title: The impact of conveying the diagnosis when using a biopsychosocial approach: A qualitative study among adolescents and young adults with NES (non-epileptic seizures).
abstract: OBJECTIVE
  This qualitative study explored the impact of using a biopsychosocial approach to explain the diagnosis of non-epileptic seizures (NES).
  
  
  METHODS
  Semi-structured interviews of eleven adolescents and young adults who had participated in an inpatient follow-up stay of the diagnosis were used. The interviews were taped, transcribed, and analysed using systematic text condensation.
  
  
  RESULTS
  Three key themes were identified:1."Threatened self-image": Patients initially perceived their diagnosis as being purely psychological. As they did not accept that they had mental disorders, they interpreted this as frightening and threatening, and resisted the diagnosis.2."Being believed and belief in oneself": Participants had many experiences of being suspected by healthcare providers of staging their seizures. Some had even begun to have doubts themselves as to whether the attacks were voluntary or not. Explaining that unconscious processes are involved in NES contributed towards increasing patients' feelings of being believed, and thereby acceptance of the diagnosis.3."Getting an explanation that makes sense": Some participants identified connections between their personal histories and their seizures and became seizure-free. Others found that the explanatory models gave personal meaning, but did not become seizure-free, while a few continued to doubt whether NES was the correct diagnosis.
  
  
  CONCLUSIONS
  Being believed was the most elemental factor for coping with the condition. Using a biopsychosocial approach to explain the diagnosis may facilitate identification with the explanatory models, and thus acceptance of the diagnosis.
authors.affiliation: National Centre for Epilepsy, Division of Neuroscience, Oslo University Hospital, Norway; Department of General Practice, Institute of Health and Society, University of Oslo, Norway. Electronic address: Hilde.karterud@ous-hf.no.
authors.forename: Hilde Nordahl
authors.initials: HN
authors.lastname: Karterud
authors.affiliation: General Practice Research Unit, Institute of Community Medicine, UiT, The Arctic University of Norway, Norway.
authors.forename: Mette Bech
authors.initials: MB
authors.lastname: Risør
authors.affiliation: Department of General Practice, Institute of Health and Society, University of Oslo, Norway.
authors.forename: Ole Rikard
authors.initials: OR
authors.lastname: Haavet
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D012640:Seizures / Q000175:diagnosis* / Q000523:psychology*; D012649:Self Concept; D055815:Young Adult
keywords: Biopsychosocial approach; Conveying the diagnosis; Illness perception; Medically unexplained symptoms; Non-epileptic seizures