Conceptualization and treatment of psychogenic non-epileptic seizures.
Psychogenic non-epileptic seizures (PNES) frequently present co-morbidly with a range of somatic and psychiatric conditions. This review discusses the relationship between PNES, a number of co-morbid psychiatric symptoms, early attachment trauma, and disruption of neurological development. We suggest that it may be clinically useful to understand PNES with reference to three patterns of co-morbidity and trauma history. In the first group, PNES are one symptom of a response to severe, chronic trauma and invalidation in attachment relationships, or a response to a recent event that overwhelms an emotion regulation system shaped by attachment trauma. For a second group, PNES occur in the context of ongoing interruptions to self and memory with or without a history of attachment trauma. For a third group, PNES occur in the absence of extensive co-morbidity and apparent trauma, primarily as a panic reaction, in a population with under-developed emotion regulation skills. Treatment approaches consistent with these conceptualizations are suggested.
Quinn
Maria
M
LaTrobe University, Melbourne, Austalia. quintusmaximus78@hotmail.com
Schofield
Margot
M
Middleton
Warwick
W
D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000453:epidemiology; D001930:Brain Injuries / Q000453:epidemiology; D002649:Child Abuse; D002650:Child Abuse, Sexual; D002675:Child, Preschool; D015897:Comorbidity; D004213:Dissociative Disorders / Q000175:diagnosis / Q000453:epidemiology*; D017579:Domestic Violence; D004827:Epilepsy / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009769:Object Attachment; D016584:Panic Disorder / Q000453:epidemiology; D011602:Psychophysiologic Disorders / Q000453:epidemiology / Q000628:therapy; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D013179:Spouse Abuse