Defense mechanisms and family dynamic characteristics of patients with nonepileptic and epileptic seizures.

摘要

The ability to distinguish nonepileptic seizures (NES) from epileptic seizures (ES) is a crucial and difficult task for medical professionals. Multiple symptoms overlap, and confounding neuropsychological and personality characteristics further complicate differential diagnosis. One symptom, sexual abuse, has been more frequently reported in patients with NES, suggesting the presence of a conversion disorder. Also the defense mechanism of denial, as discussed in the psychodynamic literature, is thought to contribute to the occurrence of NES behaviors. In addition, research has found that a dysfunctional family environment is more often reported by patients with NES as compared to patients with ES or control groups. The present study examined the relationships among defense mechanisms and family dynamic characteristics of 19 patients with NES and 16 patients with ES, who underwent continuous video-EEG monitoring in a comprehensive epilepsy monitoring unit. It was posited that immature defense mechanisms including denial, repression, and reaction formation, as measured by the Reversal subscale of the Defense Mechanism Inventory (DMI), would be characteristic features of NES. In addition, it was hypothesized that the NES and ES groups would differ with respect to family dynamic characteristics, including level of expressiveness, cohesion, conflict and perceptions of their family environment as measured by the Family Environment Scale (FES). Results from the Marlowe-Crowne Social Desirability Scale, administered to assess response bias tendencies, indicated that patients with ES responded in a more socially desirable way than patients with NES, however, these scores were not correlated with the other dependent variables. The primary analyses indicated no significant differences between patients with NES or ES on the Reversal subscale of the DMI or the Cohesion, Expressiveness, Conflict, or Incongruence subscales of the FES. However, post-hoc analyses revealed significant differences between these groups on other subscales of the DMI, with the NES group scoring significantly higher on Turning Against Object, which measures identification with the aggressor and displacement, and the ES group scoring significantly higher on Principalization, which measures intellectualization, isolation and rationalization. This study also found a greater incidence of physical or both physical and sexual abuse reported in patients with NES (84%) compared to patients with ES (12.5%). The more frequent use of immature defense mechanisms and infrequent use of a more mature defense mechanism such as those described in the psychodynamic literature are discussed. Also, the results regarding abuse are discussed with respect to the differences in abuse history, crime victimization and its implications to medical care utilization.