Dissociative events — sometimes known as “dissociative seizures” — are not epileptic seizures. Rather, they are somatic manifestations (physical reactions) to psychological stress. Other terms used for dissociative events include “psychogenic nonepileptic seizures,” “psychogenic seizures,” or “functional seizures.” Some scientists have previously used the word “pseudoseizures” to describe this type of event, but the use of this term is now discouraged because they are, in fact, a real phenomenon.
Dissociative events are challenging for clinicians to diagnose and treat because, on the surface, they look so similar to epileptic seizures. Understanding dissociative events is vital not only for doctors and specialists but also for the individuals experiencing them.
Between two and 33 people per 100,000 experience dissociative events. Roughly 75 percent of people with dissociative events are female, according to a 2017 study published in Seizure. These events most frequently start during late adolescence or early adulthood. Another study found that dissociative events were common in females of all ages, while the proportion of males increased with age.
Having preexisting mental health disorders is one of the biggest risk factors for developing dissociative events. Common mental health conditions that can come before psychogenic nonepileptic attacks include:
Dissociative events are also associated with a history of trauma and sexual abuse. One study found that this was especially true when the trauma occurred during childhood or adolescence. People with epilepsy can experience both epileptic and nonepileptic seizures.
Research also shows that dissociative events can run in families. This suggests a genetic component to this type of occurrence; however, more research is needed to confirm this.
Dissociative events can be difficult to diagnose because they are frequently mistaken for seizures typically associated with epilepsy. On the surface, they may look the same: A person having a dissociative event may display abnormal movements, changes to their senses, or loss of awareness. The person has no control over what is happening.
One way a medical professional can tell the difference between dissociative events and epilepsy is by using an electroencephalogram (EEG) to record electrical activity in the brain. A doctor may also conduct blood tests and brain scans to rule out other diseases.
When a person has an epileptic seizure, the EEG will usually show abnormal electrical activity in the brain. However, when someone is having a dissociative (or nonepileptic) event, the EEG will not show abnormal electrical activity.
Although video EEG monitoring is the most reliable way to come to a diagnosis, it’s important to understand the psychological factors that may be contributing to dissociative events. Thus, diagnosing dissociative events often requires a team of doctors including neurologists, psychiatrists, and psychologists.
Approximately 20 percent of people with dissociative events attempt suicide within 18 months of receiving a diagnosis. Therefore, it is important to begin treatment as soon as possible after diagnosis. Antiepileptic drugs will not improve dissociative events.
One large clinical trial showed that behavioral therapies can improve dissociative events, either on their own or in combination with an antidepressant. People in this study with dissociative events who attended psychotherapy — specifically cognitive behavioral therapy (CBT) — had a 51.4 percent drop in dissociative events and experienced significant improvement in depression, anxiety, quality of life, and overall functioning.
This same study showed that those individuals who combined CBT and the antidepressant drug Zoloft (sertraline) showed a 59.3 percent event reduction. They also improved in overall functioning. However, medication alone did not show a reduction in events.
All in all, dissociative events are caused by psychiatric and physical factors. Therefore, they should be treated by a team that includes a neurologist (for diagnosis), a psychiatrist (for medication management), and a psychologist (for CBT).
When witnessing someone experiencing a dissociative event, you should employ the same first-aid techniques as you would for an epileptic seizure:
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