Implicit and explicit self-esteem discrepancies in people with psychogenic nonepileptic seizures.
OBJECTIVE
Self-esteem (SE), or one's sense of competence and worth, is reduced in many mental and physical disorders. Low SE is associated with perceived stigma and disability and poor treatment outcomes. The present study examined implicit and explicit SE (automatic and deliberate views about the self) in people with epilepsy and people with psychogenic nonepileptic seizures (PNESs). Discrepancies between implicit SE and explicit SE have been found to correlate with psychological distress in disorders often associated with PNESs but are relatively unexplored in PNESs. We hypothesized that, compared with epilepsy, PNESs would be associated with lower self-reported SE and greater discrepancies between implicit SE and explicit SE.


METHODS
Thirty adults with PNESs, 25 adults with epilepsy, and 31 controls without a history of seizures were asked to complete the Rosenberg Self-esteem Scale as a measure of explicit SE and an Implicit Relational Assessment Procedure as a measure of implicit SE. The State-Trait Anxiety Inventory and Patient Health Questionnaire-15 (a somatic symptom inventory) were also administered.


RESULTS
We found significant group differences in explicit (p<0.001) but not implicit SE. Patients with PNESs reported lower SE than the other groups. No group differences were found in implicit SE. Implicit-explicit SE discrepancies were larger in the group with PNESs than in the other groups (p<0.001). Higher frequency of PNESs (but not epileptic seizures) was associated with lower explicit SE (rs=-.83, p<0.01) and greater SE discrepancies (i.e., lower explicit relative to implicit SE; rs=.65, p<0.01). These relationships remained significant when controlling for anxiety and somatization.


CONCLUSIONS
Patients with PNESs had lower explicit SE than those with epilepsy or healthy controls. In keeping with our expectations, there were greater discrepancies between implicit SE and explicit SE among patients with PNESs than in the other groups. Our results, including the strong relationship between PNES frequency, anxiety, and explicit-implicit SE discrepancies, support the interpretation that PNESs serve to reduce cognitive dissonance, perhaps protecting patients' implicit SE.
University of Nottingham, Institute of Work, Health & Organisations, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, UK. Electronic address: lian.dimaro@gmail.com.
Lian V
LV
Dimaro
School of Social and Behavioral Sciences, Arizona State University, 4701 W. Thunderbird Road, MC 3051, Glendale, AZ 85306, USA. Electronic address: Nicole.A.Roberts@asu.edu.
Nicole A
NA
Roberts
Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK. Electronic address: nmoghaddam@lincoln.ac.
Nima G
NG
Moghaddam
Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK. Electronic address: ddawson@lincoln.ac.uk.
David L
DL
Dawson
Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK. Electronic address: ianbrownemail@yahoo.co.uk.
Ian
I
Brown
Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. Electronic address: markus.reuber@sth.nhs.uk.
Markus
M
Reuber
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000209:etiology / Q000523:psychology*; D012649:Self Concept; D013001:Somatoform Disorders / Q000523:psychology*
Cognition; Epilepsy; IRAP; Implicit; Nonepileptic; Psychogenic; Seizures; Self-esteem