Catastrophising and normalising in patient's accounts of their seizure experiences

Purpose: To extend our previous research demonstrating that linguistic/interactional features in patients' talk can assist the challenging differential diagnosis of epilepsy and psychogenic nonepileptic seizures (PNES) by exploring the differential diagnostic potential of references to non co-present persons (third parties).

Method: Initial encounters were recorded between 20 seizure patients (13 with PNES, seven with epilepsy) who were subsequently diagnosed by the recording of typical seizures with video-EEG. An analyst blinded to the medical diagnoses coded and analysed transcripts.

Results: There were no significant differences between the two diagnostic groups in terms of the total number of third party references or references made spontaneously by patients without prompting from the doctor. However, patients with PNES made significantly more prompted references to third parties (p=0.022). 'Castrophising' third party references were made in 12/13 (92.3%) of encounters with PNES patients and 1/7 (14.3%) of encounters with epilepsy patients (p=0.001, OR 72, 95% CI=3.8-1361.9). Normalising references were identified in 2/13 (15.4%) of encounters in the PNES and 6/7 (85.7%) of encounters in the epilepsy groups (p=0.004, OR 33, 95% CI=2.5-443.6).

Conclusion: There are significant differences in how patients with epilepsy or patients with PNES refer to third parties. Patients with PNES are more likely to be prompted to tell doctors what others have told them about their seizures. Patients using third party references to catastrophise their seizure experiences are more likely to have PNES, whilst patients who use third party references to normalise their life with seizures are more likely to have epilepsy.