Hesperian Health Guides
Seizures with psychological causes
HealthWiki > Epilepsy and Seizures > Chapter 3: Types of seizures and how to identify them > Seizures with psychological causes
Seizures with psychological causes can be reduced or cured by improving a person’s emotional and psychological wellbeing, including by changing the conditions causing their stress. Antiseizure medicines that treat epilepsy will not help control these seizures.
Contents
Signs of seizures with psychological causes
People who have seizures with psychological causes often describe feeling spacey or “zoned out,” having difficulty remembering things or concentrating, or their brain “shutting down.” Some people feel disconnected from themselves or their surroundings. Seizures with psychological causes can also have physical signs:
- tiredness or weakness in the limbs
- tremors, shaking, or convulsions
- physical pain
As with epileptic seizures, some people may feel a warning sign before a seizure with a psychological cause. These can include feelings of anxiety, discomfort, or a general sense that “something is off.” These feelings are often more random than the specific “aura” that may signal a seizure from epilepsy.
Differences between seizures with psychological causes and epilepsy seizures
Seizures with psychological causes can look a lot like seizures from epilepsy. Here are some ways to tell them apart.
| Seizures from psychological causes | Seizures from psychological causes |
| Physical effects may differ from one seizure to another | Physical effects are identical from one seizure to another |
| Emotional trigger common | Physical or no specific trigger |
| Seizure progresses slowly | Seizure happens suddenly, progresses quickly |
| Seizure can last longer than 2 minutes | Seizure usually lasts a few seconds to 2 minutes |
| Person usually conscious during seizure | Person loses consciousness partially or completely during seizure |
| Seizure rarely causes injury, tongue-biting, or loss of bladder or bowel control | Seizure may cause injury, tongue-biting, or loss of bladder or bowel control |
| Convulsions or other movements rarely cause arm to hit face | Convulsions or other movements may cause arm to hit face |
| Eyelids may be held closed or eyes stare without moving | Eyelids not tightly closed, eyes may move irregularly |
| Person can follow commands, respond, or talk during seizure | Person cannot follow commands or talk during seizure |
| Brain scan (EEG) will show no seizure activity | Brain scan (EEG) will show seizure activity |
Names for seizures with psychological causes
Several names are used to describe seizures caused by psychological or emotional distress, including:
- psychogenic non-epileptic seizures (PNES)
- non-epileptic seizures
- functional dissociative seizures
- conversion disorder
Some health workers avoid using the word “seizure” to put seizures from psychological causes in a different category than epileptic seizures. Instead, they call them “dissociative attacks” or “episodes.” No matter what name is used, non-epileptic seizures and the emotional and psychological distress that causes them are real. They are a mental health challenge that can be treated.
Triggers for seizures with psychological causes
Many psychologically-caused seizures are triggered by high levels of stress. Everyone has stress in their lives—from work, illness, family, and life in general. Most of the time, we resolve our stresses without paying much attention. But sometimes, they pile up and become too much for us. Unresolved stress can lead to mental health issues like anxiety and depression. If left untreated, these may contribute to or cause non-epileptic seizures. These seizures can also be a response to a past or continuing trauma. Sometimes, a cause for non-epileptic seizures cannot be identified.
Anxiety and Depression
A person with anxiety may be always worried, with no specific situation causing their worry. They may feel a constant dread or fear that something awful will happen.
The worry may come with other signs:
- feeling tense, restless, or nervous
- difficulty thinking clearly
- difficulty sleeping
- sweating, headaches, muscle aches, stomach aches, or unexplained pains that get worse when upset
A person with depression can be taken over by constant feelings of sadness, hopelessness, or numbness. These feelings last for weeks or months and can be so strong that the person does not leave home or even get out of bed. Different from sadness that follows a difficult event or feelings of distress about the state of their life or the world, depression may feel like a fog in which nothing seems important.
Depression may have other signs, such as:
- sleeping too much or difficulty sleeping.
- loss of interest in activities, such as eating, spending time with others, or sex.
Anxiety and depression not only affect how we feel and think, they affect our bodies. One effect can be non-epileptic seizures triggered by stress and emotional harm. Not everyone with anxiety or depression will have non-epileptic seizures. They usually happen when the stress of these conditions is severe and unresolved.
Of course, anxiety and depression can also affect people with epilepsy. For example, anxiety itself may be a seizure trigger, and if anxiety prevents a person from sleeping, that may also trigger an epileptic seizure. The same may be true for depression.
People with anxiety and depression may need mental health support to help them recover, just as someone with a physical health problem may need help to get better. Encourage and help them find a group or an individual with counseling experience.
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| Anxiety and depression can take the joy out of life. | But you don’t have to face them alone. |
Trauma
Trauma is an emotional or physical response to a terrible event a person saw or experienced in the past or is going through now that feels life-threatening to them or others. Events or situations that can cause trauma include:
- war, or social and political unrest.
- police, mob, and gang violence.
- abuse or bullying.
- physical, sexual, or emotional violence.
- unexpected injury, illness, or death of a friend, caregiver, or family member.
- disasters like flood, cyclones, earthquakes, and fires.
- car crashes or other accidents.
- severe untreated pain due to physical illness or injury.
- sudden loss of basic income or housing.
Trauma can follow:
- a single incident, like a dog bite.
- a horrific event affecting many people, like a mass shooting or war.
- events taking place over a long time, like growing up with abuse in the home.
Trauma can make a person feel unsafe, insecure, helpless, and unable to trust anyone or anything. Instead of feeling better over time, their condition may become so severe that it becomes hard for them to function. They may develop posttraumatic stress disorder (PTSD) which can trigger non-epileptic seizures.
SIGNS
Post-traumatic stress disorder (PTSD)
- Reliving traumatic experiences (flashbacks) while awake or in dreams
- Feeling numb or hopeless
- Severe anxiety
- Always being watchful and alert to danger, overreacting when startled
- Feeling disconnected from thoughts, feelings, memories, or one’s body or identity
Anxiety, depression, trauma, PTSD, and other mental health challenges can also be caused by structural violence: when social conditions harm people because of their identity (race, gender, sexual orientation, class, caste, religion, language, disability, or another characteristic). Structural violence has a greater effect on people with less control over their lives and can put them at risk of harms that cause epilepsy and seizures. See Chapter 9 for information about how preventing violence can prevent epilepsy.
Miranda worked as a nanny for the Santos family, caring for baby Sophie. She liked it—good pay, reasonable hours, and Sophie was adorable! Then Sophie’s parents started fighting. Miranda tried her best to ignore it, focusing on keeping Sophie happy and healthy. Finally, Mr. Santos left home with a suitcase and did not come back. Both Sophie and Mrs. Santos cried a lot and the house became gloomy. Suddenly Miranda felt she had to care for the family’s emotional health.
Then Mrs. Santos started seeing Lucas. When he moved in, Miranda was hopeful he would bring happiness and stability back to the household. But Lucas’s behavior toward Miranda quickly worried her. He made unwanted comments about her body and tried to touch her in a sexual way whenever Mrs. Santos was not around.
At first, Miranda just tried to avoid him. She was scared Mrs. Santos would fire her if she said anything. But Lucas didn’t stop. One day he grabbed her from behind as she was putting Sophie down for a nap. She got away from him and ran out of the house, deciding never to return.
Miranda began looking for a new job, but because she could not show references from Mrs. Santos, no one would hire her. Low on money and worried she would never find a job, Miranda began having nightmares. In her dreams, she was a child again, being touched by a man and powerless to stop him. The dreams were so real and so upsetting. They kept coming back, night after night.
Miranda didn’t tell anyone about her dreams, not her parents and not her friends. She just kept being upset by them.
One night, Miranda woke up from another scary dream. When she got out of bed and walked to the bathroom, the bathroom light seemed brighter than usual, and she felt dizzy. Miranda suddenly found herself lying on the floor beside the toilet with no idea how she had gotten there. She pulled herself up and went back to bed. The experience frightened her enough that she went to a health clinic in the morning.
A health worker listened to Miranda describe waking up on the floor and told her she had a seizure because of epilepsy. She gave her a prescription for an antiseizure medicine and told Miranda to start taking it the next morning and every morning after that.
Miranda took the medicine but continued to have seizures—she had 2 more in the month after starting the medicine. During a follow-up visit, the health worker said that if Miranda really was taking the medicine every day but was still having seizures, it must be because her epilepsy was “drug resistant.” (See information about drug-resistant epilepsy.)
Miranda wondered if she really had epilepsy, or if she had some other problem. But whatever it was, she had to find a job and support herself. She thought about how the lights got brighter before her seizures. From now on, she would sit down when that happened, so she would not fall and hurt herself.
Other than that, Miranda felt like she was left with nothing but her bad dreams and feeling out of control. She did not know what to do.
Misunderstanding Miranda’s seizures
The health worker’s failure to try to learn more about Miranda’s life and the onset of her seizures did not help Miranda and did not help solve her health problem. Since Miranda quit a job where she experienced sexual harassment and abuse that triggered memories of childhood trauma, her seizures could likely be caused by the unresolved stress and anxiety of these events. This is why epilepsy seizure medicines did not work for Miranda.
If the health worker believed Miranda’s seizures were caused by epilepsy, she should have tried another medicine after the first one did not work. Typically, a health worker needs to try at least 2 different antiseizure medicines and be as certain as possible about a person’s seizure type before calling their epilepsy “drug resistant.”
What to do about seizures with psychological causes
While seizures caused by epilepsy are typically managed with antiseizure medicines, seizures with psychological causes need different treatments, and antiseizure medicines will probably not affect them. But because stopping antiseizure medicine suddenly may make a person feel worse, it is important to talk with a doctor or other health worker about how to safely reduce and stop using any antiseizure medicine. For more information, see “How to stop taking medicine”.
A mental health worker or experienced counselor can help someone try to understand what is causing these seizures and support them to deal with anxiety, depression, trauma, or other mental health challenges. When a person feels better emotionally, their seizures often happen less or stop completely.
Paying attention to the body can also help a person heal. For example, in situations that make you anxious, learning to slow your breathing might help you become calm. But speaking with a counselor or participating in a mental health support group can help uncover the root of the problem causing the seizures. Where the cause of anxiety is related to larger injustices, it is especially helpful to share experiences with others.
For anxiety, depression, and trauma, finding support and treatment that works is key. Talk therapy is useful, and many find that massage, yoga, prayer, and artistic expression help as well. Sometimes, anti-depressant medicines are combined with other types of therapy. Everyone is different. The main point is to get support to get better.
Asking questions about mental health
Signs of anxiety, depression, trauma, and other mental health challenges may not be visible to a health worker. A person may be living with these challenges for a long time before a non-epileptic seizure occurs. Often, it is not until someone has a chance to discuss their emotional wellbeing that connections can be made between seizures and mental health challenges.
Just as you would when asking questions about a person’s physical health, show compassion, empathy, and patience, and listen more than talk to help a person speak freely. Taking time to build trust can make someone comfortable enough to talk about their emotional pain.
Challenges of promoting mental health
In general, most health workers receive little training about either epilepsy or mental health. As a result, both seizures caused by epilepsy and seizures with psychological causes are often misunderstood. Some people think seizures are caused by God, ghosts, or magic. Even when non-epileptic seizures are understood to be a mental health issue, a person may still be met with ridicule, discrimination, and fear, making it harder to get the help they need. For information about support groups to help with stigma no matter what the cause, see Chapter 5.
A health worker may not always find the cause of a person’s non-epileptic seizures. Emotional and psychological problems can be hard to understand. But by taking an interest in a person’s situation, the health worker can offer ideas about how to cope with distress and make appropriate referrals to other services in the community.
For information on ways to manage and treat anxiety, depression, and trauma, as well as ideas to create community support for people with mental health challenges, see Hesperian’s Promoting Community Mental Health
Seizure information collection form
Collect information about seizures on this sample form or add to it, change it, or use it as a guide to asking questions. If some questions cannot be answered, that is OK. Just try to gather as much information as possible. The answers can help identify seizure type, cause, and treatment options.
