Etiology	Description	Suggested treatments
Acute or situational stressors	Seizures develop after multiple or acute stressors overwhelm the patient’s coping ability; underlying psychopathology may not be present.	Supportive psychotherapy, lifestyle changes, group or family therapy as indicated
Anxiety, panic, physical symptoms	Atypical symptoms of anxiety or panic are misdiagnosed as psychogenic nonepileptic seizures, or the patient misinterprets physical sensations or symptoms as seizures.	Treatment of panic attacks; reassurance that physical symptoms are not seizures
Depression, dissatisfaction	A specific stressor does not precipitate psychogenic nonepileptic seizures; rather, the patient is generally unhappy, and the seizures function as distraction or an acceptable way to get support and attention.	Antidepressant drug therapy, cognitive behavior therapy to challenge the patient’s depressive thoughts and basic assumptions about self and illness; encouragement of the patient’s active involvement in lifestyle changes and problem solving
Poor interpersonal skills and affect regulation, disturbed family systems	Patients with this profile often are diagnosed with borderline personality disorder and frequently have a history of abuse. The patient may come from a family with poor emotional expression and therefore may be unable to identify and effectively express strong emotions. The seizures function to resolve interpersonal crises or threatening emotions or situations.	Intensive psychodynamic psychotherapy to help identify and express threatening situations or emotions (e.g., conflict, anger, feelings of rejection) and to set realistic goals for relationships; family therapy when the family system supports maintenance of psychogenic nonepileptic seizures
Psychosis	Rarely, psychogenic nonepileptic seizures can be a manifestation of psychosis; in most instances, however, the diagnosis of psychosis is clear.	Treatment of underlying psychosis
PTSD, dissociation	The patient has active chronic PTSD and dissociative symptoms. Flashbacks, recollections, or sensory triggers often initiate psychogenic nonepileptic seizures. Often, there is a history of severe childhood or current abuse.	Exposure-based therapies and selective serotonin reuptake inhibitors for PTSD
Reinforced behavior pattern	Reinforced behavior pattern often is the underlying cause of psychogenic nonepileptic seizures in cognitively impaired patients. The patient develops psychogenic nonepileptic seizures because of the functional advantages that are reinforced by the seizures (e.g., attention, avoidance of responsibility).	Behavior modification therapy
Somatization, somatoform disorder, conversion disorder	The seizures represent emotional distress converted into physical symptoms. Often, there is a long history of medical attention for unexplained physical symptoms. The patient often can identify precipitating stressful events; the seizures therefore are a conversion symptom.	Cognitive behavior therapy to identify links between stress and psychogenic nonepileptic seizures and to develop more adaptive coping; for severe somatization, regular visits not contingent on symptoms but with a focus on living with the symptoms rather than investigating and treating them