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Faking it?


Dear Dr. Guterson: I have a cousin who has a seizure almost every week. I don’t want to sound unkind, but I think he’s faking it. How do I know for sure?


A: Your question is one that we psychiatrists are challenged with all the time - and not only with regard to seizures. Are our patients telling us the truth?


We do have a name for seizures that are not real: psychogenic nonepileptic seizures (PNES). In short, patients with PNES often exhibit certain symptoms - like screaming or crying, side-to-side movements of the head, and closed eyes - that do not generally occur in those with real seizures. Also, those with PNES will usually ‘wake up’ quickly after the event whereas those with real seizures can be quite confused for many minutes to hours.


To help these patients, it is important to be nonjudgmental and to show understanding. In psychiatry, we see patients all the time who may make things up or who intensify their problems. Recognize that this person is in pain, probably a type of pain that is vastly different from what they are saying or exhibiting, oftentimes a deep, psychological, traumatic pain.


By listening with kindness, you will see that amazing gates of sharing will soon open up.

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