A psychogenic blackout, formally known as a Psychogenic Non-Epileptic Seizure (PNES), is a physical episode that closely resembles an epileptic seizure. These events are not caused by abnormal electrical activity in the brain, which defines true epilepsy, but rather by underlying psychological distress or emotional factors. PNES episodes are categorized as a type of functional neurological disorder.
Understanding Non-Epileptic Seizures (PNES)
Psychogenic Non-Epileptic Seizures are a manifestation of a functional neurological symptom disorder, sometimes classified as conversion disorder, where psychological stress is expressed through physical symptoms. Unlike epileptic seizures, which result from uncontrolled electrical discharges between neurons in the brain, PNES episodes show no epileptiform activity on an electroencephalogram (EEG) during the event. The distinction lies in the origin: neurological for epilepsy and psychological for PNES, although the physical symptoms can appear nearly identical.
Despite the psychological origin, the symptoms experienced during a PNES episode are involuntary and genuine; the person is not consciously faking or pretending to have a seizure. The episodes are a complex physical reaction to significant internal distress, which the body expresses when the mind cannot process it effectively. This distinction is significant because anti-epileptic medications are ineffective for treating PNES, requiring a different therapeutic approach.
Typical Duration and Variability
The duration of a psychogenic blackout is one of the most distinguishing features when compared to a true epileptic seizure. Most epileptic seizures are self-limiting and last for less than two minutes, whereas PNES episodes frequently persist for a significantly longer time. Research indicates that the mean duration of PNES is around 148.7 seconds, which is substantially longer than the mean duration of epileptic seizures, which is about 47.7 seconds.
Episodes lasting five minutes or longer are much more likely to be psychogenic in nature, making it about 24 times more probable that an event extending past this threshold is PNES. It is not uncommon for a psychogenic blackout to last for several minutes to over an hour, due to the lack of a self-limiting electrical process in the brain. The end of the episode is often influenced by the resolution of the immediate emotional or psychological trigger, or by external intervention aimed at calming the individual.
The duration can also be variable, sometimes featuring a gradual start and slow resolution rather than the abrupt onset and end seen in many epileptic events. This extended time course is a consequence of the psychological mechanism, which resolves only when the underlying dissociative or conversion state is alleviated. The episode may continue until the person is removed from the triggering environment or until a supportive person can help them regain emotional regulation.
Observable Signs During an Episode
PNES episodes present with several observable signs that can help distinguish them from generalized tonic-clonic seizures, even without an EEG. One common feature is asynchronous or fluctuating limb movements, where the shaking or jerking does not follow the rigid, rhythmic pattern typical of an epileptic seizure. These movements may wax and wane in intensity or involve side-to-side head shaking.
A person experiencing a psychogenic blackout may exhibit maintained eye closure, often resisting attempts to open their eyelids, which is a sign rarely seen in generalized tonic-clonic seizures. Other movements include pelvic thrusting or bicycling movements of the legs, which are highly suggestive of PNES. While the person may appear unresponsive, they might retain some awareness, such as responding to touch or voice, or instinctively protecting themselves from injury.
A significant difference is the post-episode state. After a true epileptic seizure, a person is usually deeply confused, drowsy, or sleeps for a period, a condition called the post-ictal state. In contrast, individuals with PNES often do not experience this period of deep confusion and may recover their full awareness relatively quickly once the movements subside. Emotional outbursts, such as crying or sobbing, may also occur during or immediately following the episode.
Psychological Roots and Common Triggers
The foundation of psychogenic blackouts lies in a functional disruption where psychological distress is converted into a physical symptom, a concept known as conversion. The episodes are often a physical manifestation of unresolved emotional conflict, trauma, or difficulty with emotional regulation. This mechanism explains why PNES is often considered a type of dissociative event, where the mind’s ability to process reality or emotions is temporarily disconnected.
Common triggers for these episodes include acute psychological stress, interpersonal conflict, or situations that induce high emotional arousal. A significant number of individuals with PNES have a history of chronic trauma, such as physical, emotional, or sexual abuse, and may also be diagnosed with post-traumatic stress disorder (PTSD). The blackout can be triggered by an event that subtly mirrors or brings back memories of past traumatic experiences.
PNES is often connected to underlying mental health conditions, such as anxiety, depression, and dissociative disorders. Effective treatment focuses on addressing these psychological roots, typically through specialized psychotherapy like Cognitive Behavioral Therapy (CBT), rather than relying on anti-epileptic drugs. Treating the underlying psychological issues is necessary for reducing the frequency and severity of the episodes.