Dimaro Lian V, Roberts Nicole A, Moghaddam Nima G, Dawson David L, Brown Ian, Reuber Markus
University of Nottingham, Institute of Work, Health & Organisations, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, UK.
School of Social and Behavioral Sciences, Arizona State University, 4701 W. Thunderbird Road, MC 3051, Glendale, AZ 85306, USA.
Epilepsy Behav. 2015 May;46:109-17. doi: 10.1016/j.yebeh.2015.03.032. Epub 2015 Apr 25.
Self-esteem (SE), or one's sense of competence and worth, is reduced in many mental and physical disorders. Low SE is associated with perceived stigma and disability and poor treatment outcomes. The present study examined implicit and explicit SE (automatic and deliberate views about the self) in people with epilepsy and people with psychogenic nonepileptic seizures (PNESs). Discrepancies between implicit SE and explicit SE have been found to correlate with psychological distress in disorders often associated with PNESs but are relatively unexplored in PNESs. We hypothesized that, compared with epilepsy, PNESs would be associated with lower self-reported SE and greater discrepancies between implicit SE and explicit SE.
Thirty adults with PNESs, 25 adults with epilepsy, and 31 controls without a history of seizures were asked to complete the Rosenberg Self-esteem Scale as a measure of explicit SE and an Implicit Relational Assessment Procedure as a measure of implicit SE. The State-Trait Anxiety Inventory and Patient Health Questionnaire-15 (a somatic symptom inventory) were also administered.
We found significant group differences in explicit (p<0.001) but not implicit SE. Patients with PNESs reported lower SE than the other groups. No group differences were found in implicit SE. Implicit-explicit SE discrepancies were larger in the group with PNESs than in the other groups (p<0.001). Higher frequency of PNESs (but not epileptic seizures) was associated with lower explicit SE (rs=-.83, p<0.01) and greater SE discrepancies (i.e., lower explicit relative to implicit SE; rs=.65, p<0.01). These relationships remained significant when controlling for anxiety and somatization.
Patients with PNESs had lower explicit SE than those with epilepsy or healthy controls. In keeping with our expectations, there were greater discrepancies between implicit SE and explicit SE among patients with PNESs than in the other groups. Our results, including the strong relationship between PNES frequency, anxiety, and explicit-implicit SE discrepancies, support the interpretation that PNESs serve to reduce cognitive dissonance, perhaps protecting patients' implicit SE.
自尊（SE），即一个人的能力感和价值感，在许多精神和身体疾病中都会降低。低自尊与感知到的耻辱感、残疾以及不良治疗结果相关。本研究考察了癫痫患者和精神性非癫痫发作（PNES）患者的内隐和外显自尊（对自我的自动和刻意看法）。已发现内隐自尊和外显自尊之间的差异与通常与PNES相关的疾病中的心理困扰相关，但在PNES中相对未被探索。我们假设，与癫痫相比，PNES会与更低的自我报告自尊以及内隐自尊和外显自尊之间更大的差异相关。
30名患有PNES的成年人、25名患有癫痫的成年人以及31名无癫痫发作史的对照组被要求完成罗森伯格自尊量表作为外显自尊的测量，以及内隐关系评估程序作为内隐自尊的测量。还进行了状态-特质焦虑量表和患者健康问卷-15（一种躯体症状量表）的测试。
我们发现在外显自尊方面存在显著的组间差异（p<0.001），但在内隐自尊方面没有。患有PNES的患者报告的自尊低于其他组。在内隐自尊方面未发现组间差异。PNES组的内隐-外显自尊差异比其他组更大（p<0.001）。更高频率的PNES（而非癫痫发作）与更低的外显自尊（rs = -0.83，p<0.01）以及更大的自尊差异相关（即相对于内隐自尊，外显自尊更低；rs = 0.65，p<0.01）。在控制焦虑和躯体化后，这些关系仍然显著。
患有PNES的患者的外显自尊低于患有癫痫的患者或健康对照组。与我们的预期一致，PNES患者的内隐自尊和外显自尊之间的差异比其他组更大。我们的结果，包括PNES频率、焦虑和内隐-外显自尊差异之间的强关系，支持了这样一种解释，即PNES有助于减少认知失调，可能保护患者的内隐自尊。
