What Are Pseudoseizures That Happen in Some Mental Health Disorders?

Summary: Pseudoseizures are physical events during which a person shows the physical symptoms associated with epileptic seizures but have no physiological cause.

Key Points:

• Pseudoseizures are now known by their clinical name, psychogenic nonepileptic seizures (PNES).
• They resemble epileptic seizures, and a person who experiences pseudoseizures may be misdiagnosed with epilepsy.
• The most common causes of pseudoseizures include stress associated with mental health disorders, traumatic life events, and physical injury or pain.
• Standard psychotherapeutic techniques are an effective treatment for pseudoseizures.

Stress and Mental Health, Stress and the Body

For years, western medicine – i.e. the type of medicine practiced in the U.S. – maintained a solid wall between the mind and body. Physical illnesses require physical treatment, and mental illness requires talk or behavioral therapy. That was the standard dogma, followed by most mainstream providers and accepted by most patients.

But this division has always been false: the human mind is part of the human body, and human thoughts and emotions are the result of chemical processes in the human brain.

The western medical establishment began to recognize this – in terms of the approach to healing – beginning in the late 1970s, and the idea gathered momentum through the 1980s. In the 1990s, science-based medicine offered tacit acknowledgement of the mind-body connection with the widespread acceptance of the disease model of mental health and the disease model of addiction, which propose that mental health disorders – including addiction – are the result of chemical imbalances in the brain caused in part by genetics and in part by individual experience.

Which brings us to the topic of pseudoseizures and the question most people ask when they hear the word: what are pseudoseizures?

Pseudoseizures, or psychogenic nonepileptic seizures (PNES), are a perfect example of the mind-body connection: they’re a physical phenomenon that resemble a symptom of a serious physical disorder – the seizures observed in epilepsy – but in most cases, they have no observable physical origin.

In other words:

PNES are not caused by atypical or abnormal electrical activity in the brain, like epileptic seizures.

Scientists don’t yet fully understand the cause of pseudoseizures. However, research indicates they may be associated with:

• Personal history of trauma
• Personal history of abuse
• Presence of mental heath disorders, including:
  • Anxiety
  • Depression
  • Post-traumatic stress disorder
  • Dissociative disorders
  • Schizophrenia
• Stress:
  • Chronic stress
  • Extreme acute stress
• Physical injury

That’s what pseudoseizures are, and those are the conditions or circumstances that can cause and/or trigger them. But what do they look like? And how do providers diagnose them?

Pseudoseizures (PNES): Signs, Symptoms, and Diagnosis

When a person experiences a pseudoseizure or PNES, they may display some or all of the following symptoms:

• Convulsions and/or tremors while conscious or unconscious
• Shaking/tremors that last longer than 10 minutes
• Loss of consciousness
• Shifting changes in consciousness: conscious, unconscious, conscious but confused, conscious and aware of surroundings, conscious but unaware of surroundings.
• Outbursts of emotion, including laughing, crying, or shouting
• Atypical movement of limbs and/or pelvis
• Atypical sensations in body: burning, tingling, numbness

Diagnosing PNES can be difficult because the symptoms mirror those of epileptic seizures. If a person has a mental health disorder or is under extreme stress, a provider may misdiagnose an epileptic seizure as PNES, which can lead to untreated epilepsy or an untreated separate condition and serious complications. Or a provider may mistake PNES in a person with no previous diagnoses as an epileptic seizure, which can result in unnecessary treatment, which may also cause serious complications.

That’s why diagnosis of PNES requires:

• Full medical history
• Complete neurologic and psychiatric history
• Full physical examination
• EEG (electroencephalogram) testing

According to the Epilepsy Foundation, the gold standard for PNES diagnosis involves:

• Ruling out a diagnosis of epilepsy
• Video EEG, which involves monitoring patient simultaneously with video and EEG of a period of hours or days, to ensure a seizure is captured and documented by both video and EEG
• Close analysis of video EEG
• Input of individuals who’ve witnessed previous seizures

An accurate diagnosis which rules out epilepsy is essential because the antiseizure medications most often prescribed for epilepsy does not help PNES, and the side effects of antiseizure medication can exacerbate PNES.

Treatment for Pseudoseizures (PNES)

Once an individual receives an accurate diagnosis, evidence-based treatment options for PNES include:

• Cognitive behavioral therapy (CBT)
• Prolonged exposure therapy (PET), for PTSD related PNES
• Interpersonal/Psychodynamic psychotherapy
• Mindfulness-based psychotherapy
• Family therapy, for children or adolescents diagnosed with PNES

When an individual receives an accurate diagnosis and appropriate treatment for PNES, evidence indicates the prognosis is – in most cases – positive:

• Estimates show that after diagnosis, 20%-50% of people report seizures stop occurring without any treatment
• Among those for whom seizures persist after diagnosis, most report significant improvement after three months of psychotherapy
• Chances of improvement with no treatment are higher for adolescents, people with only one PNES, and people with a mental health disorder with mild/minor/minimal symptoms.

Protective factors against further seizures after diagnosis include:

• Regular exercise and activity
• Quality sleep
• Robust social and family connections/support
• Eating a healthy diet
• Stress management techniques, i.e. mindfulness, meditation, yoga
• Community and peer support groups for PNES

The most important aspect of treatment for a person with pseudoseizures that don’t disappear after diagnosis is identifying and resolving the root cause of the emotional distress that triggers the seizure. Root causes are often traumatic experiences that later manifest in mental health disorders such as PTSD, anxiety, trauma, or disorders with dissociative symptoms.

In many cases, pseudoseizures (PNES) are self-defense mechanisms individuals develop to cope with overwhelming thoughts and emotions. With targeted treatment and appropriate psychiatric support, it’s possible to resolve pseudoseizures and develop healthy, helpful coping mechanisms that allow individuals to manage stress, emotions, and/or the symptoms of a mental health disorder. These presence of these coping mechanisms – identified and developed with the support of an experienced clinician – can reduce or eliminate the phenomenon of pseudoseizures, and allow an individual to return to full, practical daily activities and productive function in essential domains such as work, school, and relationships.