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Associations among epilepsy phenotypes and pain, sleep interference, and dissociative symptoms

Jack D Watson¹, Elise V Bailey², Amy Henion¹

¹Informatics, Decision Enhancement, and Analytic Sciences Center, Salt Lake City Department of Veterans Affairs.

Rehabilitation Psychology

|February 19, 2026

Abstract

Purpose/Objective:

The current study investigated the extent to which epilepsy comorbidity phenotypes (relatively healthy, posttraumatic stress disorder, polytrauma, bipolar/substance use disorder, chronic disease, and anxiety and depression) are associated with pain interference, sleep interference, and dissociative symptoms for post-9/11 Veterans with epilepsy (VWE).

Research Method/Design:

A total of 482 veterans were recruited via postal mail with a final sample size of 423 veterans included for analysis, with 59 veterans removed due to incomplete data. Veterans were largely non-Hispanic White (85.80%) and predominantly female (54.80%). Three series of hierarchical blockwise regressions were conducted to test the predictive capability of the epilepsy phenotypes for pain interference, sleep interference, and dissociative symptoms while controlling for covariates (age, ethnicity, sex, traumatic brain injury severity, epilepsy interference, caregiver status, blast exposure, and warzone deployment).

Results:

After adjusting for covariates, the posttraumatic stress disorder, polytrauma, and chronic disease phenotypes remained significant predictors of pain interference, and the polytrauma and bipolar/substance use disorder phenotypes remained significant predictors of sleep interference. No phenotype predicted dissociative symptoms in fully adjusted models. Critically, epilepsy interference was the single most consistent and strongest predictor across models (p < .001), accounting for the largest unique share of variance in pain, sleep, and dissociative symptom scores.

Conclusion/Implications:

Among VWE, some epilepsy phenotypes may account for independent risk beyond demographic and injury characteristics for pain and sleep interference. These findings underscore the importance of targeted assessment and intervention strategies tailored to specific comorbidity profiles in the management of pain and sleep difficulties among VWE. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

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