Objective: To determine whether cognitive dysfunction is associated with emotion regulation strategies and psychological distress in two psychogenic movement disorder (PMD) variants: non-epileptic seizures (PNES) and other hyperkinetic motor manifestations (PMD-H).

Background: Patients with PMD have difficulties identifying and regulating their emotions, and tend to use less effective emotion regulation strategies (suppression vs. reappraisal). Recent research suggests that PNES and PMD-H may represent phenotypic variants of psychogenic disturbance. Based on previous findings of greater frontal-executive inefficiencies in PNES vs. PMD-H subtypes and independent observations that frontal-executive control is necessary for effective emotion regulation, we hypothesized that PNES patients would demonstrate poorer cognitive status, use less effective emotion regulation strategies (i.e., suppression), and have greater psychological distress than PMD-H patients.

Methods: Sixteen PNES (vEEG verified) and 16 PMD-H (F&W criteria) patients, ages18-64 years (M=42.2), underwent an abbreviated neuropsychological battery including self-report measures of emotion regulation and psychopathology. Data were analyzed using regression analyses.

Results: For the total sample, lower frontal-executive function was associated with greater use of suppression than re-appraisal strategies. In the PNES group, lower general cognition was associated with more severe symptoms of posttraumatic stress disorder (PTSD), greater suppression and lower positive emotions, whereas lower cognition was associated with more severe PTSD symptoms and greater reappraisal in the PMD-H group. When controlling for general cognition, individuals who were classified as “suppressors” had a greater number of trauma events, more symptoms of dissociation, greater internalizing dysfunction, and more severe emotional distress than individuals classified as “re-appraisers.”

Conclusions: Current findings highlight the clinical utility of examining psychogenic subtypes, rather than combining them, and the importance of examining different types of emotion regulation strategies that may mediate the relationship between cognitive function and mental health outcomes. Future investigations using a similarly integrative perspective comparing psychogenic variants may facilitate the development of symptom-specific treatment approaches.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/emotion-regulation-and-neuropsychological-status-in-psychogenic-subtypes/