Psychogenic non-epileptic seizures: so-called psychiatric comorbidity and underlying defense mechanisms.
In Diagnostic and Statistical Manual of Mental Disorders, fifth edition, psychogenic non-epileptic seizures (PNES) do not have a unique classification as they can be found within different categories: conversion, dissociative, and somatization disorders. The ICD-10, instead, considers PNES within dissociative disorders, merging the dissociative disorders and conversion disorders, although the underlying defense mechanisms are different. The literature data show that PNES are associated with cluster B (mainly borderline) personality disorders and/or to people with depressive or anxiety disorders. Defense mechanisms in patients with PNES with a prevalence of anxious/depressive symptoms are of "neurotic" type; their goal is to lead to a "split", either vertical (dissociation) or horizontal (repression). The majority of patients with this type of PNES have alexithymia traits, meaning that they had difficulties in feeling or perceiving emotions. In subjects where PNES are associated with a borderline personality, in which the symbolic function is lost, the defense mechanisms are of a more archaic nature (denial). PNES with different underlying defense mechanisms have different prognoses (despite similar severity of PNES) and need usually a different treatment (pharmacological or psychological). Thus, it appears superfluous to talk about psychiatric comorbidity, since PNES are a different symptomatic expression of specific psychiatric disorders.
Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy ; Department of Mental Health, "Guido Salvini" Hospital, Garbagnate Milanese, Milan, Italy.
Massimiliano
M
Beghi
Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy.
Paola Beffa
PB
Negrini
Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy ; Rehabilitation Medicine, Istituti Clinici Zucchi, Carate Brianza, Monza and Brianza, Italy.
Cecilia
C
Perin
Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy ; Rehabilitation Medicine, Istituti Clinici Zucchi, Carate Brianza, Monza and Brianza, Italy.
Federica
F
Peroni
Epilepsy Center, Department of Neuroscience, University of Messina, Messina, Italy.
Adriana
A
Magaudda
Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy ; Rehabilitation Medicine, Istituti Clinici Zucchi, Carate Brianza, Monza and Brianza, Italy.
Cesare
C
Cerri
Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy ; Rehabilitation Medicine, Istituti Clinici Zucchi, Carate Brianza, Monza and Brianza, Italy.
Cesare Maria
CM
Cornaggia
PNES; comorbidity; defense mechanisms; epilepsy