Dissociative seizures (DS) are involuntary events that look physically similar to epileptic seizures but stem from psychological distress rather than abnormal brain activity. They are a genuine physical manifestation of underlying emotional conflict. A lack of understanding often leads to misdiagnosis, which can delay appropriate care for years. Effective diagnosis and management begin with understanding the nature of DS.
Defining Dissociative Seizures
Dissociative seizures are classified as a type of Functional Neurological Disorder (FND), meaning they result from a problem with the functioning of the nervous system rather than a structural issue or disease. They are also frequently referred to as Psychogenic Non-Epileptic Seizures (PNES) or Non-Epileptic Attack Disorder (NEAD).
The term “dissociative” refers to a mental process where a person disconnects from their thoughts, feelings, memories, or sense of identity. In the context of a seizure, this dissociation acts as an unconscious coping mechanism where overwhelming emotional distress is converted into a physical symptom.
How Dissociative Seizures Differ from Epilepsy
The fundamental difference between dissociative seizures and epileptic seizures lies in the brain’s electrical activity during the event. Epileptic seizures are caused by an abnormal, sudden surge of electrical activity in the brain. In contrast, a dissociative seizure occurs without any corresponding excessive electrical discharge in the brain.
The definitive way to distinguish between the two is through Video-Electroencephalogram (Video-EEG) monitoring. This test records brain waves while simultaneously filming the person during an episode. If the seizure-like event occurs with normal brain electrical activity on the EEG, it confirms a diagnosis of a dissociative seizure.
Observing the physical presentation of the event, known as semiology, also provides important clues. Epileptic seizures are often brief and involve rhythmic, synchronized movements of the limbs. Dissociative seizures tend to be longer, often lasting more than five minutes, and may feature asynchronous, fluctuating, or side-to-side thrashing movements. Eye closure is a common feature in dissociative seizures, occurring in about 95% of cases, while most epileptic seizures involve the eyes being open.
Recognizing the Signs and Symptoms
The physical manifestations of a dissociative seizure are varied and highly individualized. Many episodes involve uncontrolled shaking and jerking, which can appear violent or chaotic. Movements during a DS event may include side-to-side head shaking or sometimes pelvic thrusting.
A person experiencing a DS event may appear to go completely motionless, staring blankly and becoming unresponsive to their surroundings. Although they may seem unconscious, a person often retains some level of awareness or may become partially aware during the episode. It is also common for the person to have a loss of memory for part or all of the event immediately afterward.
The end of a dissociative seizure often differs from that of an epileptic one, which usually results in a period of deep confusion and sleepiness. After a DS event, a person may be immediately tearful, confused, or emotionally overwhelmed. Warning signs, such as a rising sense of fear, dizziness, or a feeling of detachment, may precede the physical symptoms for some individuals.
Underlying Causes and Risk Factors
Dissociative seizures are understood as a biopsychosocial phenomenon, arising from a complex interplay of biological predisposition, psychological factors, and environmental stressors. The most strongly correlated risk factor is a history of psychological trauma, particularly childhood trauma such as physical, sexual, or emotional abuse. However, not everyone with DS has a history of trauma, and other significant life stressors can also contribute.
This process is a form of conversion disorder, where psychological conflict is converted into a physical symptom that has no medical explanation. Other psychological conditions frequently coexist with DS and act as contributing factors, including Post-Traumatic Stress Disorder (PTSD), anxiety disorders, depression, and personality disorders. Chronic pain, sleep disorders, and ongoing emotional distress also increase the likelihood of developing these episodes. Specific triggers that can precipitate an attack include current emotional overload, acute stress, or exposure to a reminder of a past trauma.
Treatment Approaches and Recovery
The accurate diagnosis of dissociative seizures is a prerequisite for effective treatment, as anti-epileptic medications are ineffective for DS and can carry harmful side effects. The primary approach focuses on psychological intervention to address the root causes of the episodes. The goal is to reduce the frequency and severity of the seizures while improving the individual’s overall quality of life.
Cognitive Behavioral Therapy (CBT) that is specific to dissociative seizures is the most well-studied and recommended treatment. CBT helps individuals understand the link between their thoughts, emotions, and the physical attacks, and it teaches practical coping skills to manage stress and emotional triggers. For those with a history of trauma, specialized trauma-focused therapies, such as Trauma-Focused CBT or Eye Movement Desensitization and Reprocessing (EMDR), are often beneficial in helping the brain process distressing memories.
A multidisciplinary team approach involving a neurologist, psychiatrist, and clinical psychologist is important for comprehensive care. Patient education about the diagnosis is a powerful therapeutic tool, as understanding that the seizures are real but not epileptic helps de-medicalize the condition and opens the door for psychological healing. While relapse is possible, a significant number of individuals experience a reduction in seizure frequency and severity, and some achieve complete seizure freedom with appropriate treatment.