23yo with PNES (and other symptoms)
23 yo. Has an auditory processing disorder and reports hearing only 50-70% of what a person says. Diagnosed in 2017. Not officially diagnosed, but suspected to be on the spectrum despite not “ticking all the boxes”. Did not look into it any further because he was so high functioning and quite brilliant. Diagnosed with ADHD. Not currently on medication for it because he was unable to swallow pills – has recently learned how to take medication orally and is not considering medication for the ADHD.
The client reports “seizure-like” episodes where he is non-verbal and has whole-body spasms that last for about 30-60 minutes. These started about 4 years ago. The first episode occurred during a very stressful period in the client’s life when he was in advertising school. These episodes currently occur about once or twice a month. They happen especially when the client has been overstimulated (being with people, going out, being at a busy restaurant, having lots of responsibilities, active stressors) and tend not to happen when the client is not busy or doesn’t have as many stressors. Doing nothing for several days and sleeping help. He has seen several doctors, but no solid diagnosis was provided. One of the doctors he saw did suggest that anxiety was a significant factor. Therapist felt that CBT wasn’t an option for the client because he was on the spectrum, and concluded that the seizures were due to overstimulation and noted that the client shouldn’t have to limit their life, but also had to understand that they couldn’t handle too much. The family refer to them as “episodes”. EEG ruled out epileptic seizures. The client was prescribed lorazepam to take when the episodes start and this reduces the length of the episodes to 15 to 40 minutes. The client is also taking escitalopram oxalate, which reduces the frequency of the episodes to the current one/two per month.
The client reports the ability to recognize when they are getting to the point of having an episode and can prevent it by being mindful about the amount of stimulation he is getting. When one does happen, sometimes the paramedics need to be called. And after an episode, the client is unable to do anything for 3-4 days because they are sore and exhausted.
The client has to be careful about the level of stimulation they have day to day. It impacts their ability sometimes to do certain activities. Due to this issue, the client has left college twice because they were unable to receive proper accommodation to allow them to continue. He is currently in an online certificate program that is self-paced. This has allowed the client to take breaks when needed and work harder when they are feeling well. The client believes that stress is a contributing factor to an episode occurring.
According to the client’s mother, when the client talks about overdoing it, it means that there was one visitor at home, he had one young student and installed a pet door for the cat. He really has it in his head that he can’t do too much or a PNES will occur – one of his therapists has told him as much. He also feels tremendous guilt when he can’t attend family events because he has done too much. The client worries about not seeing family because they are old. When he starts worrying about family members dying, he then goes to worrying about his parents dying (they are in their late 50s). His father’s father was also very critical and demeaning of everyone (including his grandchildren) who did not show up for family events and the client’s father is still fearful of disappointing his own father and this has had an impact on the client, who is also very concerned about disappointing people.
Carpal Tunnel Syndrome
Injured his right hand in a skateboarding accident. And later developed bilateral carpal tunnel syndrome. Has had it for 8.5 years. Believes there is a connection to the skateboarding accident and from playing a lot of video games with friends when he started high school – by winter, had significant pain in hands, wrists and forearms. Currently has this pain 1-2 times per month. It gets worse if he does a lot of typing or intensive computer activities for several days in a row or after a lot of physical activity involving his hands (e.g., building furniture). Resting helps and stretching with resting speeds up recovery. The pain can be so bad at times that he is unable to pick up a glass of water or write. He is careful to schedule tasks around his hands – so that he’s never doing intense hand work. It started at a really stressful time. Was doing school and also trying to do piano training (at professional level). Felt a lot of pressure. At this time, he also couldn’t go to gym class at school because he was terrified of someone getting hit and hurt by balls – teachers described it as a “freakout” or “meltdown”. He feels a tremendous sense of responsibility for others and keeping them safe.
One cousin had surgery due to carpal tunnel.
During the summer about 6 years ago, client noticed he was getting prolonged headaches lasting several days unless he took Tylenol. He continues to have these headaches a couple times a month and find they occur more often during summer and not as much of a problem in the winter. Lying down and resting his head reduces the pain slightly and taking Tylenol Sinus tablet “is very effective”. Client believes air pressure changes are a trigger for these because they happen when the weather changes from clear to rainy or vice-versa. He has not consulted a doctor on this. The headaches can interfere with getting together with friends and going to school and it also affects his ability to concentrate. He reports that both his mother and his sister get headaches fairly frequently too, but they don’t follow the patterns that his headaches do.
The client’s father has general anxiety and depression (on medication for it), and the client describes him as loving, silly and responsible. His mother has migraines, chronic back pain and general anxiety, and is described as loving, caring and a teacher. His sister has migraines, PTSD (due to horrific bullying “go kill yourself”), social anxiety and depression, and the client describes her as loving, relatable and a companion. The mother has recovered using mind body work and feels both her children have mind body syndrome too.
The client has other symptoms including asthma for which he was hospitalized several times between 2008 and 2013. Has inhalers. Says it comes up when he is sick and also if it’s either really cold or really hot. The client reports previously suffering with heartburn, depression and obsessive-compulsive thought patterns and these symptoms are no longer present. The client reports the following that are still present: stomach pains (starting in 2007), tension headaches (starting in 2006), migraine headache (2008), eczema (2013), anxiety (2020) (you can see throughout this history that there is a significant amount anxiety present), shoulder pain (2018), carpal tunnel syndrome (2014) and dizziness (2017). Saw specialists for the stomach pain and there was no ulcer and nothing else found. The doctor suggested it was anxiety induced. At the time, the client was experiencing bullying at school. The client also has gotten and still gets canker sores, especially when stressed.
The client suffered a number of symptoms in fall 2021 when he was doing an extremely demanding course (3 year program in 1 year) (10-16 hrs of class/work, 6 days a week) and renting a room from a family friend who was very demanding about others living in his house (don’t this or that with just about everything, don’t touch the thermostat, don’t make too much noise – to the point where he was afraid to do anything) – and because it was a family friend, he felt that he could not say anything, although he eventually told his mother. He returned home.
The client describes himself as being a perfectionist, having high expectations of himself, wanting to be good/liked, feeling dependent on others, being conscientious, being hard on himself, often feeling responsible for others, often worrying, having difficulty making decisions, being a rule-follower, having difficulty letting go, putting others’ needs first and being hypervigilant.
He believes that some of his symptoms could be caused by emotions, but not sure all of them are.
Outside of living with a parent with depression/anxiety, he does not have any other ACEs.