Emotional dysregulation, alexithymia, and attachment in psychogenic nonepileptic seizures

Epilepsy Behav. 2013 Oct;29(1):178-83. doi: 10.1016/j.yebeh.2013.07.019. Epub 2013 Aug 22.


Objectives: 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.

Keywords: Alexithymia; Attachment; Conversion disorder; Emotional regulation; Psychogenic nonepileptic seizures.

MeSH terms

  • Adult
  • Affective Symptoms / etiology*
  • Affective Symptoms / psychology*
  • Cluster Analysis
  • Electroencephalography
  • Epilepsy / complications*
  • Epilepsy / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Object Attachment*
  • Psychiatric Status Rating Scales
  • Psychophysiologic Disorders*
  • Surveys and Questionnaires
  • Video Recording