Biopsychosocial Approach To Dissociative Convulsions

Background: Psychogenic nonepileptic seizures (PNES), also termed dissociative convulsions, are paroxysmal events resembling epileptic seizures but without ictal EEG correlates, reflecting complex biopsychosocial etiology. Despite high prevalence and significant functional impairment, limited research has comprehensively examined biological, psychological, and social determinants of PNES in Indian clinical populations.Aim: To examine biopsychosocial factors in patients with dissociative convulsions and evaluate interrelationships among these domains.Methods: Seventy‑two patients (mean age 26.15±8.87 years; 91.7% female) diagnosed with dissociative convulsions per ICD‑10 criteria at a tertiary psychiatric center in North India were recruited. Participants completed validated self‑report instruments assessing dissociative experiences (DES‑II), cognitive distortions (CD‑Quest), alexithymia (TAS‑20), trauma symptoms (ITQ‑18), emotion dysregulation (DERS‑18), and sleep disturbances (ISDI). Sociodemographic and clinical data were obtained via semi‑structured interview. Spearman correlations explored associations among biopsychosocial variables. Principal component analysis and k‑means clustering identified distinct patient subgroups, with discriminant analysis validating cluster membership.Results: Psychological measures were strongly intercorrelated (rs 0.58–0.94; p<0.01). Sleep disturbances correlated positively with dissociation and emotion dysregulation (rs 0.71–0.88; p<0.01). Lower education, joint family status, and lower socioeconomic status were significantly associated with greater sleep pathology and higher dissociation (p<0.01). Cluster analysis yielded two distinct groups: a high‑trauma cluster (n=23, 32.8%) characterized by greater trauma history, elevated DES‑II, ITQ‑18, DERS‑18, TAS‑20, CD‑Quest scores, and more severe sleep disturbances; and a low‑trauma cluster (n=49, 67.2%) with comparatively lower scores across biopsychosocial domains. Discriminant analysis achieved 99% classification accuracy (Wilks’ λ=1.00).Conclusions: Dissociative convulsions in this sample are associated with pervasive emotion dysregulation, alexithymia, cognitive distortions, trauma exposure, and sleep disturbances, particularly among socioeconomically disadvantaged individuals. Identification of high‑ and low‑trauma phenotypes underscores the importance of tailored, multidisciplinary interventions targeting trauma processing, emotional regulation, and sleep hygiene to optimize outcomes in PNES.© 2025 Akhand Pratap Singh. All rights reserved. No part may be reproduced without written permission.