The differential diagnosis of epilepsy, pseudoseizures, dissociative identity disorder, and dissociative disorder not otherwise specified

The authors review the co-occurrences of dissociative symptoms and disorder s with epilepsy and pseudoseizures and examine newer diagnostic instruments that assist in accurate diagnosis of persons with concomitant seizure beha viors and dissociative symptoms. They also review seizure behaviors and ele ctroencephalographic findings in persons with dissociative identity disorde r (DID) and dissociative disorder not otherwise specified (DDNOS) and disso ciative symptoms in persons with epilepsy and with pseudoseizures. Dissocia tive symptoms in 15 patients with epilepsy and 15 with pseudoseizures were examined using the Dissociative Experiences Scale (DES) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). On the SCID- D, pseudoseizure patients had significantly higher dissociative symptom sco res than epileptic patients, but DES scores did not reliably distinguish ep ileptic and pseudoseizure patients. Misdiagnosis of persons with seizures a nd dissociative symptoms can be avoided by careful adherence to DSM dissoci ative disorder criteria, the use of video-EEG monitoring, and systematic as sessment of dissociative symptoms with the SCID-D.