Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): A systematic review.
PURPOSE The purpose of the present study was to assess stress coping strategies employed by patients with psychogenic non-epileptic seizures (PNES) and determine whether these approaches were associated with other psychopathological features. Ineffective stress coping strategies can have a variety of unhealthy consequences fueling psychopathology just as psychopathology can also have an impact on stress coping. Because of this, the study of stress coping has the potential to inform our understanding of the PNES condition and underscore a potential target for psychological treatment. METHODS Eighty-two consecutive patients with PNES were studied using the Coping Inventory for Stressful Situations (CISS). The CISS is a self-rating coping strategies scale that has three main subscales (Task-Oriented, Emotion-Focused, and Avoidance-Oriented). Other psychological variables that were thought to potentially influence the chosen coping mechanisms including alexithymia, symptoms of post-traumatic stress disorder, anger expression and select scales from the Minnesota Multiphasic Personality Inventory 2-RF (MMPI 2-RF) were also evaluated. RESULTS Fifty patients (60.9%) endorsed using at least one coping strategy that was 1.5 standard deviations or more away from the normal adult mean. Over 30% of the participants endorsed using elevated Emotion-Focused coping strategies (T score ≥ 65), and just over 25% endorsed underusing Task-Oriented coping strategies (T score ≤ 35). Elevations in avoidance strategies were endorsed by only 15.9% of the respondents. ANOVA comparing T scores between the coping strategies was significant (F=13.4, p=.0001) with a significantly lower Task-Oriented strategy than Emotion-Focused (p=.001) and Avoidance (p=.005) strategies. Patients with high scores of Emotion-Focused coping strategies also had significantly high scores on diverse psychopathology factors including elevations on depressive mood, intrusive experiences, anger state, and general anger scores. In contrast, those who used Task-Oriented strategies and who used Avoidance-Focused strategies had less psychopathology including low positive emotion scores (RC2). CONCLUSION Nearly one-third of patients with PNES tended to use the less effective Emotion-Oriented coping strategies and one fourth reported underusing the more effective Task-focused strategies. Substantial differences were noted between coping strategies with a significantly lower Task-Oriented strategy than Emotion-Focused and Avoidance strategies. In addition, high Emotion-Focused coping was seen in patients with underlying psychological symptoms that were not observed in other coping strategies. This information supports the relevance of assessing stress coping in patients with PNES because it allows the identification of useful behavioral targets for the psychotherapist.