Background. Non-epileptic attack disorder (NEAD) is one of the most common differential diagnoses to epilepsy. Due to the impact of misdiagnosis, research has focused on improving differential diagnosis by identifying factors distinguishing the two populations. These factors, though non-specific and common place comprise much of the understanding of the aetiology of NEAD. Theories which adequately explain the processes by which attacks develop and are maintained are lacking. Although it is agreed that psychological processes underpin NEAD, therapeutic approaches targeting specific processes are under developed. In light of the limitations of currently employed structural approaches, a functional approach may improve understanding of possible mechanisms underpinning NEAD development and maintenance.
Aim. This study aimed to use Multiple Sequential Functional Analysis to explore whether behavioural principles of learning, applied to detailed life histories, can be used to understand the developmental pathway of non-epileptic attacks.
Method. Three adult participants were recruited from outpatient Neurology clinics in the East Midlands, UK. Clinical interviews were conducted using a biographical format to collate detailed information around all aspects of the participant’s histories, current situation, and non-epileptic attacks. To improve the hypotheses made, interview data was triangulated with data from an interview with a relative and a file review. The MSFA was conducted according to the principles of radical behaviourism and applied functional analysis. Data was utilised in the analysis based on the pragmatic truth criterion of functional contextualism.
Results. The results are three detailed functional analytic case studies that track the development of non-epileptic attacks for each participant from formative experiences to their current attack experiences. The results demonstrate that functional analytic principles can be used to understand the developmental pathway of NEAD in these three adults. Though the participants had very different experiences and presentations, an across-case analysis identifies that attacks have similar functional values for these people. Issues including avoiding/reducing stress and emotional suppression appear to be important factors in the development and maintenance of the behaviour.
Discussion. The findings that non-epileptic attacks hold functional value for this group of people, supports the theorised roles of avoidance and secondary gain in the developmental process. The findings have important implications for future research. A strength of the present methodology is that it identifies subtle differences in the learning histories, which has implications for the development of assessment and treatment approaches for those with NEAD.
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Acknowledgement
