The relationship between Stigma and Self-Efficacy in individuals with epilepsy or nonepileptic attack disorder

Abstract
Stigma is when a certain characteristic (such as weight or race) causes an individual or group to be treated negatively based on a feature that differentiates them from other members of society. Stigma can be considered in different ways; Stigma can be ‘enacted’, when the individual is directly discriminated against, and ‘perceived’, when individual believes the negative actions of others to be linked to an undesirable characteristic of their self. Stigma can have serious consequences, such as reduced quality of life, lower rates of employment and less overall life satisfaction.
Epilepsy is a reasonably common neurological disorder where individuals experience seizures. Over 500,000 UK residents are estimated to be affected by Epilepsy. It can be caused by a number of different factors, such as brain lesions, but there may be no known cause for up to two-thirds of individuals with epilepsy. Historically, seizures have been associated with negative factors, such as demonic possession, and have experienced stigma. There is also evidence that stigmatising attitudes towards seizures continue to be prevalent.
Non-epileptic attack disorder (NEAD) is a condition whereby an individual experiences seizures that are outwardly similar to epileptic seizures. These seizures, however, are not associated with the neurological correlates of epilepsy. NEAD is a fairly common disorder with an estimated 15 000 UK residents receiving a diagnosis. The causes of NEAD are often considered psychological rather than physical and, as such, NEAD is often considered a mental health disorder.
The causes and manifestations of stigma in NEAD are unclear. This project aimed to extend the current understanding of stigma in NEAD by first: reviewing the literature on the experiences of stigma for NEAD and second: investigating the possible underlying factors that may cause perceived stigma in NEAD compared to epilepsy.
Part I describes the outcomes of a systematic narrative review that identified 22 papers investigating the experiences of stigma by individuals diagnosed with NEAD. The results indicate that individuals with NEAD experience stigma from healthcare professionals, the public, and family and friends. Some evidence suggests that individuals with NEAD experience higher rates of stigma than epilepsy.
Part II presents a cross-sectional study that investigate the relationship between perceived stigma and self-efficacy, depression, anxiety and seizure symptom severity in 2 groups (epilepsy and NEAD). The study found individuals with NEAD report more perceived stigma than those with epilepsy and higher, clinical, levels of depression. The severity of symptoms was not associated with perceived stigma for NEAD but it was with epilepsy. Depression was significant predictive factor for perceived stigma in both epilepsy and NEAD.
These studies develop the current understanding of stigma in NEAD and epilepsy. The findings suggest individuals with NEAD experience more stigma than those with Epilepsy and that depression predicts perceived stigma for other groups. The findings also suggest that stigma may be a useful target for future interventions for individuals with NEAD.