symptoms and avoidance behaviour prevalent in DS are a potential focus for a cognitive behavioural approach analogous to that used in the treatment of other anxiety disorders.
authors.affiliation: Institute of Psychiatry, Department of Psychology, King's College London, and Neuropsychiatry Department, Maudsley Hospital, SE5 8AF, UK. l.goldstein@iop.kcl.ac.uk
authors.forename: L H
authors.initials: LH
authors.lastname: Goldstein
authors.forename: J D C
authors.initials: JD
authors.lastname: Mellers
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000175:diagnosis / Q000523:psychology; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D001362:Avoidance Learning; D003291:Conversion Disorder / Q000175:diagnosis* / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D003937:Diagnosis, Differential; D004213:Dissociative Disorders / Q000175:diagnosis* / Q000523:psychology; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D012640:Seizures / Q000175:diagnosis* / Q000523:psychology; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000523:psychology