Psychogenic nonepileptic seizures (PNES), also called functional seizures, are episodes that look and feel like epileptic seizures but have a completely different cause. These events are not due to abnormal electrical activity in the brain—instead, they arise from psychological distress and changes in how the brain processes stress, trauma, and emotions.

Understanding Psychogenic Nonepileptic Seizures

When someone experiences a psychogenic nonepileptic seizure, their body goes through movements and sensations that strongly resemble epilepsy. They might shake, lose awareness, or become unresponsive. However, if doctors monitor their brain waves during these episodes using an electroencephalogram (EEG)—a test that records electrical activity in the brain—they won’t find the abnormal patterns typical of epileptic seizures. This fundamental difference shapes everything about how these seizures are understood and treated.^[1]

It’s crucial to understand that people experiencing PNES are not faking their symptoms. These episodes are real, involuntary, and beyond conscious control. The person having a functional seizure has no ability to start or stop the event at will. These seizures represent the body’s physical response to psychological distress, often related to past trauma, ongoing stress, or mental health conditions. The seizures are genuine manifestations of suffering that deserve compassionate medical care.^[2]

PNES is classified as a type of functional neurological disorder, sometimes described as a problem with the “software” rather than the “hardware” of the brain. The brain’s structure remains intact, but the way different parts communicate and process information becomes disrupted. This disruption can cause physical symptoms that feel completely real to the person experiencing them because they are real—just caused by functional changes rather than structural damage.^[1]

How Common Are Functional Seizures?

Psychogenic nonepileptic seizures are more common than many people realize, though they remain poorly understood and frequently misdiagnosed. When doctors evaluate patients who have seizures that don’t respond to treatment, approximately 20 to 30 percent turn out to have PNES rather than epilepsy. This represents a substantial portion of people referred to specialists for difficult-to-control seizures.^[4]

In the general population, estimates suggest that between 2 and 33 people per 100,000 have PNES. The wide range in these numbers reflects how challenging it can be to accurately diagnose this condition. Many people may go years without receiving the correct diagnosis, sometimes being treated for epilepsy when they actually have a psychological condition requiring completely different care.^[4]

PNES affects women more frequently than men, with approximately 70 percent of cases occurring in women. The condition most commonly begins in young adulthood, though it can develop at any age. About 15 percent of people diagnosed with PNES also have epilepsy, meaning some individuals genuinely experience both types of seizures—those caused by abnormal brain electrical activity and those caused by psychological factors. This overlap can make diagnosis even more complicated.^[4]

Diagnosis should be made with particular caution in children and older adults. In these age groups, other types of nonepileptic events such as sleep disorders or fainting episodes may be more likely explanations for seizure-like symptoms. Careful evaluation is essential to avoid misdiagnosis in these populations.^[4]

What Causes Psychogenic Nonepileptic Seizures?

The causes of PNES are complex and not fully understood, but researchers believe these seizures develop from an intricate combination of biological, psychological, and social factors. This multifaceted explanation is known as the biopsychosocial model, which recognizes that human health involves the interplay between body, mind, and environment.^[1]

From a psychological perspective, unresolved trauma plays a significant role in many cases. People who experienced physical, sexual, or emotional abuse or neglect during childhood appear to have higher risk of developing PNES later in life. Traumatic events in adulthood—such as assault, accidents, or witnessing violence—can also contribute. When trauma isn’t properly processed and healed, the emotional distress can manifest physically through seizure-like episodes.^[4]

Mental health conditions frequently accompany or trigger PNES. Depression, anxiety disorders, panic attacks, and post-traumatic stress disorder (PTSD)—a condition that develops after experiencing or witnessing a terrifying event—are commonly found in people with functional seizures. Some individuals have difficulty identifying and expressing their emotions, a condition called alexithymia. When people cannot process emotional distress through normal channels, their bodies may express it through physical symptoms like seizures.^[1]

Biological factors also play a role. Some people have a physiological susceptibility that makes them more prone to developing functional symptoms when under stress. Genetics may contribute, with studies showing increased concordance in identical twins. Additionally, people with chronic physical conditions such as chronic pain, fibromyalgia, or migraine headaches have higher rates of PNES, suggesting that ongoing physical stress on the body may contribute to the development of functional seizures.^[4]

Social factors round out the picture. Ongoing stressors like family dysfunction, marital problems, financial instability, bullying, or difficulties at work or school can all contribute. A death in the family or divorce can precipitate the first seizure in vulnerable individuals. Often, PNES develops when multiple factors combine—a person with genetic vulnerability who experienced childhood trauma and currently faces high stress levels may reach a tipping point where functional seizures emerge.^[6]

Who Is at Risk?

Certain factors increase a person’s vulnerability to developing functional seizures. Understanding these risk factors can help identify individuals who might benefit from preventive mental health support and careful monitoring if seizure-like symptoms appear.^[1]

The strongest risk factor is a history of trauma, particularly trauma experienced during childhood. People who endured physical abuse, sexual abuse, emotional abuse, or neglect in their early years carry a higher risk of developing PNES later in life. The earlier and more severe the trauma, the greater the risk appears to be. Childhood is a critical period for brain development and learning how to process emotions; disruptions during this time can have lasting effects on how a person handles stress as an adult.^[4]

Living through difficult or traumatic events in adulthood also increases risk. This might include experiencing assault, being in a serious accident, witnessing violence, or going through other life-threatening situations. The development of PTSD following such events appears particularly linked to PNES risk. When traumatic memories aren’t properly processed, they can contribute to physical symptoms including seizures.^[1]

Having a chronic physical condition places individuals at higher risk. Conditions like chronic pain, fibromyalgia, irritable bowel syndrome, asthma, migraine headaches, and insomnia all show associations with higher rates of PNES. The ongoing physical distress from these conditions, combined with the emotional burden of living with chronic illness, may create vulnerability to functional symptoms.^[6]

Pre-existing mental health conditions significantly elevate risk. Depression, anxiety disorders, panic disorder, mood disorders, personality disorders, dissociative disorders—conditions where a person experiences disruptions in memory, awareness, or identity—and substance use disorders all increase the likelihood of developing functional seizures. These conditions affect how the brain processes stress and emotions, potentially making physical expression through seizures more likely.^[1]

Maladaptive coping styles also contribute to risk. People who have an avoidant coping style—meaning they tend to avoid dealing with stressful situations or emotions rather than confronting them—may be more vulnerable. Similarly, those with heightened awareness of bodily sensations who fixate on physical symptoms may channel psychological distress into physical manifestations more readily than others.^[6]

Recognizing the Symptoms

The primary symptom of PNES is seizure-like episodes that can vary dramatically from person to person and even from episode to episode in the same individual. These events might look like the dramatic full-body shaking typically associated with epilepsy, or they might be much more subtle—a brief lapse in awareness, sudden loss of muscle tone leading to collapse, or isolated twitching in one part of the body.^[1]

Common features seen during PNES episodes include changing patterns of movement where the type of shaking or jerking shifts during the event. The person might have out-of-sync limb movements where arms and legs move independently rather than in the coordinated pattern typical of epileptic seizures. Rapid side-to-side head movements and pelvic thrusting motions are more common in functional seizures than epileptic ones. Some people experience convulsive-type shaking while remaining partially aware of their surroundings, which rarely happens in true epileptic seizures.^[1]

Episodes that last longer than 10 minutes are more suggestive of PNES than epilepsy. During the event, the person’s eyes are often closed, whereas people having epileptic seizures typically have their eyes open. After a functional seizure ends, people often don’t experience the deep confusion or exhaustion—called the postictal state—that typically follows epileptic seizures. However, every individual is different, and these features aren’t definitive; diagnosis requires professional evaluation.^[5]

Before an episode begins, some people notice warning signs. These might include shaking in the arms, legs, or body, a tight feeling in the chest, light-headedness, headache, or changes in breathing. Recognizing these early signals can sometimes help people use coping strategies to reduce the intensity or duration of the episode, though they cannot always prevent it entirely.^[3]

Importantly, functional seizures typically result in fewer physical injuries than epileptic seizures. People rarely bite their tongue severely, lose bladder or bowel control, or sustain serious injuries from falling. Even when appearing unresponsive, individuals with PNES may retain some awareness and instinctively protect themselves from harm. However, injuries can still occur, so these seizures should not be dismissed as harmless.^[5]

In addition to the seizure episodes themselves, people with PNES commonly experience symptoms related to underlying mental health conditions. Anxiety, depression, panic attacks, and PTSD symptoms frequently occur alongside the seizures. These additional symptoms can significantly impact quality of life and require treatment in their own right.^[1]

Preventing Psychogenic Nonepileptic Seizures

While there’s no guaranteed way to prevent PNES, certain strategies may reduce risk, particularly for people who’ve experienced trauma or have risk factors for developing functional seizures. Prevention focuses on addressing underlying vulnerabilities before they manifest as physical symptoms.^[13]

Seeking mental health support after traumatic experiences is perhaps the most important preventive step. When trauma is addressed promptly through appropriate therapy, it’s less likely to create the long-term psychological disruption that can later manifest as functional symptoms. People who’ve experienced childhood trauma, assault, accidents, or other distressing events should consider working with a mental health professional even if they don’t feel they have “problems” currently. Early intervention can prevent complications later.^[6]

Managing chronic stress is crucial. Learning and regularly practicing stress-reduction techniques—such as deep breathing exercises, meditation, yoga, or mindfulness (a practice of paying attention to the present moment without judgment)—can help prevent stress from accumulating to levels that trigger physical symptoms. Building these skills during calmer times makes them more available when stress increases.^[9]

Addressing mental health conditions promptly also provides protection. Depression, anxiety, and other psychiatric conditions should be treated seriously and comprehensively rather than ignored or minimized. Proper treatment of these underlying conditions may prevent them from manifesting through physical symptoms like seizures. Regular check-ins with mental health professionals can catch problems early.^[6]

Developing healthy coping mechanisms is protective. This means learning to confront and process difficult emotions rather than avoiding them, finding healthy outlets for stress like exercise or creative activities, and building strong social support networks. People who can express and work through emotions verbally or through other direct channels may be less likely to express distress through physical symptoms.^[6]

For people already experiencing early symptoms or at high risk, self-care becomes especially important. This includes maintaining regular sleep schedules, eating balanced meals, staying physically active within safe limits, and avoiding excessive alcohol or drug use. Managing chronic pain or other physical conditions as effectively as possible also helps reduce overall stress on the body and mind.^[13]

What Happens in the Body During Functional Seizures

Understanding the pathophysiology—the changes in normal body functions—of PNES requires looking beyond traditional structural brain abnormalities to consider how the brain processes and responds to psychological stress. Unlike epileptic seizures, which result from sudden, excessive electrical discharges in the brain that can be measured on an EEG, functional seizures occur without these electrical abnormalities.^[2]

Current theories suggest that PNES involves disruptions in how the brain processes information from the senses and converts it into movement and action. This is called sensorimotor processing. In people with functional seizures, the pathways between brain areas that perceive sensations, process emotions, and control movement may not communicate effectively. This functional disruption—as opposed to structural damage—leads to involuntary physical symptoms.^[1]

The nervous system in people with PNES appears to respond differently to physical triggers, environmental stressors, and internal emotional states. When faced with stress that would cause anxiety or emotional distress in most people, individuals with PNES may instead experience a physical manifestation—the seizure—as their body’s way of expressing distress. This isn’t a conscious choice but rather an automatic response pattern that develops over time.^[1]

Dissociation appears to play a role in many cases. Dissociation is a mental process where a person becomes disconnected from their thoughts, feelings, memories, or sense of identity. It’s a protective mechanism that often develops in response to trauma. During functional seizures, dissociative processes may cause the person to lose normal control over their body while also potentially protecting them from fully experiencing overwhelming emotions or memories.^[5]

People with PNES often have difficulty identifying and describing their emotions—the alexithymia mentioned earlier. When emotional experiences cannot be recognized and processed through normal psychological channels, the body may express them physically instead. The seizures essentially become a physical language for psychological distress that cannot be communicated otherwise.^[6]

Heightened awareness of bodily sensations also contributes. Some individuals with PNES are highly attuned to internal physical sensations and may interpret normal bodily functions as threatening or abnormal. This hypervigilance can create a feedback loop where noticing unusual sensations triggers anxiety, which triggers physical symptoms, which increases anxiety further, eventually culminating in a seizure.^[6]

The brain areas involved in emotion regulation, threat detection, and voluntary movement all show altered activity patterns in functional neurological disorders. Rather than a single “broken” part, PNES appears to involve disrupted communication between multiple brain networks. This helps explain why these seizures are real, involuntary events rather than voluntary actions—the person has genuinely lost normal control over these brain networks during an episode.^[2]