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Ictal symptoms of anxiety, avoidance behaviour, and dissociation in patients with dissociative seizures
  1. L H Goldstein1,
  2. J D C Mellers2
  1. 1King’s College London, Institute of Psychiatry, Department of Psychology, London SE5, UK
  2. 2Neuropsychiatry Department, Maudsley Hospital, Denmark Hill, London SE5, UK
  1. Correspondence to:
 Dr L H Goldstein
 Institute of Psychiatry, Department of Psychology, PO77 The Henry Wellcome Building, De Crespigny Park, London SE5 8AF, UK; l.goldstein{at}


Objective: To examine anxiety related seizure symptoms and avoidance behaviour in adults with dissociative (psychogenic non-epileptic) seizures (DS) in comparison with a group suffering from partial epilepsy.

Methods: 25 DS and 19 epilepsy patients completed an attack symptom measure, the hospital anxiety and depression scale, the dissociative experiences scale, and the fear questionnaire.

Results: DS patients reported the presence of significantly greater numbers of somatic symptoms of anxiety during their attacks than the epilepsy group, despite not reporting subjectively higher levels of anxiety. The DS patients also reported higher levels of agoraphobic-type avoidance behaviour than the epilepsy group. Measures of dissociation were higher in the DS group, who also reported greater symptoms of depression.

Conclusions: The findings support a model whereby DS occur as a paroxysmal, dissociative response to heightened arousal in the absence of raised general anxiety levels. The model has practical implications for clinical assessment and treatment: in clinical practice, inquiry about these symptoms may help in the diagnosis of DS; with respect to treatment, the anxiety related symptoms and avoidance behaviour prevalent in DS are a potential focus for a cognitive behavioural approach analogous to that used in the treatment of other anxiety disorders.

  • DES, dissociative experiences scale
  • DS, dissociative seizures
  • DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition
  • FQ, fear questionnaire
  • HADS, hospital anxiety and depression scale
  • ICD-10. International Classification of Diseases, 10th revision
  • dissociative (non-epileptic) seizures
  • anxiety
  • dissociation

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  • Competing interests: none declared