Non-epileptic seizures and child sexual abuse: A critical review of the literature
Section snippets
Non-epileptic seizures
Liske and Forster (1964) bestowed the term pseudoseizure to episodes that resemble epileptic seizures but lack the physiological symptoms of genuine epilepsy. Pseudoseizures, hysterical seizures or non-epileptic seizures (NES) share many features with epileptic seizures, including impairment of consciousness and excessive movements of the limbs, trunk and head (Reuber & Elger, 2003). These seizures occur, however, in the absence of epilepsy, other physiological causes (e.g., drug reactions or
Childhood trauma and NES
A direct relationship between trauma and psychopathology has been investigated in hundreds of studies (see Merckelbach & Muris, 2001). While a large body of evidence supports an association between childhood abuse and adult psychological dysfunction (Fergusson et al., 1996, Horowitz et al., 2001, Mullen et al., 1993), direct assessments of the relationship between trauma and psychopathology have produced varied and modest effect sizes (Kendler et al., 2000, Merckelbach & Muris, 2001). According
Our literature review
It seems evident that despite a growing body of literature addressing the potential link between NES and CSA, the precise nature of this relationship remains ambiguous and warrants careful consideration. To further investigate this relationship, we conducted a literature search similar to that of Fiszman et al. (2004). We too searched for studies exploring the relationship between NES and trauma, but we narrowed our trauma focus specifically to child sexual abuse. Like Fiszman et al., we
Inferential errors
From the preceding brief analyses, it would appear that a substantial percentage of NES participants have a history of child sexual abuse, and that this percentage is significantly greater than that which is found for non-NES comparison groups. Is this sufficient evidence to conclude that CSA causes NES? In reviewing the typical research design for assessing a relationship between CSA and adult outcomes, Briere (1992) cautioned that it is in “the generalization from sexual abuse correlates to
Research design
Research investigating the relationship between child sexual abuse and later psychological problems including NES is almost always cross-sectional (Briere, 1992). Fiszman et al. (2004) described 15 of their 17 trauma studies as cross-sectional. In such a study, adults with psychopathology such as NES are assessed at a single point in time for a history of child sexual abuse. Because the research is cross-sectional rather than longitudinal, the functioning of individuals pre-molestation is
Sampling
Unrepresentative samples are another source of inferential errors made when testing the relationship between childhood trauma and adult psychopathology. As Horowitz et al. (2001) point out, “the inadequate samples that most studies rely on… seriously limit the conclusions we can draw about the later impacts of childhood trauma” (p. 186). The NES–CSA literature illustrates some of the difficulties that may arise in regards to sampling.
Definitions
A third source of inferential errors pertains to the definition of core constructs such as CSA. According to Betts and Boden (1991), “the problems in deciding if previous sexual abuse or incest is a factor in the genesis of [NES] in women are that first one has to define the type of ‘pseudoseizure’ one is describing… secondly, one must define what one means by sexual abuse” (p. 253). The definition of the CSA construct has been anything but uniform.
Measurement
Inferential errors around measurement issues pertain to how CSA is assessed in primary studies. Providing a clear operational definition of child sexual abuse is the first step in measurement, but beyond that, there are also issues with regards to correctly identifying individuals with a history of child sexual abuse. Retrospective determinations of child sexual abuse require a great deal of “experience and patience” (Betts & Boden, 1991, p. 253). Child sexual abuse may not be detected because
Inferential errors and limitations
Many authors regard sexual abuse in childhood as a cause of non-epileptic seizure disorders in adulthood. As our meta-analysis demonstrates, a growing body of research data indeed seems to support the notion that CSA is somehow linked to NES. We found that, across all studies, 33% of NES participants reported a history of sexual abuse. The rate of CSA among NES participants was three times greater than that reported in comparison samples.
A relationship between child sexual abuse and
References (112)
- et al.
Psychogenic seizures: Clinical features and psychological analysis
Epilepsy and Behavior
(2003) - et al.
Behavioural mechanisms involved in pseudo-epileptic seizures: A comparison between patients with epileptic seizures and patients with pseudo-epileptic seizures
Seizures
(1997) - et al.
Psychopathology and trauma in epileptic and psychogenic seizure patients
Psychosomatics
(1996) - et al.
Psychiatric disorders, trauma, and MMPI profile in a Spanish sample of non-epileptic seizure patients
General Hospital Psychiatry
(2004) Explaining links between sexual abuse and psychological distress: Identifying mediating processes
Child Abuse and Neglect
(2003)The problem of psychogenic symptoms: Is the psychiatric community in denial?
Epilepsy and Behavior
(2005)- et al.
An estimate of the prevalence of psychogenic non-epileptic seizures
Seizure
(2000) Medical consequences of child sexual abuse
Child Abuse and Neglect
(1998)- et al.
Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder: Part I
Seizure
(1992) - et al.
Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder: Part II. Previous childhood sexual abuse in the aetiology of these disorders
Seizure
(1992)