Psychogenic Crisis: What It Is, Symptoms, And Causes
Psychogenic crises are those that appear without an organic alteration that justifies them, with the objective of mobilizing and attracting the attention of the environment.
In this way, we will distinguish between epileptic seizures, where we do observe a brain alteration, the subject showing loss of consciousness and occurring unintentionally, and psychogenic seizures, with causes that have to do with personality.
In this article we will talk about psychogenic crises what are their distinctive features and what characteristics differentiate them from epileptic seizures.
Before focusing on the definition of psychogenic crises, we will talk about a more general term that encompasses them, seizures.
Convulsions are muscle movements where violent, involuntary and uncontrollable contractions are observed of the voluntary muscles of the body. They can be observed only in some of the muscle groups, that is, only in one part of the body or generally throughout the body.
The causes of seizures can be different, although the most common is epilepsy; This pathology shows a brain alteration in neuronal functioning that produces the uncontrolled appearance of movement and seizures. The most characteristic type of seizure in epilepsy is the so-called grand mal seizure, where different symptoms can be observed. in three different phases.
Before the crisis, a state known as an aura usually appears, where the subject already perceives symptoms that signal the imminent crisis. When the aura occurs, the crisis can no longer be avoided. These symptoms that appear in the aura period can be: obtundation, flashes of light or basic hallucinations, among others.
Subsequently, the crisis will take place, differentiating into 3 phases: tonic phase, where we observe apnea (the subject stops breathing), loss of consciousness and the beginning of contractions of the head and extremities; convulsive phase, apnea is maintained and seizures begin, it is also known as clonic phase, in this phase we can observe that the subject bites his tongue and/or urinates involuntarily and breathes again; Finally, in the recovery phase, the individual recovers little by little, it is common for him to appear confused, disoriented and even agitated.
Well, this pattern of seizures, which people with epilepsy present, It can also be observed in people with psychogenic crises. This type of crisis may seem similar to those already mentioned, they can confuse us, but there are features that distinguish them and help us differentiate when it is one or the other, since the relevant intervention for each one will be different.
Distinction between psychogenic seizure and epileptic seizure
In order to better understand the characteristics of psychogenic seizures, it will help us to mention and point out the differences that exist between these and epileptic seizures, since by referring to these it is easy to understand what hysterical seizures consist of. We will see that there are multiple differences, some of them being easier to observe and identify.
1. Personality traits
A distinctive characteristic that can help differentiate both crises is the personality traits displayed by the subject. Thus, if they stand out for hysterical traits or histrionic attitude, they are subjects who show great emotional lability, They are egocentric, narcissistic with a superficial expression of emotions, always seeking to attract attention, it is more likely that the type of crisis shown is psychogenic.
On the other hand, subjects who show epileptic seizures do not stand out for having the hysterical personality traits mentioned above, but for showing greater impulsivity.
2. Trigger
Another variable that we can consider is whether or not there is a trigger, a triggering stimulus that precedes the appearance of the crisis. This way, whether there are identifiable triggers that precipitate the crisis it will most likely be a psychogenic type episode.
On the contrary, in epileptic seizures we cannot identify any trigger; the episode begins unexpectedly, spontaneously, without a stimulus activating it.
3. Cause of the crisis
One of the most significant distinctive characteristics is the etiology that explains the appearance of each crisis. In epileptic seizures there is a brain alteration in neuronal connections which affect the correct development of brain functions and thus trigger seizures.
On the contrary, in hysterical crises there is no organic, cerebral cause that justifies the appearance of the alteration. For this reason, this type of crisis is called psychogenic, since the causes that explain its manifestation are psychological.
4. Electroencephalogram
Related to the previous point, with the organic alteration or not, we observe that subjects who suffer epileptic seizures, where there is an organic involvement, will obtain pathological results in the electroencephalogram, a test that serves to detect and know brain electrical activity.
While people who develop psychogenic crises do not show altered brain activity, that is, the electroencephalogram is normal.
5. Pattern of crises
The seizure pattern refers to the aforementioned phases and the characteristic symptoms shown in each one. This typical pattern of development is seen in people with epilepsy. Instead, Subjects who present psychogenic crises do not express a constant pattern of crises but this is variable, and can appear differently in each crisis.
6. Characteristics of auras
Auras, which as we said are the state prior to the crisis appearing, the symptoms that anticipate the appearance of seizures, in the case of hysterical crises this is usually dramatic, with the purpose of attracting the attention of the environment. However, auras are less striking or theatrical when they precede epileptic seizures.
We see how auras linked to crises of organic etiology, the symptoms are more internal, sensations of tingling, flashes of light or different perception of smells, are more related to variation in one’s own sensations.
7. What is the beginning like?
One of the characteristic symptoms of grand mal epileptic seizures is the loss of consciousness that causes fainting and thus the possible fall of the subject. In this case The onset is abrupt and the individual does not have time to take safety measures. Loss of consciousness is common and the patient may injure himself when hit.
On the contrary, the onset of psychogenic crises is more progressive, the subject has time to look for a safe place and try not to hurt themselves.
8. How the crisis ends
Similar to the previous point, psychogenic crises will end progressively, the subject will little by little show fewer symptoms. As opposed, epileptic seizures will show a more abrupt termination we can consider that just as the symptoms appear, they go away.
9. Presence of other people
A condition that is always observed in psychogenic crises is the presence of subjects in their environment when they appear. As we said, one of the characteristic features of histrionic subjects is to attract attention, therefore, there must be other people for this purpose.
Instead, In epileptic seizures the variable presence or non-presence of people is irrelevant, is not one of the causes of appearance. It can develop with or without people around.
10. Night presence
Epileptic seizures can appear at night. On the contrary, hysterical crises never arise while the subject is sleeping.
11. Loss of consciousness
In grand mal epileptic seizures, total loss of consciousness occurs. However, in psychogenic crises the loss occurs partially, the subject in a certain way remains conscious.
12. Characteristics of seizures
The seizures observed in psychogenic seizures are uncoordinated, anarchic, and occur intentionally. On the other hand, in epileptic seizures the seizures are symmetrical and occur without the subject’s intention; they are not intentional.
13. Shouting and talking during the crisis
In psychogenic crises the subject can speak during the crisis, as well as shout during its course. As opposed, In the crisis of organic origin the patient does not speak during the crisis and if he shouts he does so at the beginning, not during it.
14. Sphincter relaxation
Relaxation of the sphincter or urination is frequently observed during epileptic seizures, in the convulsive phase. While in psychogenic crises, sphincter emptying is much less common, it almost never occurs.
15. Biting your tongue
Another symptom that usually occurs during the convulsive phase is biting the tongue. Thus, it is common to observe this episode in epileptic seizures, but it never occurs during psychogenic seizures.
16. Physical damage
Since the start occurs abruptly and there is no time to adopt safety measures, Subjects who suffer epileptic seizures frequently have trauma caused by blows. On the other hand, in people with hysterical crises, as they show a more progressive onset and have time to seek safety measures, the injuries or damage caused are minimal or non-existent.
17. Response to painful stimulus
Total or partial loss of consciousness is also linked to whether or not we respond to painful stimuli. The total loss of consciousness in epileptic seizures means that the individual does not respond and is not activated by pain. On the contrary, since it is a partial loss of consciousness, subjects with psychogenic crises will respond to the pain by trying to avoid it.
18. Duration of the crisis
Epileptic seizures usually last a few minutes. On the other hand, psychogenic crises have a much more variable duration, and can last from minutes to hours.
19. Patient recovery
After the crisis, hysterical subjects recover faster and more easily. On the contrary, individuals with epilepsy show a more progressive recovery, they are more disoriented and confused at the end of the crisis.
20. Frequency
Psychogenic crises They can appear multiple times during a day, more than once a day For their part, epileptic seizures are rarely observed more than once in a day.
21. Objective of the crisis
As we already said, the objective or intention of psychogenic crises is to attract attention, to seek the environment to act. On the other hand, in epileptic seizures no purpose or intention is observed, since as we saw they appear unintentionally.
