Emotion dysregulation in patients with psychogenic nonepileptic seizures: A systematic review based on the extended process model

Abstract

Psychogenic nonepileptic seizures (PNES) are characterized by paroxysmal alterations in motor and sensory functions resembling epileptic seizures, but are not caused by epileptiform activity. In recent years, there has been increasing scientific interest in emotion dysregulation in patients with PNES (pwPNES), but the literature has not yet been interpreted within a broader model of emotion dysregulation. The aim of this review was therefore to synthesize the existing literature on emotion dysregulation in pwPNES within the extended process model (EPM) of emotion regulation. MethodsPubMed and Web of Science were searched for studies relevant to emotion dysregulation as defined by the EPM. These studies were subjected to a bespoke quality appraisal tool. Studies of acceptable quality were categorized to the different stages of the EPM and critically appraised. ResultsStudies of emotion regulation in pwPNES were generally of low quality — a finding largely driven by small sample sizes. However, there was evidence of emotion dysregulation characterized by deficits in the identification of patients' own emotional states, as well as the selection and implementation of maladaptive regulatory strategies, and altered exteroceptive emotional processing. However, heterogeneity in findings suggests that emotion dysregulation is likely linked to other psychological factors and not common to all pwPNES. SignificanceThis review suggests that while pwPNES are likely to experience emotion dysregulation as defined by the EPM, there is variability in the distribution of regulatory deficits in this patient population, and a person-centered approach should be taken when working with these patients. There is a need for more high quality and better-powered studies in this area.