Examining the Role of Shame in Functional and Epileptic Seizures

This thesis aimed to explore the impact of shame and self-esteem on individuals living with functional (FS) and epileptic seizures (ES). In the review part of the thesis, 25 research articles were reviewed systematically to determine the factors linked to self-esteem in individuals with seizures. Findings suggested that in individuals with ES, lower self-esteem was associated with feeling stigmatized, anxious, and depressed. On the other hand, high self-esteem was linked to greater knowledge about epilepsy, higher life satisfaction, better quality of life, increased self-efficacy, better community integration, and helpful coping strategies. We did not observe a clear association between self-esteem seizure frequency in people with epilepsy. Only one article investigated self-esteem in individuals with FS, which discovered that higher self-esteem was linked to lower seizure frequency. In the second part of the thesis, a research study was conducted with 138 participants who had either FS or ES. The study aimed to compare the levels of shame and mental health difficulties between the two groups and to examine whether shame predicted seizures and mental health difficulties. Results showed that people with FS and ES reported high depression and somatic symptoms, but the FS group had significantly higher symptoms. People with FS had higher anxiety, but not significantly higher than ES. Findings suggested that perceived lower socioeconomic status (PSES) was associated with anxiety, depression, somatic symptoms, and seizure frequency. Interestingly, shame proneness did not provide additional information beyond PSES in explaining mental health difficulties and seizures. On the other hand, it was discovered that shame aversion was a significant predictor of anxiety and depression, even more so than the impact of perceived socioeconomic status (PSES). Based on the findings, authors recommend comprehensive care for individuals with seizures, taking into account their medical, psychological, and social needs. This is especially important because of the higher occurrence of depression and physical symptoms in those with seizures, as well as the negative effects that shame and low socioeconomic status can have on their mental health outcomes.