Cognitive-emotion processing in psychogenic nonepileptic seizures

Epilepsy Behav. 2020 Jan;102:106639. doi: 10.1016/j.yebeh.2019.106639. Epub 2019 Nov 12.


Background: Previous literature suggests that cognitive-emotion processing contributes to the pathogenesis of psychogenic nonepileptic seizures (PNES). Characterization of alterations in cognitive-emotion processing in PNES could inform treatment.

Methods: In this descriptive, cross-sectional study, 143 patients with video electroencephalogram (EEG) confirmed PNES were prospectively recruited. Patients completed self-report questionnaires on emotion perception (Trait Meta-Mood Scale (TMMS) attention and clarity subscales) and coping style (Affective Styles Questionnaire [ASQ] concealing, adjusting, and tolerating subscales) at the time of their initial evaluation for PNES. Demographic, clinical data and measures of psychopathology severity were also obtained. The TMMS and ASQ subscale scores were compared to available normative data and between PNES subgroups (based on presence of trauma-related factors). Correlation coefficients were obtained to evaluate associations between subscale scores and measures of psychopathology.

Results: Mean scores on both TMMS subscales (attention 47.0 [SD 7.4] and clarity 37.5 [SD 8.0]) and the ASQ adjusting subscale (22.2 [SD 6.3]) were significantly lower than available normative data (p < .001). Among patients with PNES, those with a history of childhood abuse or active posttraumatic stress disorder (PTSD) were found to have significantly lower scores on emotion clarity, adjustment, and tolerance subscales than those without such histories (p < .05). Degree of clarity of emotions correlated negatively with severity of depression, anxiety, stress, and illness perception (p ≤ .001). Adjustment to and tolerance of emotional states correlated negatively with severity of depression and stress (p < .01).

Conclusions: Patients with PNES, especially those with active PTSD and childhood trauma, have lower clarity of their emotions and lower ability to adjust to emotional states than healthy individuals. These cognitive-emotion processing deficits are more pronounced in patients with more severe depression and reported stress. This study characterizes alterations in cognitive-emotion processing in PNES that are well-suited therapeutic targets and can therefore inform treatment interventions.

Keywords: Emotion processing; Emotions; Functional neurological disorder; Psychogenic nonepileptic seizures; Psychopathology.

MeSH terms

  • Adult
  • Anxiety / etiology
  • Anxiety / psychology
  • Attention
  • Child
  • Child Abuse / psychology
  • Cognition*
  • Conversion Disorder / psychology*
  • Cross-Sectional Studies
  • Depression / etiology
  • Depression / psychology
  • Electroencephalography
  • Emotions*
  • Epilepsy / psychology*
  • Female
  • Humans
  • Male
  • Neuropsychological Tests
  • Psychiatric Status Rating Scales
  • Seizures / psychology*
  • Stress Disorders, Post-Traumatic / psychology