機能的/解離性発作における自己嫌悪体験の解釈学的現象学的分析

Previous research in individuals with epilepsy suggests that some of the physical, disgust-eliciting manifestations of seizures may trigger self-disgust. Self-disgust has previously been linked to experiences of emotional neglect and trauma, especially in childhood. Both these are more common in people with functional dissociative seizures than in those with epilepsy. Hence, this study aimed to understand the experience of self-disgust in people with functional/dissociative seizures (FDS).

This qualitative study used interpretative phenomenological analysis (IPA). Following initial screening using the Self-Disgust Rating Scale, purposive sampling was used to recruit eight eligible participants with high levels of self-disgust to participate in individual semi-structured interviews.

In the larger sample (n = 108), 85.2% of participants reported high levels of self-disgust. The exploration of the phenomenology of self-disgust in a group of high scoring individuals produced four themes: 'understanding the origin of self-disgust as based in rejection', 'experiencing self-disgust as intense and inescapable', 'understanding the relationship between self-disgust and FDS' and 'suppression and seclusion - attempting to cope with self-disgust'.

Self-disgust may be highly relevant to a subpopulation of pwFDS and may arise from the internalisation of traumatic, seizure-related experiences. While attempts to reduce self-disgust may provide short-term relief, these could reinforce and maintain the underlying cognitive-affective state. Although often under-recognised, it is important to assess for the presence of self-disgust in clinical settings and to offer additional support around engagement and therapeutic alliance development. A number of therapeutic and systemic approaches to address high levels of self-disgust are discussed.