title: Emotional dysregulation, alexithymia, and attachment in psychogenic nonepileptic seizures.
abstract: OBJECTIVE
  Psychogenic nonepileptic seizures (PNESs) are poorly understood and difficult to treat. Research and theory suggest that problems with recognizing, acknowledging, and regulating emotional states (i.e., emotional dysregulation) may contribute to the development and maintenance of PNESs. However, there is a lack of well-controlled studies using dedicated measures of emotional regulation with patients with PNESs. The current study sought to address this gap.
  
  
  METHODS
  Forty-three patients with PNESs and 24 with epilepsy completed a postal survey comprising measures of emotional dysregulation (Difficulties in Emotion Regulation Scale), alexithymia (Toronto Alexithymia Scale), attachment (Relationship Scales Questionnaire), and psychopathology (Generalized Anxiety Disorder-7; Patient Health Questionnaire-9; Somatoform Dissociation Questionnaire-20). Cluster analysis was used to identify possible subgroups of patients with PNESs characterized by distinct patterns of emotional dysregulation.
  
  
  RESULTS
  Two clusters of patients with PNESs were identified. The first (n=11) was characterized by higher levels of psychopathology, somatization, alexithymia, and difficulties with most aspects of emotional regulation (including identifying, accepting, and describing feelings, accessing adaptive regulatory strategies, performing goal-directed behaviors, and controlling feelings and actions) compared with the group with epilepsy. The second (n=32) was characterized by relatively high somatization and depression scores but comparatively normal levels of alexithymia and emotional regulation.
  
  
  CONCLUSIONS
  The findings suggest that patients with PNESs can be divided into at least two meaningful subgroups characterized by distinct psychological profiles, only one of which is characterized by significant problems with emotional dysregulation. Further research is needed to determine whether the relatively normal emotional dysregulation and high somatization scores of some patients with PNESs are due to emotional avoidance or more basic problems with perceptual and behavioral control.
authors: School of Psychological Sciences, University of Manchester, UK. Electronic address: richard.james.brown@manchester.ac.uk.
authors: Richard J
authors: RJ
authors: Brown
authors: Julia F
authors: JF
authors: Bouska
authors: Anna
authors: A
authors: Frow
authors: Antonia
authors: A
authors: Kirkby
authors: Gus A
authors: GA
authors: Baker
authors: Steven
authors: S
authors: Kemp
authors: Christine
authors: C
authors: Burness
authors: Markus
authors: M
authors: Reuber
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000209:etiology* / Q000523:psychology*; D016000:Cluster Analysis; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D011569:Psychiatric Status Rating Scales; D011602:Psychophysiologic Disorders; D011795:Surveys and Questionnaires; D014741:Video Recording
keywords: Alexithymia; Attachment; Conversion disorder; Emotional regulation; Psychogenic nonepileptic seizures