Psychogenic Non-Epileptic Seizures (PNES) and Dissociation

Psychogenic Non-Epileptic Seizures (PNES) are seizure-like episodes that resemble epileptic seizures but do not have a neurological basis. Instead, they are caused by psychological factors, often linked to trauma, stress, or dissociation. Many individuals with PNES also experience dissociative symptoms, further complicating their diagnosis and treatment.

In this blog post, we’ll explore what PNES is, how it connects to dissociation, and what can help manage both conditions.

What is PNES?

PNES, or Psychogenic Non-Epileptic Seizures, are sudden episodes that look like epileptic seizures but are not caused by abnormal electrical activity in the brain. Instead, they are triggered by psychological stress, trauma, or emotional dysregulation.

Common Symptoms of PNES:

• Uncontrollable shaking or convulsions
• Loss of awareness or unresponsiveness
• Muscle stiffness or limpness
• Confusion or difficulty speaking after an episode
• Emotional distress before or after the seizure
• Unlike epileptic seizures, PNES does not show abnormal brain activity on an EEG (electroencephalogram), which is one way it can be distinguished from epilepsy.

How is PNES Connected to Dissociation?

Dissociation is a psychological process where a person feels disconnected from themselves, their emotions, or their surroundings. Many individuals with PNES also experience dissociation, either before, during, or after their episodes.

Ways Dissociation and PNES Overlap:

1️⃣ Dissociation as a Precursor to PNES: Many people experience derealisation (feeling the world is unreal) or depersonalisation (feeling detached from themselves) before a PNES episode. These dissociative states may act as a warning sign before a seizure-like episode occurs.

2️⃣PNES as a Dissociative Response: Some researchers believe that PNES itself is a form of dissociation, where the body shuts down or reacts physically to overwhelming emotions. This aligns with the idea that PNES is a trauma-related response, similar to how dissociation helps individuals mentally "escape" distress.

3️⃣Emotional Numbness and Disconnection After PNES: After an episode, individuals often report feeling mentally foggy, emotionally numb, or detached, which are classic dissociative symptoms.

4️⃣ Both Are Linked to Trauma: PNES and dissociation frequently co-occur in individuals with a history of trauma. Childhood abuse, neglect, or ongoing stress can increase the likelihood of experiencing both conditions.

The Role of Trauma in PNES and Dissociation

Many people with PNES and dissociation have a history of childhood trauma, PTSD, or prolonged stress. When emotions become too overwhelming, the body and mind may respond in extreme ways:

• Dissociation helps mentally "escape" distress.
• PNES acts as a physical response to unresolved emotions. Since the body holds onto trauma, PNES and dissociation can develop as unconscious ways to express unprocessed emotions.

Challenges in Diagnosing PNES and Dissociation

One of the biggest challenges with PNES is misdiagnosis. Many individuals are initially diagnosed with epilepsy, leading to unnecessary medications or treatments. Since PNES does not show abnormal electrical activity in the brain, it can take time for a correct diagnosis.

Similarly, dissociation is often misunderstood—many people do not realise they are experiencing dissociation until they learn about it. Because dissociation is invisible and internal, it can be harder to recognise than physical symptoms like seizures.

How to Manage PNES and Dissociation

Since both PNES and dissociation are psychological in nature, treatment focuses on emotional regulation, trauma processing, and stress management.

1.Grounding Techniques for Dissociation & PNES Grounding helps prevent dissociation and reduce PNES triggers by keeping you connected to the present.

• 5-4-3-2-1 Technique: Identify 5 things you see, 4 you can touch, 3 you hear, 2 you smell, and 1 you taste to bring yourself back to the present.
• Cold Sensations: Hold an ice cube, run cold water over your hands, or use a cooling gel to help snap out of dissociation.
• Physical Movement: Clenching and releasing muscles, stretching, or pacing can bring awareness back to the body.

2.Therapy & Emotional Processing

• Trauma-Focused Therapy (TF-CBT, EMDR) – Helps process underlying trauma that may be contributing to PNES and dissociation.
• Cognitive Behavioural Therapy (CBT) – Helps change thought patterns that may contribute to stress and dissociation.
• Dialectical Behaviour Therapy (DBT) – Focuses on emotional regulation, distress tolerance, and mindfulness to manage dissociative episodes.

3.Reducing Stress & Emotional Suppression Since stress and emotional suppression can trigger both PNES and dissociation, finding healthy ways to express emotions is key.

• Journaling: Writing down feelings before they build up.
• Creative Expression: Painting, music, or movement to channel emotions safely.
• Social Support: Talking to trusted friends, family, or a support group can help reduce emotional overload.

4.Understanding Triggers Tracking when and why episodes happen can help in managing both PNES and dissociation. A journal or symptom tracker can be useful for noticing patterns.

When to Seek Professional Help

If PNES or dissociation is affecting your daily life, relationships, or ability to function, seeking professional support is important. A specialist trained in trauma, dissociation, and somatic disorders can provide targeted strategies for managing symptoms.

Signs you may need additional support:

• Frequent PNES episodes that disrupt work, school, or relationships.
• Long periods of dissociation, memory loss, or time gaps.
• Feelings of being emotionally disconnected from life.
• Past trauma that feels unprocessed or overwhelming.

Conclusion

PNES and dissociation are deeply connected, often acting as the body and mind’s way of coping with stress or trauma. While these experiences can be confusing or distressing, there are effective strategies to reduce episodes, increase awareness, and regain control over your mental and physical well-being.

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