Pseudo Seizures

EKUGRAD, BSN, MSN, RN, CNS · May 11, 2016

By definition, PNES (Psychogenic NonEpileptic Seizures) is a psychiatric disorder; more specifically it is a conversion disorder, which falls under the diagnostic category of somatic symptom disorders. In practice however, the term "seizures" is confusing to patients, families and caregivers. The American Psychiatric Association recommends that it is probably best to replace the word "seizures" with more general terms that so not imply epilepsy, such as "episodes" or "events".

Factitious disorder and malingering imply that the patient is purposely deceiving the caregiver (i.e., faking the symptoms). The difference between factitious disorder and malingering is that, in malingering, the reason for the deception is tangible and rationally understandable such as avoiding schoolwork, evading punishment, or being seen as different (attention-seeking). In factitious disorder, the motivation is a pathologic need for the sick role.

How many of our students (and fellow faculty, for that matter) have reaped rich rewards from their role in the family of "the sick one"? All human beings need some semblance of control over their own world, their own destiny. When this is threatened (rules, requirements, testing, schedules, etc.) people will revert to their past learned successes, such as "having a seizure".

The response from the Nurse of preventing harm and phoning the parents is more than just crisis management. I might add to the nurse's technique is to remove the audience.

As a behaviorist and Psychiatric Nurse, I know that all behavior has meaning. "Faking it" has no place in the lexicon of professional caregivers. That said, the specific behavior must be addressed; reinforce it to preserve it or ignore it to increase the likelihood that it will die of neglect (the behavior, not the student. Sorry)

Keepstanding, ASN, RN · May 11, 2016

Thank you EKUGRAD ! You have totally described this to a T. I gained an enormous amount of wisdom from your response. EXCELLENT :yes:

Farawyn · May 11, 2016

By definition, PNES (Psychogenic NonEpileptic Seizures) is a psychiatric disorder; more specifically it is a conversion disorder, which falls under the diagnostic category of somatic symptom disorders. In practice however, the term "seizures" is confusing to patients, families and caregivers. The American Psychiatric Association recommends that it is probably best to replace the word "seizures" with more general terms that so not imply epilepsy, such as "episodes" or "events".
Factitious disorder and malingering imply that the patient is purposely deceiving the caregiver (i.e., faking the symptoms). The difference between factitious disorder and malingering is that, in malingering, the reason for the deception is tangible and rationally understandable such as avoiding schoolwork, evading punishment, or being seen as different (attention-seeking). In factitious disorder, the motivation is a pathologic need for the sick role.
How many of our students (and fellow faculty, for that matter) have reaped rich rewards from their role in the family of "the sick one"? All human beings need some semblance of control over their own world, their own destiny. When this is threatened (rules, requirements, testing, schedules, etc.) people will revert to their past learned successes, such as "having a seizure".
The response from the Nurse of preventing harm and phoning the parents is more than just crisis management. I might add to the nurse's technique is to remove the audience.
As a behaviorist and Psychiatric Nurse, I know that all behavior has meaning. "Faking it" has no place in the lexicon of professional caregivers. That said, the specific behavior must be addressed; reinforce it to preserve it or ignore it to increase the likelihood that it will die of neglect (the behavior, not the student. Sorry)

I had a kid trying to "fake" a nosebleed yesterday with red paint, so, while I MOSTLY agree with your well written post (really, thank you! :) ) I reserve the right as a SN to utilize "faking it."

Welcome to the SN Board.

We wear Pink on Wednesdays, which is today.

Jedrnurse, BSN, RN · May 11, 2016

Unfortunately, some are quick to "pathologize" everything that our snowflakes do. I had a conversation with a nurse who said "we don't use the term 'frequent flyers'- they're just kids trying to get their needs met."

Well, yes. But in many cases the need is to get out of math class.

NutmeggeRN, BSN · May 11, 2016

How many of our students (and fellow faculty, for that matter) have reaped rich rewards from their role in the family of "the sick one"? All human beings need some semblance of control over their own world, their own destiny. When this is threatened (rules, requirements, testing, schedules, etc.) people will revert to their past learned successes, such as "having a seizure".

THIS!!! (bolding is mine)

Been in this role for 20+ years, I still cannot wrap my head around the thought of needing a neurologist for a first time headache, a gastroenterologist for a bout of diarrhea...I have seen more than my fair share of parent who insist on big time hospitals and having their identity so driven by their child's illness.

I'm not talking about a chronically ill kids or a cancer diagnosis etc. I am talking about everyday life people!

rporter342 · May 12, 2016

I had a patient in a hospital setting have pseudo seizures so that he could keep getting ativan. This went in for 3 rounds. During one of his active seizures I pressed the edge of my scissors on the nailbed of his thumb. He yelled ow, snatched his hand back and sat up. I cured him! No more seizures!!! He did get a psych consult though.

DistrictNurse19 · May 13, 2016

I have had a female teen who has had several pseudoseizures--all occur when she is upset or just looking for attention. They look so real sometimes!

Jlacl7 · May 20, 2016

I had a high school student my first year as a school nurse who had them . He would give the appearance of having tonic-clinic seizures without any EEG changes. He also had other mental illness issues including depression and episodes of acute psychosis including hallucinations. They usually occurred when he was under stress.

ron m · May 28

NEPS is a situation where the subconscience mind is triggered and desides to manifest a seizure. lucky me double whammie, catatonia follows. It is not faking. Lose the if I can't treat it who cares attitude. faking is a medical problem. Instead of raining hate on "fakers" consider why they need the attention, and if you insist on tests, best decide when the test shows they are not faking, passing generates more hate than failing. 1 hour in the most uncomfortable position you can imagine baby, and the nurse was livid she had to straighten me out. The most disgusting test is placing anxiety medication 6 inches away and say take it when you can. If I can, I don't need it, if I do need it, relief is never coming when the need is genuine. This rewards the faker, punishes the genuine

beachynurse, ASN, BSN · May 30

I have had several students with psychogenic seizures over the years I've worked in a high school. The first student that had these types of seizures would fall on the floor, always on her back, and would be shaking and scratching at her neck. However, while I was sitting on the floor next to her, we would have conversations about her horse, dogs, what she did for the weekend. It was very obvious that this was attention seeking behavior.

Another student that had them would just drop to the floor, and have the tonic clonic movements of a grand mal. There were times he would seize for hours. Nothing could stop the seizure, no ativan, or valium. He would just have to seize until he would stop. We called 911 so often that the paramedics would walk in and look at him and say hi ****. They got to know him very well. Mom told me that the longest he seized was 8 hours. He has had numerous EEG's which were all normal. He graduated 6 years ago, and still comes to visit me, and yes, he still has those seizures.

BlondieRN19 · 2025-06-12T18:34:28Z

I've been a child/adolescent psych nurse for many years, and pseudo seizures is an attention-seeking behavior in my opinion. The more attention and TLC that is given for the "seizure", the more "seizure" behaviors occur. Its almost insulting. Nobody has time for that...

ron m · 2025-06-12T23:24:28Z

It is a trauma response. I've never failed a "test" yet, and the unethicalness of those tests is scary and considered torture because people like you do not have a test condition for a genuine reaction. I find your response that you don't have time to comfort scared children upsetting too. Try addressing why they need attention, and show them how to get the attention they need constructively. I have no doubt I am a unicorn, but raining disrespect isn't the answer for "faking" either. Imagine a kid in a psych facility needing psychologic, not physical help. Not getting it from you I see.