Are psychogenic non-epileptic seizures (PNES) the same in men and women?

In 2017, we set about trying to answer a question that had been on my mind for a few years. The query was whether women and men with PNES were the same in all respects or different, and if they were different, in what ways. The reason answering this question is important is because better understanding differences in the general PNES classification can help clinicians know better what factors to keep an eye open for and what treatment approaches might be tried first.

Since there are many more women who carry the diagnosis of PNES than men, it was often hard for researchers to obtain a large enough sample of men in their studies. Often this was mentioned in articles as a limitation because whatever conclusions were arrived at might only be relevant to women. Of the handful of studies in the past that examined PNES and gender a few of those had sample sizes that were quite small. This led the reader to be unsure as to how reliable these findings were.

So, the way we focused on this project was by first collecting a large enough number of males (51 in all) diagnosed with PNES and comparing them to females (97) who also carried this diagnosis. We examined demographic (e.g. age, education), social/clinical (e.g. age when seizures started, history of psychological trauma) as well as psychological measures (trauma symptoms, anger, quality of life, stress coping) in this sample.

What we found was that the women in our sample reported having suffered a significantly greater number of sexual traumas than men. Therefore, as might be expected, they reported higher levels of dissociation (an experience of being detached from reality, from your own physical and emotional experiences, “feeling like you are in a dream or outside of your body”). Dissociation often develops in those who have suffered severe trauma as children from which they could not “fight or flee”. The only other option in this type of situation is to “leave your own mind” in a way. Women in this sample also reported more “sexual disturbances (“bad thoughts or feelings while having sex” or “having sex with someone you hardly knew”) which would also not be unexpected in a victim of sexual abuse. In contrast, men did not report as much sexual abuse as women, but this is not to say that they did not report past psychological traumas. Among some of the events they reported: physical abuse, military psychological trauma, death of a loved one. They also reported a greater use of avoidance as a stress coping strategy and higher levels of depression.

We concluded that these gender differences may be helpful in deciding different first-line treatment approaches. What I mean by this is that perhaps trauma-focused treatment might be a first choice especially with women diagnosed with PNES and with a history of sexual abuse, while a more traditional cognitive behavioral therapy might be a first choice for men whose prominent symptoms are depression and a tendency to avoidant stress coping.

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