Abstract
ObjectiveDissociative traits represent a disturbance in selfhood that may predispose to, and trigger, functional seizures (FSs). The predictive representation and control of the internal physiological state of the body (interoception) are proposed to underpin the integrity of the sense of self (“minimal selfhood”). Therefore, discrepancies between objective and subjective aspects of interoception may relate to symptom expression in patients with FSs. Here, we tested whether individual differences in trait measures of interoception relate to dissociative symptoms, and whether state interoceptive deficits predict FS occurrence.MethodsForty‐one participants with FSs and 30 controls completed questionnaire ratings of dissociation, and measures of (1) interoceptive accuracy (IA)—objective performance on heartbeat detection tasks; (2) trait interoceptive sensibility—subjective sensitivity to internal sensations (using the Porges Body Perception Questionnaire); and (3) state interoceptive sensibility—subjective trial‐by‐trial measures of confidence in heartbeat detection. Interoceptive trait prediction error (ITPE) was calculated from the discrepancy between IA and trait sensibility, and interoceptive state prediction error (ISPE) from the discrepancy between IA and state sensibility.ResultsPatients with FSs had significantly lower IA and greater trait interoceptive sensibility than healthy controls. ITPE was the strongest predictor of dissociation after controlling for trait anxiety and depression in a regression model. ISPE correlated significantly with FS frequency after controlling for state anxiety.SignificancePatients with FSs have disturbances in interoceptive processing that predict both dissociative traits reflecting the disrupted integrity of self‐representation, and the expression of FSs. These findings provide insight into the pathophysiology of functional neurological disorder, and could lead to novel diagnostic and therapeutic approaches.
Highlights
Functional seizures (FSs), otherwise known as psychogenic nonepileptic seizures, are paroxysmal, time-limited alterations in motor, sensory, autonomic, and/or cognitive function that superficially resemble epileptic seizures but are not caused by ictal epileptiform activity.[1]
We show that patients with FSs have significantly greater interoceptive sensibility, but lower interoceptive accuracy compared with healthy controls
This study demonstrated that patients who experience more dissociation during FSs experience higher levels of trait depersonalization as measured by the depersonalization subscale of Multiscale Dissociation Inventory (MDI-DP)
Summary
Functional seizures (FSs), otherwise known as psychogenic nonepileptic seizures, are paroxysmal, time-limited alterations in motor, sensory, autonomic, and/or cognitive function that superficially resemble epileptic seizures but are not caused by ictal epileptiform activity.[1]. Dissociative symptoms phenomenologically involve psychological variables,[8] and the dissociation reflects a state of “detachment” encompassing depersonalization.[11] This form of “psychological” dissociation can be measured using the depersonalization subscale of the Multiscale Dissociation Inventory (MDI).[12]. Such psychological-level accounts are poorly integrated with advances in neurobiological understanding of brain function.
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