BACKGROUND Psychogenic nonepileptic seizures (PNES) are still poorly understood and difficult to treat. Attachment theory could add new aspects to the understanding of the multifactorial genesis and maintenance of PNES and the therapeutic needs of this patient group. OBJECTIVE The aim of the present study is to systematically assess attachment in adult patients with PNES with a focus on the role of unresolved/disorganized attachment. METHODS A cross-sectional design was chosen to compare patients with confirmed PNES (n = 44) and healthy controls (n = 44) matched for gender, age, and education. Attachment was assessed using the Adult Attachment Projective Picture System. Psychometric questionnaires included the Childhood Trauma Questionnaire; Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) axis II disorders, Patient Questionnaire; the Somatoform Dissociation Questionnaire; and the Patient Health Questionnaire. RESULTS We found significantly less secure (P = 0.006) and more unresolved/disorganized (P = 0.041) attachment classifications in the PNES group. Among patients with PNES, 7% were classified secure and 43% were classified unresolved/disorganized. Patients with an unresolved attachment representation were significantly more likely to be screened positive for personality pathology in the Structured Clinical Interview for DSM-IV axis II disorders, Patient Questionnaire (P = 0.03) and to report more emotional abuse in the Childhood Trauma Questionnaire (P = 0.007) than patients with other attachment classifications. CONCLUSIONS Our findings suggest that unresolved/disorganized attachment might be the predominant attachment style in patients with PNES and might be associated with more severe personality pathology. This could be of therapeutic relevance. The present study is the first to assess adult attachment in patients with PNES using a semi-structured interview in comparison to matched healthy controls.

中文翻译：

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心因性非癫痫发作 (PNES) 患者的不安全和未解决的杂乱依恋

背景 心因性非癫痫性癫痫发作 (PNES) 仍然知之甚少且难以治疗。依恋理论可以为理解 PNES 的多因素发生和维持以及该患者群体的治疗需求增加新的方面。目的 本研究的目的是系统地评估成年 PNES 患者的依恋，重点关注未解决/混乱依恋的作用。方法 选择横断面设计来比较确诊为 PNES 的患者 (n = 44) 和性别、年龄和教育程度匹配的健康对照 (n = 44)。使用成人依恋投影图片系统评估依恋。心理测量问卷包括童年创伤问卷；精神疾病诊断和统计手册的结构化临床访谈，第四版 (DSM-IV) 轴 II 障碍，患者问卷；躯体形式分离问卷；和患者健康问卷。结果 我们发现 PNES 组中的依恋分类明显不安全 (P = 0.006) 和更多未解决/混乱 (P = 0.041)。在 PNES 患者中，7% 被归类为安全，43% 被归类为未解决/混乱。在 DSM-IV 轴 II 障碍的结构化临床访谈、患者问卷 (P = 0.03) 中，依恋表征未解决的患者更有可能被筛查出人格病理阳性，并在童年创伤问卷 (P = 0.007) 与其他依恋分类的患者相比。结论 我们的研究结果表明，未解决/无组织的依恋可能是 PNES 患者的主要依恋类型，并且可能与更严重的人格病理有关。这可能具有治疗意义。本研究首次使用半结构化访谈与匹配的健康对照相比评估 PNES 患者的成人依恋。