Objective The study sought to examine further the previously reported attentional bias for facial emotion in individuals diagnosed with dissociative (psychogenic non-epileptic) seizures (DS). Specifically, we assessed whether the attentional bias could be demonstrated whilst controlling for anxiety, depression and relevant cognitive abilities (i.e., facial perception, cognitive flexibility, intellectual abilities).
Method Performance of DS patients (n=38) was compared to a healthy control group (n=43) on an emotional Stroop test, in which facial affect (anger, happiness, neutral) was presented subliminally. Individuals with diagnoses of clinical anxiety and depression were excluded from both groups. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression in those not excluded. Facial perception, intellectual abilities and cognitive flexibility were assessed with standardised cognitive tests (Benton Facial Recognition Test, Wechsler Abbreviated Scale of Intelligence, Stroop test). Groups were matched for age, gender and handedness.
Results The DS group exhibited an elevated attentional bias for facial emotion (happy and angry faces), that was not attributable to differences in relevant cognitive abilities or the presence of symptoms of anxiety or depression. A positive relationship was observed between seizure frequency and attentional bias for happy faces in the DS group.
Conclusion Individuals with DS automatically and disproportionately allocate attention to emotional faces relative to neutral faces. This attentional bias is not explained by the existence of more common psychopathological symptoms or cognitive deficits. Combined with recent findings of impaired overt recognition of facial emotion in this group, it seems that individuals with DS display hypervigilance for the presence of facial emotion, alongside misinterpretation of the nature of the emotion being displayed. Such abnormalities in social-emotional processing may contribute to significant distress and dysfunction in social encounters in daily life, possibly predisposing to the development of the disorder or contributing to the emotional distress hypothesised to trigger individual seizures. As such, these social-emotional processing impairments might represent an important target for psychological intervention.
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