title: Comparisons of childhood trauma, alexithymia, and defensive styles in patients with psychogenic non-epileptic seizures vs. epilepsy: Implications for the etiology of conversion disorder.
abstract: BACKGROUND
  It has been theorized that conversion disorder is the result of emotion that cannot be experienced consciously as feeling states or put into words (i.e., alexithymia), but there is little confirming empirical evidence. We sought to characterize subjects with conversion disorder compared to subjects with a distinct medical illness, using the model of psychogenic non-epileptic seizures (PNES) vs. epilepsy (ES), on measures of childhood traumatic experience, alexithymia and maturity of psychological defensive strategies.
  
  
  METHODS
  All subjects admitted to the Epilepsy Monitoring Unit of the University of Cincinnati Medical Center were offered self-report questionnaires (Childhood Trauma Questionnaire, Toronto Alexithymia Scale-20 and Response Evaluation Measure-71) at the outset of evaluation. Diagnosis of each subject was confirmed by video-EEG and we compared subjects with PNES to those with ES on these measures.
  
  
  RESULTS
  82 subjects had ES AND 96 had PNES. Those with PNES were significantly more likely to have experienced childhood trauma in all domains (p=.005 to p=.05), and were significantly more likely to have alexithymia (p=.0267). There was a significant difference in the capacity to identify feelings, and a trend towards significance in capacity to describe feelings. There were no differences in defensive styles between the two groups.
  
  
  CONCLUSIONS
  PNES diagnosis was associated with female sex, higher alexithymia scores and higher rates of childhood trauma, but not with differences in defensive styles compared to ES. These findings add empirical evidence for theories regarding the cause of conversion disorder and may aid in the design of prospective treatment trials in patients with conversion disorder.
authors.affiliation: Cincinnati Center for Psychotherapy and Psychoanalysis, USA. mkaplan@3001.us
authors.forename: Marcia J
authors.initials: MJ
authors.lastname: Kaplan
authors.forename: Alok K
authors.initials: AK
authors.lastname: Dwivedi
authors.forename: Michael D
authors.initials: MD
authors.lastname: Privitera
authors.forename: Kelly
authors.initials: K
authors.lastname: Isaacs
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hughes
authors.forename: Michelle
authors.initials: M
authors.lastname: Bowman
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms / Q000523:psychology*; D000368:Aged; D003291:Conversion Disorder / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D003937:Diagnosis, Differential; D004827:Epilepsy / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012640:Seizures / Q000175:diagnosis / Q000523:psychology*; D012737:Sex Factors; D011795:Surveys and Questionnaires
keywords: Alexithymia; Childhood Trauma Questionnaire; Childhood trauma; Conversion disorder; Defensive styles; Psychogenic non-epileptic seizures; Toronto Alexithymia Scale