The effect of attachment style on long-term outcomes in psychogenic nonepileptic seizures: Results from a prospective study, 2022, Villagrán et al

[Andy]

Highlights

• Patients with psychogenic nonepileptic seizures had low levels of secure attachment.
• High attachment anxiety was a risk factor for persistent PNES.
• In our cohort from a tertiary epilepsy center the long-term prognosis of PNES is poor.

Abstract

Introduction

Insecure and fearful attachment styles have been reported in psychogenic nonepileptic seizures (PNES). We have investigated associations between long-term clinical outcome in PNES, parenting and attachment styles and demographic, clinical, and neuropsychiatric factors.

Material and methods

Patients aged at least 16 years and with documented PNES, according to criteria from the International League Against Epilepsy, were prospectively recruited to this study. They were assessed at baseline to determine clinical characteristics, experience of attachment and perceptions of experienced parenting styles, trauma history, dissociation, and health-related quality of life. At a mean of 70.45 (SD 29.0, range 22–130) months after inclusion, participants were contacted by telephone and asked about their current medical status and psychiatric/psychological interventions.

Results

Of 53 patients included in the study, 51 (96 %) provided follow-up data. Most (84.9 %) patients were female, and the mean age of PNES onset was 25.6 years. At follow‐up, 20 patients (39 %) were free of PNES. Those patients that had achieved PNES freedom at follow-up had lower levels of attachment anxiety (p = 0.01) and reported to have experienced their fathers as less controlling (p = 0.02) and their mothers as more caring (p = 0.04) at baseline compared with those patients still suffering from PNES. Seizure freedom at follow-up was predicted by male gender, younger age at PNES onset, and less attachment anxiety.

Conclusion

In our cohort from a tertiary epilepsy center the long-term prognosis of PNES is poor. Attachment anxiety is a risk factor for persistent PNES. It may be of therapeutic relevance to assess attachment patterns in patients with PNES.

Open access, https://www.epilepsybehavior.com/article/S1525-5050(22)00339-0/fulltext

 

[Sean]

Because having unexplained seizures, and having to deal with moronic psycho-babbling pseudo-explanations about it from doctors, could not possibly be a source of anxiety and disruption in relationships?

 

[Peter T]

When looking at relationships with parents the child’s physical health and also medical professionals’ past management of their child’s health can be very relevant issues.

When working with adults with congenital physical disabilities, such as cerebral palsy, I was aware of situations where unhelpful or insensitive medical advice from twenty or thirty years earlier still impacted on the relationship between parent and child decades later. Though I have been retired for well over twenty years and one hopes medical professionals are more sensitive and better informed than forty or fifty years ago, professionals’ prejudices and misconceptions presented at the wrong time can have a potentially life long impact. One would imagine the scope for this in the context of a diagnosis of presumed ‘psychogenic non epileptic seizures’ is not insignificant. Inserting into the parent child relationship the idea of a psychogenic condition must be particularly fraught, especially when going from a diagnosis of seizures of unknown aetiology to PNES depends as much on the clinician’s belief system as it does on medical fact.

Even if a study of this size could demonstrate an association between attachment style and long term outcomes, it does not demonstrate causality or the direction of any supposed causality.

 

[dave30th]

Even if a study of this size could demonstrate an association between attachment style and long term outcomes, it does not demonstrate causality or the direction of any supposed causality

But as we know, any association gets interpreted in the direction that favors their hypothesis.

 

[Sean]

Even if a study of this size could demonstrate an association between attachment style and long term outcomes, it does not demonstrate causality or the direction of any supposed causality.

Which is exactly the situation they want. Ambiguity suits them fine. The moment they start gathering data that allows causal relationships to be clarified their pseudoscience will be exposed.

That is why they are working so hard to lower methodological standards. So they can can eliminate the possibility of their claims being falsified.

There is no dispute about that anymore after the PACE authors admitted on the formal record that they don't want to use objective measures (actimeters, in this case) because they don't give a 'positive' result.