Abstracts

Rationale: Many psychological and social variables have been correlated with Psychogenic Non-epileptic Seizures (PNES), but an understanding of the underlying psychological processes remains elusive. We aimed to qualitatively explore the psychological processes underlying PNES, with an emphasis on the formation of personal and social identity or self. Methods: 20 patients (13 female; mean age 43.6 ± 15.3 years) with PNES were recruited through Austin Health (Melbourne, Australia) for an in-depth semi-structured interview (90 minutes) covering themes about individual development, emotional experiences, and the social milieu. Interpretative Phenomenological Analysis was used to analyze the interview transcripts. Key themes present in at least 50% of the sample were extracted and clustered using Nvivo9 qualitative analysis software. Results: Overall, 38 themes were identified and grouped into four broad categories; maladaptive childhood experiences, poor development of personal and social identity, difficulty reflecting on one's thoughts and emotions, and poor understanding of the behaviour of others. More frequently reported themes indicating adverse childhood experiences included childhood abuse (100%) and a lack of parental attention or care (95%). Poor adaptation to stress (100%) and avoidant and dependent coping styles (95%) represented poor regulation of the patient's emotions and thought processes, and chronic acrimonious relationships with partners, family, and friends (100%) highlighted the difficulties these patients have relating to other people. Most striking, poor formation of personal and social identity were strongly represented by 95% of patients reporting their PNES was integral to the way they defined themselves, yet out of their control. Themes related to poor identity or self-development were common to 95% of patients reporting themes covering maladaptive childhood experiences, difficulty reflecting on their own thoughts and emotions, and a poor understanding of the behaviour of others. Conclusions: This initial analysis highlights a new framework for understanding PNES, in which poor identity or self-development is critical for its expression. Themes representing poor identity or self-development provide a basis for understanding the association between poor mental and social outcomes in these patients and the emergence of PNES. A more comprehensive understanding of the psychological processes underlying PNES and their development across the lifespan will enhance treatment specificity and efficacy.