Coyne Brendan, Elghazzawy Mariam, Yoo Bo Ram, Mehta Varun S, Bodaghi Mahdieh
Psychiatry, George Washington University School of Medicine and Health Sciences, Washington, USA.
Psychiatry, University of California (UC) San Diego, San Diego, USA.
Cureus. 2025 Mar 8;17(3):e80267. doi: 10.7759/cureus.80267. eCollection 2025 Mar.
Psychogenic non-epileptic seizures (PNES), also known as functional seizures, clinically mimic seizure-like activity without the presence of brain wave abnormalities on electroencephalogram (EEG). PNES, among other functional neurological disorders, demonstrates an increased prevalence among transgender and non-binary individuals, particularly those with ongoing gender dysphoria. It is established that PNES episodes can be triggered by states of severe distress and that mirror-gazing may cause distress in individuals with gender dysphoria. Herein, we review the available research on the pathophysiology of PNES. We also describe a 16-year-old non-binary patient with gender dysphoria, initially admitted following a suicide attempt, who experienced multiple PNES episodes upon entering their bathroom. Once bathroom access was restricted and the patient was supervised with a bedside commode, they experienced no further episodes on the unit. With no other potential triggers identified, we hypothesized that the patient's symptoms were evoked by their reflection in the bathroom mirror, causing such great distress that it resulted in dissociation and PNES. This is a case of mirror-gazing potentially inducing PNES in a non-binary patient.
心因性非癫痫性发作（PNES），也称为功能性发作，临床上模拟癫痫样活动，但脑电图（EEG）上不存在脑电波异常。PNES与其他功能性神经障碍一样，在跨性别者和非二元性别个体中患病率增加，尤其是那些患有持续性性别焦虑症的人。已确定PNES发作可由严重痛苦状态引发，并且照镜子可能会给患有性别焦虑症的个体带来痛苦。在此，我们综述了关于PNES病理生理学的现有研究。我们还描述了一名16岁患有性别焦虑症的非二元性别患者，最初因自杀未遂入院，在进入浴室时经历了多次PNES发作。一旦限制其使用浴室并在床边使用便桶对患者进行监护，他们在病房内就没有再发作。由于未发现其他潜在触发因素，我们推测患者的症状是由他们在浴室镜子中的倒影诱发的，这种倒影造成了极大的痛苦，导致解离和PNES发作。这是一例照镜子可能诱发非二元性别患者PNES发作的病例。
