Predictors of antecedent factors in psychogenic nonepileptic attacks

OBJECTIVES: To elucidate the role of antecedent factors in psychogenic nonepileptic attacks (PNEA). METHODS: In a consecutive series of 288 patients with PNEA, clinical and demographic variables were entered into binary logistic regression models and tested for their power to predict commonly reported antecedent factors. RESULTS: Three quarters (75.4%) of patients reported traumatic antecedent factors: 32.5% reported sexual abuse, 26.0% physical abuse, 18.7% bereavement, 8.3% health-related trauma, and 8% accident or assault. A total of 8.6% had learning disability (LD) and 10.8% had epilepsy. Antecedent trauma in general was predicted by later age at onset (p = 0.011), and medically unexplained symptoms (MUS) other than PNEA (p = 0.004); its absence was predicted by LD (p = 0.016). Sexual abuse was predicted by female gender (p < 0.001), physical abuse (p < 0.001), self-harm (p < 0.001), and MUS (p < 0.001): its absence was predicted by LD (p = 0.019) and health-related trauma (p = 0.023). Bullying was predicted by early onset of PNEA (p = 0.012). Health-related trauma was predicted by late age at onset (p < 0.001); its absence was predicted by sexual abuse (p = 0.020). LD was predicted by male gender (p = 0.019), epilepsy (p = 0.005), circumstantial triggering of spells (p < 0.001), and pseudostatus (p = 0.012). Epilepsy was predicted by LD (p = 0.001) and early age at onset (p = 0.013). CONCLUSIONS: The clinical predictors that we found provide further evidence of heterogeneity of psychogenic nonepileptic attacks populations related to antecedent factors. Some predictive clusters may have clinical utility in the early stages of assessment: in particular the combination of medically unexplained symptoms and self-harm should raise the possibility of undisclosed sexual abuse.