Emotion in psychogenic nonepileptic seizures: Responses to affective pictures

We examined emotional responses to standard affective pictures in 18 psychogenic nonepileptic seizure (PNES) patients. Given reports of trauma and posttraumatic stress symptoms (PTS) in many PNES patients, comparison groups were seizure-free individuals high and low in PTS (PTS-high, PTS-low; n = 18 per group). Patients with psychogenic nonepileptic seizures (1) reported more emotional intensity to neutral and pleasant pictures than PTS-low and more intensity to neutral pictures than PTS-high, and (2) showed less positive emotional behavior to pleasant pictures than PTS-high. Groups did not differ in pleasantness/unpleasantness ratings, negative emotional behavior, cardiac interbeat interval, or respiratory sinus arrhythmia (RSA) reactivity to the pictures. Patients with psychogenic nonepileptic seizures reported more general emotion regulation difficulties and showed lower baseline RSA than PTS-low but not PTS-high. In sum, intense emotional experience and diminished positive emotional behavior characterized PNES patients' emotional responses.

► We examine emotional reactivity in psychogenic nonepileptic seizure patients. ► Comparison groups are seizure-free individuals with posttraumatic stress symptoms. ► Stimuli are pleasant, neutral, and unpleasant pictures. ► PNES patients experience more emotional intensity and show less positive emotion. ► Baseline emotion dysregulation and attention to somatic cues may characterize PNES.