Seizure phobia: A distinct psychiatric disorder among people with epilepsy

Aviva Weiss; Laura Canetti; Shiri Ben David; Inbal Reuveni; Dana Ekstein

doi:10.1016/j.seizure.2021.12.009

Seizure phobia: A distinct psychiatric disorder among people with epilepsy

Seizure. 2022 Feb:95:26-32. doi: 10.1016/j.seizure.2021.12.009. Epub 2021 Dec 24.

Authors

Aviva Weiss¹, Laura Canetti², Shiri Ben David³, Inbal Reuveni⁴, Dana Ekstein⁵

Affiliations

¹ Psychiatric Hostels affiliated with Kidum Rehabilitation Projects, Jerusalem, Israel; Alma Center for Treatment of Sexually Abused Patients, Jerusalem, Israel.
² Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel; Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.
³ Neuropsychiatry Clinic, Hadassah Medical Center, Jerusalem, Israel; Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.
⁴ Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
⁵ Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel; Department of Neurology, Ginges Center for Neurogenetics, Hadassah Medical Center, Jerusalem, Israel. Electronic address: dekstein@hadassah.org.il.

PMID: 34974230
DOI: 10.1016/j.seizure.2021.12.009

Abstract

Objective: Epilepsy is characterized by unpredictable attacks. Hence, people with epilepsy (PWE) may develop anxious anticipation of upcoming seizures. Seizure phobia is an anxiety disorder wherein seizure anticipatory situations trigger fear, accompanied by avoidance behaviors. Research on seizure phobia among PWE is scarce. Therefore, we aimed to describe the diagnosis of seizure phobia and its association with demographic, psychiatric and neurological variables.

Methods: This is a cross-sectional study of adult PWE in a tertiary epilepsy outpatient clinic. Data were collected from semi-structured interviews, demographic questionnaires and medical records. Patients with and without seizure phobia were compared in terms of sociodemographic, psychiatric, and neurological variables. A logistic regression analysis was performed to identify variables that predicted seizure phobia.

Results: Among 69 PWE included in the study, 19 (27.5%) were diagnosed with seizure phobia. In comparison with PWE without seizure phobia, PWE with seizure phobia were predominantly female (84.2% vs 44.2%, p = 0.005), and had more comorbid anxiety disorders (84.2% vs 34.9%, p = 0.01), past major depressive episode (MDE) (63.2% vs 20.9%, p = 0.003), and post-traumatic stress disorder (26.3% vs 7%, p = 0.05). There was a significant association between seizure phobia and comorbid psychogenic non-epileptic seizures (36.8% vs 11.6%, p = 0.034). However, no significant association was found with epilepsy-related variables. A multivariate logistic regression model indicated anxiety and a past MDE as predictive factors for seizure phobia (R² = 0.43).

Conclusion: Seizure phobia is a distinct psychiatric entity among PWE. Further research is required to understand its etiology, risk factors, and potential interventions for these patients.

Keywords: Anxiety; Depression; Post-traumatic stress disorder (PTSD); Psychogenic non-epileptic seizures (PNES); Specific phobia.

MeSH terms

Adult
Cross-Sectional Studies
Depressive Disorder, Major*
Epilepsy* / complications
Epilepsy* / epidemiology
Female
Humans
Phobic Disorders* / complications
Phobic Disorders* / epidemiology
Seizures / complications
Seizures / epidemiology