Psychological Non Epileptic Seizures
Northeast Regional Epilepsy Group

The connection between Psychological (Psychogenic) non epileptic seizures and a history of trauma

How many people with PNES have a history of trauma?

An interesting article was published in the Journal Epilepsy and Behavior ( 2004) by Fiszman et.  al. It reviewed 17 PNES studies and found that traumatic events and PTSD in persons with PNES were very common.  Depending on the study: 44-100% of PNES patients had suffered some form of general trauma and 23-77% had a history of physical or sexual abuse. 

What is trauma:

Trauma is the Greek word for “wound.”There are many sources of psychological trauma: physical or sexual abuse, being the victim of an accident,  crime or torture, natural disasters, divorce, death of a loved one, medical illness, etc.  One person’s trauma may not seem all that serious to another person, but remember, trauma is individual and personal.

 How does trauma hurt us?

The combination of 1) not expecting the incident and 2) suffering a wound as a result can shatter our sense of safety and leave us stuck trying to make sense of what occurred. 

Healthy processing of trauma:

Sometimes after experiencing something shocking (e.g. witnessing a gory accident), we feel compelled to keep talking about it with everyone we meet and we keep thinking about the event for some time.  What your mind is doing is trying to get a handle on that event.  Once complete, the memory of that event is ready to be stored away in a long term memory niche.  Afterwards, we can remember it at will rather than having the memory intrude onto us randomly.  

What happens when healthy trauma processing gets blocked?:

Sometimes the healthy processing of the event does not happen.  There could be many reasons:

  • The event is so incredibly horrific that it shocks us and all we can manage to do is to push it away from our thoughts
  • We are not allowed to speak about it
  • We are so young and mentally immature that we don’t even have the words to process it. 

When that happens we are left with “untreated wounds” and roaming memories. Those highly charged fragments of memories are left unattached and can surface when least expected.  A traumatized mind does not have smooth connections but rather has splits and breaks in between memories. As a result it can sometimes “short circuit.” 

The connection between Psychological (Psychogenic) non epileptic seizures and a history of trauma:

In some patients, trauma will set the groundwork for many symptoms including psychological non-epileptic events.  Life happens all the time and whenever something comes up that puts stress on you, you respond to the situation.The problem is that if you’re doing so in an injured state, PNES may happen as an attempt to respond to the stress.  Unfortunately, they end up being a short-circuit. 

The Fiszman article is showing us that trauma is very common in PNES.  I suspect trauma is one of the ingredients that keeps triggering the short circuits that follow. Therefore this is where PNES treatment must start.

7 Responses to “The connection between Psychological (Psychogenic) non epileptic seizures and a history of trauma”

  1. Stephen Harlan says:

    To me, this is self evident. At least to my situation. My therapist and I have gone over traumatic experiences many times. The one she doesn’t quite have a handle on is the trauma of adoption. If you’re not just a few weeks old when adopted, the mind has had the opportunity to start the memorization process about environment. And the information retained is the barometer by which the child perceives/compares/evaluates new experiences. If the first experiences are negative in some way, and the new experiences do not overshadow the old, the seed of unhappiness, and eventually trauma, takes root.

    RSVP…if you wish

    PS…I was 47 and when the sh…t hit the fan. Now I’m 57 and I’m still having to deal with it.

  2. Psychogenic? says:

    How about a very healthy control freak (finally) being diagnosed with epilepsy after 17 years? Yes, I do have partial complex seizures and had brain surgery in 2008, but I have intractable seizures. In other words, not in control. Every time a medication does not work? PNES. Stress of grandmother’s illness i.e. not controllable? PNES. More medication that did not work. PNES. Not being able to figure this thing out. PNES. Docs need to learn to work together to understand this enough to treat patients.

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  4. S says:

    I grew up in a household of 4 siblings, homemaker mother and father, PROFESSIONAL DOCTOR, I born in late late 1950s. Life was good. I recall my first remembered immunizaion at about 6 yrs old. I was shy and quiet and tried to hide my fear of seeing the needle. All I recall is my shock after waking up lying down, what happened?? My doctor said I fainted. No big deal.
    My next trauma that I recall was having a reading test in 6th grade. I had a best friend but over the summer she dropped me as a friend. When I entered 6th grade I had been traumatized from my girlfriend not being my friend. I was shy, soooo shy. Now I was paralyzed with FEAR. I sat alone in lunch, class, and had no friends and NO self confidence on how to make new friends. I was lost. During my individual PRIVATE reading test, for an unknown reason to me, I frooze as the teacher asked me to read aloud the story. I rushed through the story, trying to hide my NERVOUSNESS I HAD NEVER REMEMBERED HAVING PANIC OR EVEN knew what it was. I couldn’t recall the story, so when she asked me to take the written test I flunked it. She screamed at me. What is wrong with you? You FAILED THE TEST. I AM PUTTING YOU INTO 4TH GRADE reading CLASS.

    I developed a low self esteem and unbenost to me Social ANXIETY. I was criticized by kids giving me
    Weird looks. As I WAS, PAST TENSE, in the highest level classes.

    From then I developed SEVERE ANXIETY WHEN EVER I HAD TO read aloud. I used to feel confident getting in front of classes,

  5. S says:

    I still have SEVERE FEAR and ANXIETY at 50 yrs old, growing up with a critical mother who instilled that everyone was watching me, waiting for me to fail because, I was from a prestigious family. She used to say you kids were ACCIDENTS, my father’s, favorite was my sister as she was Confidant..My fatherwas loving , kind, loyal, no abuse ever. I ran my whole life at full speed carried fight /flight with me at any type of performance, even people’s eyes LOOKING at me frightened me and still do. I married a husband who I thought was nice but turned out to be an Emotional Abusive person. I developed black outs 16 years ago. I couldn’t handle the stress of my marriage, on top of the emotional abuse from him.
    ( I dont know how I passed nursing RN school but I managed at age 24 years old.)

  6. S says:

    I was working as a nurse and felt funny when I got home from a hard3-11shift. I got a phone call to come back to work in the morning as they were short staffed. I said yes. I suddenly was flooded with OVERWHELMING ANXIETY, I felt a rush of fear run from my head going down to my toes. I passed out. I awoke and started crying, WHAT HAPPENED TO ME. I quickly called into work canceling the next morning. I thought this was a message from my body telling me NO NO MORE STRESS. I quit working shortly after that. My body was in OVERLOAD. I had to listen to it…..

    I have not worked a nursing job in an institution since. My episodes continued for 16 years, infrequent and without a conscience awareness of when they would happen. But most always no other witnesses. No warning then bang!!! I would find myself on the floor coming back to conscience Ness. After about 5 episodes I started to recognize the warning signs. I would get a aura of some kind. I knew to lay down or sit down and let them take their course. Diagnosis from 1st psychiatrist was Panic attacks //ANXIETY. Was given ativan as long as I did not increase the dose and antidepressant. The attacks were very infrequent but continued. I began to realize that a STRESSOR of some sort always PRECIPITATED it. I began to shelter myself from all Social activities. I lived isolated and felt alone. My husband continued his mental ABUSE.
    One time I was driving and it happened, I was able to get the warning, I pulled over and parked the car. Next thing I know my 2 daughters were screaming MOM, MOM MOM WAKE UP, they were terrified as to have witnessed this both were in the back seat. Next doctor was a Cardiologist. All tests NORMAL. Dx: Vasovagagal syncope. MRI from neurologist NORMAL.

    Fast fforward 10 years..to the present. Episodes are very very infrequent maybe 1 per year. Last summer I had an episode while visiting my brother, his wife and neice. I felt the episode come on, I put my head down on the table to protect my head. I awoke to panic from them calling out my name, Susie WAKE UP.
    “what happened i said” they said :YOU HAD A SEIZURE!!!!

    Next doctor neurologist, Dx : unknown. EEG NORMAL. Put on keppra.

    Today I am off keppra as I was taken off one week before a 3 night video EEG at Johns Hopkins hospital. Video EEG: inconclusive due to me not having an episode during it. PERMANENTLY off keppra. PSYCHIATRIC consulted during the 3 NIGHT VIDEO EEG Dx: POSSIBLE PNES. MEDS 120 mg Cymbalta and Cont Seroquel XR. Conversion disorder?????

    Susan

  7. S says:

    I made one mistake, I left out an episode Dec 28, 2012, I blacked out while driving, had warning, went to hospital 3 night stay. That is actually when I was put on keppra 1st with order to follow up with johns Hopkins hospital. Dx : POSSIBLE Seizures. I was not put on keppra last summer after the blackout at my brothers. I was on keppra when that happened. I hope this can help your RESEARCH. THANK YOU.

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