Dissociative seizures are similar to epileptic seizures in that they cause episodes of involuntary movements and behaviors. However, while epileptic seizures result from abnormal electrical signals in the brain, dissociative seizures happen for psychological reasons.

Dissociative seizures can look similar to epileptic seizures, which means that many people initially receive an incorrect diagnosis. This can be harmful, as the treatments and medications for epilepsy will not work for someone who has dissociative seizures.

However, once doctors make the correct diagnosis, people can begin psychotherapy to address the underlying cause of the seizures. With treatment, dissociative seizures can significantly improve or go away entirely.

This article discusses the symptoms, causes, diagnosis, and treatment of dissociative seizures. It also offers tips for dealing with the condition.

Black-and-white distorted image of a woman with shoulder length hair. Half of her face is in shadow, and the other half has vertical beams of light across it.Share on Pinterest
Mads Perch/Getty Images

Dissociative seizures are a type of nonepileptic seizure resulting from psychological distress. They cause episodes of involuntary movements or behaviors. In the United States, doctors refer to these seizures as psychogenic nonepileptic seizures (PNES).

During PNES, a person has dissociated, which means that they are not fully aware or in control of themself. They may fall in and out of consciousness or become unresponsive for brief periods.

PNES can look very similar to epileptic seizures. However, PNES does not cause electrical signals in the brain to misfire. This difference is one of the main ways in which doctors tell the two types apart.

For the same reason, these seizures cannot damage the brain. A person only requires emergency treatment for a dissociative seizure if they become injured.

It is unclear how common PNES is, but among people who require monitoring in a hospital for unusual seizures, 20–40% receive this diagnosis.

Other names for PNES include psychogenic nonepileptic episodes or pseudoseizures. However, many people feel that the term “pseudoseizure,” which is older, is unacceptable because it implies that the symptoms are not real, which creates stigma.

The symptoms of PNES can vary, but they often include:

  • changing levels of consciousness
  • shaking or thrashing movements
  • pelvic thrusting
  • side-to-side head shaking
  • brief episodes of unresponsiveness
  • yelling, crying, or other vocalizations
  • tightly closed eyes or mouth

Yes, it is possible for the two types of seizures to coexist. An older 2013 review states that about 10% of people with PNES also have epilepsy. This co-occurrence can make diagnosing PNES more challenging.

However, there are some key differences between epileptic and nonepileptic seizures. For example, the eyes are closed during about 95% of dissociative seizures, whereas they are open during most epileptic seizures.

Similarly, being able to speak or yell during a seizure can be a sign of PNES, as can jumping at the sound of a loud noise — neither of which is common during an epileptic seizure.

PNES appears to be an involuntary response to severe emotional distress. The symptom is strongly associated with mental health conditions, such as anxiety and depression, as well as past trauma.

Psychological trauma refers to the effects that severely stressful events have on the mind. These events can include a one-off incident, such as a car accident, or multiple events that take place over an extended period.

A history of physical or sexual abuse is one of the risk factors for PNES, which may partially explain why most people who experience them are women. Women are more likely than men to experience these types of abuse, particularly during childhood and in intimate relationships.

Some of the conditions that have an association with PNES include:

Mental health is complex, and not everyone can identify a specific cause of their PNES. Even if that is the case, though, the episodes are real.

Doctors can sometimes diagnose PNES based on how the symptoms differ from those of epileptic seizures. They may be able to do this through observation or by speaking with the individual or the family members or friends who have witnessed the seizures.

The next step is to rule out epileptic seizures by measuring electrical activity in the brain. Doctors can do this via video electroencephalography (EEG) monitoring. During this test, an EEG monitor tests the electrical signals in the brain, while a camera records a seizure. The results allow a neurologist to make a diagnosis.

To do a video EEG test, a person may need to stay in a monitoring unit or another healthcare facility.

The main treatment for PNES is psychotherapy. By speaking with a psychologist or therapist, people can begin to understand the underlying cause of the seizures.

There are many types of therapy. The most well-studied type in the treatment of PNES is cognitive behavioral therapy (CBT). CBT works by looking at the relationships between beliefs and thoughts, emotions, and behaviors.

People with a history of traumatic experiences may benefit from trauma therapies, which include a range of techniques that encourage the brain to process distressing memories, reducing their impact.

Medications may help reduce the symptoms of any coexisting mental health conditions and improve quality of life. However, they will not reduce the seizures.

PNES can be disruptive, scary, or disorienting. While a person is undergoing treatment, though, there are ways to minimize these effects. The United Kingdom’s National Health Service (NHS) recommends the following coping strategies:

Sensory grounding

If a person gets any warning signs before a seizure, they can engage in sensory grounding. This involves the steps below:

  1. Find a rough or textured object to carry around. When a seizure is coming on, rub the object between the fingers, focusing on how it feels.
  2. Place the feet firmly on the ground and notice how solid it is.
  3. Find something to look at nearby, and describe what it looks like, either out loud or silently to oneself.
  4. Listen to the sounds coming from nearby, such as birds singing or people talking.

This strategy can prevent seizures or delay them long enough that a person can go somewhere private and safe.

Abdominal breathing

Abdominal breathing can promote calmness and prevent a seizure. A person can follow these steps:

  1. Sit with one hand on the belly, below the navel.
  2. Slowly inhale through the nose and feel the belly expand.
  3. Pause for 3 seconds, then slowly exhale through the nose.
  4. Repeat for 20 breaths or until the warning signs of the seizure have passed.

Seizure first aid

Although psychogenic seizures are not harmful in themselves, people can accidentally injure themselves during one. Seizure first aid includes practices that prevent this from happening.

It is helpful to let friends, family, or coworkers know what to do if a seizure occurs. They can help by:

  • removing any potentially dangerous objects from the area
  • guiding the person having the seizure to a safe place
  • putting something soft underneath their head
  • speaking to them calmly and reassuringly
  • not trying to restrict their movements or any noise they make, as this can be frightening and potentially lead to injuries

If someone does not experience any warning signs before a seizure, they may not be able to drive.

Nonepileptic seizures rarely require medical treatment or a call to the emergency services. If someone does become injured, it is important to call 911 and say that the seizure was nonepileptic.

Identifying triggers

Some events or emotional states may trigger PNES. Identifying what these are can help someone understand how to reduce their seizures. It may help to keep a diary to record when they happen and any factors that might have contributed.

However, it is important not to try to avoid all triggers to the extent that it causes isolation or prevents someone from doing the things they enjoy. In the short term, this may reduce stress or embarrassment, but in the long term, it can make someone feel less capable or more overwhelmed by their condition.

A person should try to maintain a normal routine and independence wherever possible but ask for help if the symptoms of PNES are causing physical or emotional difficulty.

Dissociative seizures are a type of nonepileptic seizure that many refer to as PNES. They cause episodes of involuntary movements and behaviors that occur as a result of psychological distress. The similarity of dissociative seizures to epileptic seizures means that doctors misdiagnose some people with this condition.

Treatment for PNES can reduce seizure frequency and lessen the impact of any underlying mental health conditions on a person’s life. If someone believes that they may be experiencing PNES, they should undergo an evaluation from a neurologist to confirm the diagnosis.