Abstracts

Rationale: Research has demonstrated that patients with PNES tend to have difficulties identifying and describing their emotions - alexithymia and also tend to suppress problematic thoughts. Similar findings have been made in patients with epilepsy. This may impact their emotional well-being and contribute to seizure precipitation. This study tested for a relationship between alexithymia and thought suppression in these patient groups. We hypothesized that significant, positive correlations would be observed between difficulty identifying emotions and difficulty describing emotions and tendency for thought suppression in both groups and that there would be no relationship between external orientation and thought suppression. Lastly, we hypothesized that the relationships would be stronger among those with PNES than those with epilepsy.


Methods: Patients with PNES (seen between 2021 and 2024) and patients with epilepsy (seen between 2014 and 2024) seen at the Northeast Regional Epilepsy Group were included. Diagnoses were confirmed through VEEG testing. Exclusion criteria included: 1) dual PNES and epilepsy diagnosis; 2) age younger than 18 years; and 3) FSIQ < 70. Neuropsychological testing records including the Toronto Alexithymia Scale (TAS-20 total score, with difficulty identifying emotions, difficulty describing emotions, and externally oriented subscales) and the White Bear Thought Suppression Inventory (WBSI) were reviewed. A total of 61 patients with PNES and 45 patients with epilepsy were examined. Correlations were determined using Pearson correlations.


Results: A significant positive correlation was found between difficulty identifying emotions and thought suppression for patients with PNES (r = 0.593, p = < 0.001) and those with epilepsy (r=0.427, p=0.003). A significant positive correlation between difficulty describing emotions and thought suppression for those with PNES (r = 0.529, p = < 0.001) and those with epilepsy (r=0.440, p==0.003) was also found. No significant correlation was found for externally oriented thinking and thought suppression for those with PNES (r = 0.173, p = 0.183) and those with epilepsy (r=0.137, p=0.370).


Conclusions: Our samples revealed positive correlations between problems identifying and describing emotions and tendency for suppressing thoughts. In particular, the present findings revealed that those with PNES who have difficulty identifying and describing their emotions also tend to actively suppress their thoughts. They also appear to suppress thoughts and be unaware of feelings more than patients with epilepsy. Having a weak grasp on their emotions while also tending to avoid thinking of distressing topics suggests that patients with PNES are especially vulnerable to feeling overwhelmed which may predispose them to becoming symptomatic. In sum, this study revealed a more pronounced relationship between alexithymia and thought suppression in those with PNES than with epilepsy. However, for both patient groups, alexithymia and thought suppression seem to be potential therapy targets.


Funding: Supported by Ministry of Health of the Czech Republic, grant MH CZ and DRO (NHH, 193001) IG193001 and IG223001.