Abstracts

Rationale: Little is known about specific features of psychological functioning amongst pediatric samples with Psychological Non Epileptic Seizures (PNES) and Non Epileptic Events (PNEE). Comorbid psychopathology, including depression and anxiety, is one of the best predictors of prognosis in children with PNES, but this is not a distinguishing feature. Adult PNES patients have unique psychological characteristics, including higher rates of alexithymia, or the propensity to not express feelings, and less effective coping mechanisms in response to stress. Family dysfunction is also more frequently experienced. We sought to contribute to the question of what is specific about the psychological profile of PNES/PNEE patients compared to Epileptic (ES) and symptom-free patients in a pediatric sample. We hypothesized that despite comparable levels of depression and anxiety, the PNES/PNEE children would be (1) more alexithymic, (2) have weaker coping abilities, and (3) demonstrate more disrupted family relations. Methods: We present data from a sample of 30 children (aged 7 to 19; 70% girls), including 16 PNES/PNEE patients and 9 ES patients, who were referred for psychological treatment by their neurologists. PNES/PNEE diagnoses were made following Video-EEG and/or imaging to rule out organic etiologies. Five symptom-free siblings of PNES/PNEE patients were also included. No differences in variables of interest emerged between the ES patients and the siblings so they were collapsed as controls. We administered a battery of standardized and experimental tests including parent- and/or child-report objective rating scales (e.g., Achenbach and Millon inventories), the Children's Alexithymia Measure using clinician ratings, standardized projective measures (Rorschach), and a projective measure of family relations (Family Relations Button Sort™). Results: High proportions of the overall sample received clinically significant ratings of depression (64%) or anxiety (57%) symptomatology from either parent or child report; however, these psychiatric diagnoses did not distinguish between groups. Despite comparable ratings of internalizing psychopathology, the PNES/PNEE group was rated as more alexithymic than controls (p < 0.01). In addition, clinically and statistically significant differences emerged on Rorschach indices, whereby the PNES/PNEE group showed greater sensitivity to others' emotions (p < 0.02; Affective Ratio, Afr) and poorer coping ability (p < 0.05; Coping Deficit Index, CDI). Contrary to predictions, no differences were found regarding child perceptions of family relations. Conclusions: Symptoms of anxiety and depression do not distinguish PNES/PNEE from ES or symptom-free patients in a pediatric sample. Rather, their psychological profile is characterized uniquely by greater alexithymia, sensitivity to others' emotional expression, and poorer coping. Thus, when planning optimal psychotherapy interventions for pediatric patients with PNES/PNEE, the therapist must consider their non-specific psychiatric diagnoses as well as their more unique alexithymia, emotional sensitivity, and coping deficits.