Conversion Disorder with Psychogenic Seizures and Its Psychological Trauma-Related Etiology

Conversion disorder, formerly known as functional neurological disorder, does not have one known etiology, similar to many other disorders (e.g., schizophrenia, depression, etc.) (Faustman, 1995; Stansfeld & Rasul, 2007). The lack of a specific etiology may be due to the fact that there are various specifiers that can be used within the conversion disorder diagnosis.

This disorder can manifest in the form of paralysis; tremors; muscle contraction or twitching (e.g., myoclonus), difficulty with walking or gait; difficulty swallowing; slurred speech; voice issues (e.g., dysphonia); seizures; loss of consciousness (e.g., anesthesia); sensory issues; or any combination of the above (American Psychiatric Association, 2013). Specifically, psychogenic seizures are “not caused by abnormal brain electrical activity,” but rather this type of seizure usually “reflects a psychological conflict” (Gillig, 2013). One etiology that has been proposed in regards to conversion disorder with psychogenic seizures is exposure to trauma, especially during early childhood (Ozcetin et al., 2009).

Trauma does not have a definitive definition that describes one type of event, but rather is subjective and is variably experienced for each individual. A traumatic event, such as sexual assault or a car accident, does not always result in someone becoming traumatized; however, a person’s emotional experience of the trauma determines the long-term effects (Center for Substance Abuse Treatment, 2014). For example, while two people may be in involved in a traumatic event, their reactions may differ with one demonstrating resilience and using coping strategies and the other developing depression or posttraumatic stress disorder (PTSD).

Psychological trauma events are generally thought of as physical abuse, sexual abuse, emotional abuse, and neglect. Unfortunately, other types of psychological trauma are often not recognized in many studies, which begs the question of how does conversion disorder present in regards to other less commonly studied traumas?

One study that analyzed a variety of psychological traumas is Hingray et al. (2011) in which they assessed participants for medical illnesses, accidents, bereavement, and witnessing traumatic death. Since there are a variety of different types of psychological trauma, the numerous types of events may contribute to the difficulty in determine the etiology of these psychogenic seizures.

Trauma-related and dissociative phenomenon have been correlated and suggested as highly comorbid (Briere, Weathers, & Runtz, 2005). Dissociation may be the result of one’s unconscious defending itself from the trauma (Mozer, 2009).  Furthermore, dissociation has also been linked to conversion disorder with psychogenic seizures (Spinhoven et al., 2004). As such, it is important to consider the unique intersection of dissociative symptoms, trauma-related disorders and symptomatology, and psychogenic seizures as they may have overlapping features and etiologies.

Organic etiologies are one avenue that deserves consideration. In contrast to epileptic seizures, there is not an isolated part of the brain that when damaged results in these non-epileptic seizures. According to Perez et al. (2017), the cingulo-insular in the brain is altered in patients with who have both PTSD symptoms and conversion disorder; however, the article demonstrates that this alteration in the brain was a result of stress-induced neuroplasticity.

With a lack of empirical evidence supporting an organic cause for psychogenic seizures of conversion disorder, other environmental and relational factors warrant further contemplation. Ozcetin et al. (2009) found that dissociation, emotional abuse and neglect, physical abuse, and sexual abuse were endorsed at significantly higher rates in the women who had conversion disorder with psychogenic seizures as compared to women without conversion disorder.

In another study, participants with psychogenic seizures were more likely to divulge that they had a history of adverse childhood events and poor parental care as compared to those participants who had motor conversion symptoms (Stone, Sharpe, & Binzer, 2004). Hingray et al. (2011) found that individuals with psychogenic seizures and trauma were more likely to have a “strong dissociation mechanism” while those individuals with psychogenic seizures but no trauma history experienced weaker dissociation. The link between psychogenic seizures, dissociation, and psychological trauma history suggest that there may be more to learn about how the three factors evolve and interact.

For treatment of conversion disorder with psychogenic seizures, the least effective treatment modality is the use of pharmacotherapy (Lesser, 2003). According to Lesser (2003), the use of pharmacotherapy is best for targeting specific symptoms, not treating the disorder as a whole. Treatment strategies such as behavioral therapy and treatments targeting the underlying emotional component have been suggested as common and effective interventions for treating conversion disorder with psychogenic seizures (Lesser, 2003). Since psychological trauma is a factor in the etiology of this disorder, trauma-focused interventions are also important (Gillig, 2013).

Summary

Just like many other disorders, the etiology of conversion disorder with psychogenic seizures has not been determined and may not be determined. Instead, the disorder may be a combination of organic and environmental factors over time. Preliminary research findings suggest that conversion disorder with psychogenic seizures is related to a psychological trauma history as well as a presentation of dissociation.

Future studies will need to look at psychological traumas beyond sexual, emotional, and physical abuse. The understanding of the relationship between trauma and conversion disorder with psychogenic seizures is important in order to intervene appropriately for optimal treatment effectiveness.