Seizures are sudden, uncontrolled disturbances in the brain, affecting behavior, movement, feelings, or consciousness. While some seizure-like behaviors stem from genuine neurological conditions, others are either intentionally feigned or are involuntary non-epileptic events.
Motivations Behind Feigned Seizures
Individuals may intentionally feign seizure-like episodes under two main psychological classifications: Malingering and Factitious Disorder.
Malingering
Malingering involves the conscious fabrication or exaggeration of physical or psychological symptoms for an external, tangible benefit. This could include avoiding work or military service, obtaining financial compensation, securing prescription medications, or evading legal consequences. The person feigning symptoms is aware of their deception and driven by a clear external incentive.
Factitious Disorder
Factitious Disorder, formerly Munchausen syndrome, differs; motivation is internal and psychological, not for external gain. Individuals intentionally produce or feign symptoms to assume the “sick role,” seeking attention or care. They may even self-harm to appear ill. Factitious Disorder Imposed on Another involves a caregiver fabricating illness in someone under their care, often a child, for their own attention.
Distinguishing Feigned Seizures from Epileptic Seizures
Differentiating genuine epileptic seizures from feigned ones can be challenging, but observable differences exist. Epileptic seizures result from abnormal brain electrical activity, with characteristics varying by affected region. Feigned seizures, however, are consciously performed and exhibit distinct patterns.
One indicator is the context in which the event occurs; feigned seizures might happen only when observed, whereas epileptic seizures can occur at any time. Eye movements also differ; in feigned seizures, eyes are often forcibly shut or flutter, while in epileptic seizures, they may be open, rolled back, or deviate to one side.
The risk of injury is generally higher in true epileptic seizures due to uncontrolled movements, while individuals feigning seizures may instinctively protect themselves, resulting in fewer or no injuries.
The post-seizure state, known as the post-ictal period, is a significant differentiator. After an epileptic seizure, a person typically experiences confusion, drowsiness, or exhaustion, which can last minutes to hours. This post-ictal state is usually absent or only superficially mimicked in feigned seizures.
Resistance to passive movement of limbs can also be observed in feigned events, contrasted with the flaccidity or rhythmic jerking seen in true epileptic seizures. Vocalizations in feigned seizures might include consistent yelling or shouting, which differs from the grunts or cries that can occur during an epileptic seizure.
Understanding Psychogenic Non-Epileptic Seizures (PNES)
Psychogenic Non-Epileptic Seizures (PNES) resemble epileptic seizures but lack abnormal brain electrical activity. Instead, PNES are functional neurological disorders, with symptoms arising from psychological distress, not structural brain disease or epilepsy. These involuntary episodes mean the person has no conscious control over their occurrence.
PNES can be triggered by stress, trauma, or underlying mental health conditions such as post-traumatic stress disorder, anxiety, or mood disorders. Video-EEG monitoring is the diagnostic gold standard, recording both the clinical event and the absence of abnormal electrical activity in the brain, distinguishing PNES from epilepsy.
Treatment for PNES primarily involves psychological therapies, such as cognitive behavioral therapy, rather than anti-epileptic medications.
Consequences of Feigning Seizures
Feigning seizures carries medical risks from unnecessary interventions. Individuals may undergo needless tests, procedures, or medications, potentially leading to harm, including complications from self-inflicted injuries or unneeded surgeries.
Another consequence is the potential for misdiagnosis, which can delay or prevent the identification and proper treatment of any genuine underlying medical or psychological conditions.
The deceptive behavior can also erode trust with medical professionals, family, and friends, straining important relationships.
Furthermore, if feigning is done for external benefits, such as financial gain, there can be legal or social repercussions. Most importantly, the underlying psychological issues driving the feigning behavior remain unaddressed, perpetuating a cycle of distress and deception.