Post-traumatic stress and relationships to coping and alexithymia in patients with psychogenic non-epileptic seizures

Seizure. 2018 Apr:57:70-75. doi: 10.1016/j.seizure.2018.03.011. Epub 2018 Mar 10.


Purpose: There is increasing evidence that patients with PNES can form subgroups distinguished by emotion dysregulation and comorbid psychological symptoms. The purpose of this study was to determine if patients with comorbid PTSD differ from other patients with PNES in terms of alexithymia and stress coping strategies.

Methods: 156 adult patients with video-EEG confirmed PNES were assessed with the Trauma Symptom Inventory-2 (TSI-2) and diagnostic clinical interview, Toronto Alexithymia Scale (TAS-20), and the Coping Inventory for Stressful Situations (CISS). There were 3 groups: 48 patients with PTSD, 62 patients who had experienced trauma and did not have PTSD, and 46 patients who denied experiencing trauma.

Results: One-way ANCOVA revealed a significant difference between groups on reported levels of alexithymia [F(2, 154) = 18.21, p < .001] and use of emotion-focused coping [F(2, 156) = 11.12, p < .001]. Tukey HSD post-hoc comparisons indicated that the PNES/PTSD group had significantly higher mean alexithymia scores (M = 59.54, SD = 12.89) than both the no trauma (M = 49.51, SD = 14.92) and the trauma with no PTSD groups (M = 49.98, SD = 13.27), which did not differ from each other. The PNES/PTSD group was also significantly more likely (M = 62.44, SD = 11.56) than the no trauma (M = 52.87, SD = 13.57) and the trauma with no PTSD groups (M = 52.06, SD = 12.63) to utilize emotion-focused coping strategies. No significant differences were found between groups on use of task- or avoidance-focused coping.

Conclusion: The study revealed elevated alexithymia and use of potentially more maladaptive emotion-focused coping strategies among patients with PNES and comorbid PTSD. These findings highlight discrete areas to target in treatment depending on comorbid symptomatology, and suggests that PNES, which is often regarded as a homogeneous entity, appears to encompass distinct subgroups.

Keywords: Alexithymia; Coping; Emotion; PNES; PTSD; Trauma.

Publication types

  • Multicenter Study

MeSH terms

  • Adaptation, Psychological*
  • Adult
  • Affective Symptoms / complications*
  • Affective Symptoms / epidemiology
  • Comorbidity
  • Emotions
  • Female
  • Humans
  • Interview, Psychological
  • Male
  • Multivariate Analysis
  • Psychiatric Status Rating Scales
  • Seizures / complications*
  • Seizures / epidemiology
  • Seizures / psychology
  • Somatoform Disorders / complications*
  • Somatoform Disorders / epidemiology
  • Somatoform Disorders / psychology
  • Stress Disorders, Post-Traumatic / complications*
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / psychology