Psychogenic crisis: what it is, symptoms, and causes

Psychogenic crises are those that appear without an organic alteration that justifies them, with the aim of mobilizing and calling the attention of the environment.

In this way, we will distinguish between epileptic crises, where we do observe a cerebral alteration, showing the subject loss of consciousness and occurring unintentionally, and psychogenic crises, with causes that have to do with the personality.

In this article we will talk about psychogenic crises, what are their distinctive features and what characteristics differentiate them from epileptic seizures.

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What is a psychogenic crisis?

Before focusing on the definition of psychogenic crises, we will talk about a more general term that encompasses them, seizures.

Seizures 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 in a generalized way throughout the body.

The causes of seizures can be different, although the most common is epilepsy; This pathology shows a cerebral alteration, in the neuronal functioning that produces the uncontrolled appearance of movement, of convulsions. The most characteristic type of crisis of epilepsy is the so-called grand mal seizure, where different symptoms can be observed in three different phases.

Prior to the crisis, a state known as aura usually appears, where the subject already perceives symptoms that indicate the imminent crisis, when the aura occurs, the crisis can no longer be avoided. These symptoms that are shown in the aura period can be: obtundation, flashes of light or elemental hallucinations, among others.

Subsequently, the crisis will take place, differentiating 3 phases: tonic phase, where we observe apnea (the subject stops breathing), loss of consciousness, and onset of head twitching and extremities; convulsive phase, apnea is maintained and seizures begin, it is also known as the clonic phase, in In this phase we can observe that the subject bites his tongue and/or urinates involuntarily and returns to breathe; Finally, in the recovery phase, the individual recovers little by little, it is common for them to appear confused, disoriented and even agitated.

Well, this pattern of seizures, which subjects with epilepsy present, can also be seen 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 they help us to differentiate when it comes to one or the other, since the relevant intervention for each one will be different.

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Distinction between psychogenic seizure and epileptic seizure

In order to better understand what the characteristics of psychogenic crises are, it will help us to mention, point out, the differences that exist between these and epileptic seizures, since by referring to these it is easy to understand what seizures consist of hysterical 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 to differentiate both crises is the personality traits that the subject shows. Thus, if they stand out for their hysterical features or histrionic attitude, they are subjects who show great emotional lability, they are egocentric, narcissistic, with a superficial expression of emotions, always seeking attention, it is more likely that the type of crisis shown is psychogenic.

In contrast, subjects who show epileptic seizures do not stand out for having the aforementioned hysterical personality traits, but for showing greater impulsiveness.

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2. Detonating

Another variable that we can consider is whether or not there is a trigger, a triggering stimulus that precedes the appearance of the crisis. In this way, whether there are identifiable triggers that precipitate the crisis, it is more likely to be a psychogenic-type episode.

On the contrary, in epileptic crises we cannot identify any trigger, the episode starts unexpectedly, spontaneously, without being triggered by a stimulus.

3. Cause of the crisis

One of the most significant distinguishing characteristics is the etiology that explains the appearance of each crisis. In epileptic seizures there is a cerebral alteration in the 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 observed that the subjects who suffer epileptic crises, where there is organic involvement, they 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.

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5. crisis pattern

The pattern of the crisis refers to the aforementioned phases and the characteristic symptoms that are shown in each one. This typical pattern of development is seen in people with epilepsy. Instead, Subjects with psychogenic seizures do not express a consistent pattern of seizures, but this is variable, being able to appear different in each crisis.

6. Characteristics of auras

The auras, which as we said is the state prior to showing the crisis, the symptoms that anticipate the appearance of the convulsions, in the case of hysterical crises this is usually spectacular, with the purpose of calling the attention of the around. However, auras are less conspicuous or theatrical when they precede epileptic seizures.

We see how the auras linked to crises of organic etiology, the symptoms are more internal, sensation, of tingling, flashes of light or different perception of smells, is more related to variation in sensations own.

7. how is the start

One of the characteristic symptoms of grand mal epileptic seizures is the loss of consciousness that entails fainting and with it the possible fall of the subject. In this case the onset is abrupt and the individual does not have time to seek safety measures. Loss of consciousness is common, and the patient may be injured by striking.

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 himself.

8. How the crisis ends

Similar to the previous point, psychogenic crises will end progressively, the subject will gradually 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 such purpose.

Instead, in epileptic seizures the variable presence or absence of people is irrelevant, is not one of the causes of appearance. It can develop with people around or without.

10. night presence

Epileptic seizures can appear at night. In contrast, hysterical crises never arise while the subject is sleeping.

11. Loss of consciousness

Total loss of consciousness occurs in grand mal epileptic seizures.. However, in psychogenic crises the loss occurs in a partial way, the subject in a certain way continues to be conscious.

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12. Characteristics of seizures

Seizures seen in psychogenic seizures are uncoordinated, anarchic, and intentionally produced. On the other hand, in epileptic seizures, the seizures are symmetrical and occur without the subject intending it, they are not intentional.

13. Yelling and talking during the crisis

In psychogenic crises the subject can speak during the crisis, as well as scream during its course. As opposed, in the crisis of organic origin the patient does not speak during the crisis and if he screams he does it at the beginning, not during this.

14. sphincter relaxation

Sphincter relaxation or urination, is frequently observed during epileptic seizures, in the convulsive phase. While sphincter emptying is much less common in psychogenic crises, it almost never occurs.

15. To bite your tongue

Another symptom that often occurs during the convulsive phase is tongue biting. In this way, it is common to observe this episode in epileptic seizures, but it never occurs in the course of psychogenic ones.

16. Physical damage

When the start occurs abruptly and there is no time to adopt security measures, subjects who suffer epileptic seizures often have trauma caused by shock. 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 damages produced are minimal or non-existent.

17. response to painful stimuli

The total or partial loss of consciousness is also linked to the response or not to painful stimuli.. The total loss of consciousness in epileptic seizures makes the individual unresponsive and unactivated 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

Seizures usually last a few minutes. In contrast, psychogenic crises show a much more variable duration, and can last from minutes to hours.

19. patient recovery

After the crisis, hysterical subjects recover faster, more easily. On the contrary, individuals with epilepsy show a more progressive recovery, 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. On the other hand, epileptic seizures are infrequently observed more than once in a day.

21. Objective of the crisis

As we have already said, the objective or intention of psychogenic crises is to attract attention, to seek action from the environment. In contrast, in epileptic seizures no purpose or intention is observed, since, as we have seen, they appear unintentionally.