In the first of this two-article series, we have argued that excessive shame proneness and the dysregulation of shame may be a particularly common emotional link between psychiatric “comorbidities” and PNES [1]. We have also demonstrated how shame may trigger PNES and how shame (its avoidance or secondary emotions aroused by shame) could contribute to how the episodes present. Shame can also be relevant for patients’ thoughts, feelings and behavior in the interictal state. This means that shame may also affect patients’ journey after the diagnosis has been made – i.e., how they respond to the explanation of their seizure disorder, how easy they find it to engage in psychological treatment, accept a psychological formulation of their condition, participate in therapeutic activities and sustain gains at the end of therapy.
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