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BMJ Open. 2019 May 9;9(5):e026493. doi: 10.1136/bmjopen-2018-026493.

Exploring psychiatrists' perspectives of working with patients with dissociative seizures in the UK healthcare system as part of the CODES trial: a qualitative study.

Author information

Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.



There is currently limited research exploring healthcare professionals' (HCPs) experiences of working with patients with dissociative seizures (DS). Existing studies do not focus on the role of psychiatrists in treating this complex condition. The objective of this study was to gain an understanding of UK-based psychiatrists' experiences of the DS patient group. Against the backdrop of a UK-wide randomised controlled trial (RCT), the focus was broadened to encompass issues arising in everyday practice with the DS patient group.


A qualitative study using semistructured interviews was undertaken with 10 psychiatrists currently working with DS patients within the context of a large RCT investigating treatments for DS. Thematic analysis was used to identify key themes and subthemes.


The psychiatrists were working in Liaison or Neuropsychiatry services in England.


The key themes identified were other HCPs' attitudes to DS and the challenges of the DS patient group. There is a clear knowledge gap regarding DS for many HCPs and other clinical services can be reluctant to take referrals for this patient group. Important challenges posed by this patient group included avoidance (of difficult emotions and help), alexithymia and interpersonal difficulties. Difficulties with alexithymia meant DS patients could struggle to identify triggers for their seizures and to express their emotions. Interpersonal difficulties raised included difficulties in attachment with both HCPs and family members.


A knowledge gap for HCPs regarding DS has been identified and needs to be addressed to improve patient care. Given the complexity of the patient group and that clinicians from multiple disciplines will come into contact with DS patients, it is essential for any educational strategy to be implemented across the whole range of specialties, and to account for those already in practice as well as future trainees.


ISRCTN05681227; NCT02325544; Pre-results.


dissociative seizures; psychiatrists; qualitative

Conflict of interest statement

Competing interests: LHG and JM report the grant from the NIHR HTA for the conduct of the study. None of the other authors have competing interests to declare.

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