The role of multiphasic personality questionnaires in the diagnosis of dissociative disorders in patients with epilepsy

Background. Recently, patients with comorbid conditions such as epilepsy and dissociative (psychogenic non-epileptic) seizures have been increasingly identified in clinical practice. No generally accepted diagnostic algorithms for confirming such conditions are currently available. However, it is known that patients with epilepsy and comorbid pathology have certain personality characteristics, for identifying which an experimental psychological examination is conducted, which uses multidimensional personality questionnaires. Among them, the Minnesota Multiphasic Personality Inventory (MMPI) is most widespread, adapted by L.N. Sobchik (2007) as a standardized multifactorial personality study.

Objective: To examine the personality pattern in patients with epilepsy and comorbid dissociative disorders.

Material and methods. The study included 54 patients with epilepsy, 27 of them with comorbid dissociative disorders (ED group) in the form of psychogenic non-epileptic seizures, and 27 respondents with exclusively epileptic seizures (E group). All study participants underwent clinical and psychological examinations using MMPI.

Results. Patients in ED vs. E group had a higher level of hypochondria score points (74.96 vs 65.23 points; p=0.012). According to the results of the assessment by the scale of anxiety and depression, the average score in ED group was lower than in E group (64.26 vs 75.77 points; p=0.001). According to the hysteria scale, patients in ED group had a higher average score compared with E group (73.26 vs 64.08 points; p=0.014).

Conclusion. Patients with epilepsy and comorbid dissociative disorders have higher levels of hypochondria, hysteria, as well as low levels of anxiety and depression, compared with patients without conversion disorders. The results obtained correspond to the “conversion five” and characterize the personality pattern observed in such patients.

1. Kerr M.P., Mensah S., Besag F., et al. International League of Epilepsy (ILAE) Commission on the Neuropsychiatric Aspects of Epilepsy. International consensus clinical practice statements for the treatment of neuropsychiatric conditions associated with epilepsy. Epilepsia. 2011; 52 (11): 2133–8. https://doi.org/10.1111/j.1528-1167.2011.03276.x.

2. Ali S., Jabeen S., Pate R.J., et al. Conversion disorder – mind versus body: a review. Innov Clin Neurosci. 2015; 12 (5–6): 27–33.

3. Mao L., Wang K., Zhang Q., et al. Stigma and its underlying contributors in epilepsy patients. Front Public Health. 2022; 10: 879895. https://doi.org/10.3389/fpubh.2022.879895.

4. Zheleznova E.V., Kalinin V.V., Kim V.V., et al. Conversion disorders in epilepsy. Russian Journal of Psychiatry. 2018; 3: 45–52 (in Russ.).

5. Kanemoto K., LaFrance WC Jr., Duncan R., et al. PNES around the world: where we are now and how we can close the diagnosis and treatment gaps – an ILAE PNES Task Force report. Epilepsia Open. 2017; 2 (3): 307–16. https://doi.org/10.1002/epi4.12060.

6. Benbadis S.R. Errors in EEGs and the misdiagnosis of epilepsy: importance, causes, consequences, and proposed remedies. Epilepsy Behav. 2007; 11 (3): 257–62. https://doi.org/10.1016/j.yebeh.2007.05.013.

7. Peeling J.L., Muzio M.R. Functional neurologic disorder. In: Treasure Island (FL): StatPearls Publishing; 2025.

8. Pedrelli M. Minnesota Multiphasic Personality Inventory of Hathaway and McKinley. Riv Sper Freniatr Med Leg Alien Ment. 1954; 78 (1): 51–84 (in Italian).

9. Butcher J.N., Dahlstrom W.G., Graham J.R., et al. Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Manual for administration and scoring. Minneapolis: University of Minnesota Press; 1989.

10. Drayton M. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Occup Med. 2009; 59 (2): 135–6. https://doi.org/10.1093/occmed/kqn182.

11. Berezin F.B., Miroshnikov M.P., Rozhanec R.V. The methodology of multilateral personality research (in clinical medicine and psychology). Moscow: Meditsina; 1976: 176 pp. (in Russ.).

12. Sobchik L.N. The standardized multifactorial personality research method. A practical guide. Moscow; Rech; 2007: 224 pp. (in Russ.).

13. Derry P.A., McLachlan R.S. The MMPI-2 as an adjunct to the diagnosis of pseudoseizures. Seizure. 1996; 5 (1): 35–40. https://doi.org/10.1016/s1059-1311(96)80060-4.

14. del Barrio A., Jiménez-Huete A., Toledano R., et al. Validity of the clinical and content scales of the Multiphasic Personality Inventory Minnesota 2 for the diagnosis of psychogenic non-epileptic seizures. Neurologia. 2016; 31 (2): 106–12. https://doi.org/10.1016/j.nrl.2013.12.006.

15. Krámská L., Myers L., Hrešková L., et al. Diagnostic utility of the Minnesota Multiphasic Personality Inventory-2 in patients diagnosed with psychogenic non-epileptic seizures in the Czech Republic. Epilepsy Behav. 2021; 115: 107698. https://doi.org/10.1016/j.yebeh.2020.107698.