A scale based on underlying core beliefs generated by the experience of epilepsy was developed. The scale, with measures of coping, adaptability, and knowledge, was used to examine the commonly-reported differences in emotional adjustment between patients (EP) and a non-epileptic population (NEP). The EP had significantly lower perceived self efficacy and was more depressed and anxious than the NEP controls. The NEP showed greater knowledge of medical aspects of epilepsy than the EP. Positive correlations between scale values and measures of mastery, self esteem, affect balance, felt stigma and impact of epilepsy were found. Factor analysis produced a three factor solution of emotion, knowledge and anxiety which explained 61.6% of the variance in scores. Results are discussed in terms of Bandura's theory of self efficacy as the motivating and sustaining force in the ability to change behaviour. Core beliefs are central to both the development and maintenance of anxiety and depression in epilepsy patients and need to be addressed in any attempts at remedial intervention.