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Dissociative seizures

We all react to frightening or stressful situations differently. When we are frightened we might feel physical symptoms such as a racing heartbeat or feeling sweaty. When we feel sad, we might cry. So how we feel emotionally can sometimes cause a physical reaction.

An extremely frightening or upsetting experience may be so emotionally difficult for some people to think about that they cannot consciously cope with how this makes them feel.

In some cases, they will unconsciously hide or 'repress' the memory of these events. These memories may always remain hidden and the person may never remember the events that happened.

For some people, the memories of these painful past events can suddenly come back or 'intrude' in to their thoughts or awareness. This might happen during an emotional or stressful situation, or when there is something in the environment that unconsciously triggers a distressing memory.

Dissociative seizures can happen as a cut-off mechanism to stop bad memories from being re-lived. The person splits off (or 'dissociates') from their feelings about the experience because it is too difficult to cope with. The seizure happens because their emotional reaction causes a physical effect.

These seizures are an unconscious reaction so they are not deliberate and the person has no control over them.

What causes dissociative seizures (DS)?

Any experiences that we have, whether good or bad, can have a deep and long-lasting effect on us, and everyone has their own way of dealing with them. Dissociative seizures (DS) are often caused by traumatic events such as:

  • major accidents
  • severe emotional upset (such as the death of a loved one)
  • psychological stress (such as a divorce)
  • difficult relationships
  • physical or sexual abuse
  • being bullied.

It can be hard to find the cause of someone’s DS. For some, they start shortly after a specific event. For others, they may not start until years later or they may start suddenly for no apparent reason. Once DS have started, they might be triggered or brought on when the person is stressed or frightened. Or they might happen spontaneously in situations that are not stressful or frightening. Sometimes, even the fear of having a seizure can, in itself, trigger a seizure.

Finding the original event that caused the DS to start might help to find a way to treat the seizures. But this is not always possible and it can be hard to talk about traumatic or difficult events.

Seizures caused by a delayed response to a very stressful event or situation, for example, being in a war or a disaster, are a response to past events. These seizures may be part of a post-traumatic stress disorder (PTSD) - a condition that sometimes starts after a traumatic event. During the seizure the person may cry, scream or have flashbacks (sudden, vivid memories of the event). They may not remember the seizure afterwards.

What are the symptoms?

Although DS start as an emotional reaction they cause a physical effect. Features of the seizures can include palpitations (being able to feel your heart beat), sweating,a dry mouth and hyperventilation (over-breathing).

Some features of DS are very similar to epileptic seizures. These physical features include loss of awareness, loss of sensation, and loss of control over bodily movement (which may include having convulsions).

Who has dissociative seizures (DS)?

DS can happen to anyone, at any age, although some factors make DS more likely. DS are:

  • more common in women
  • more likely to start in young adults
  • more likely to happen to people who have had an injury or disease, severe emotional upset or stressful life events
  • more common in people with other psychiatric conditions (such as depression, anxiety, personality disorders or people who self-harm).

What causes epileptic seizures?

Epileptic seizures are caused by a disturbance in the electrical activity of the brain (and so they always start in the brain). Our brain controls the way we think, move and feel, by passing electrical messages from one brain cell to another. If these messages are disrupted, or too many messages are sent at once, this causes an epileptic seizures.

What happens to the person during the seizure depends on where in the brain the seizure activity happens.

Around 1 in 5 people (20%) diagnosed with epilepsy who are then assessed at specialist epilepsy centres are found to have non-epileptic seizures (NES). This may be partly because epilepsy and NES can look very similar, and can affect people in similar ways. However, the difference between epileptic and non-epileptic seizures is their cause.