Summary

Dissociation is a complex and multifaceted concept that is frequently misapplied within the field of epilepsy. In this chapter, I have explored the various components of the dissociation concept and how they relate to the phenomena of epilepsy and nonepileptic seizures. I have demonstrated why many epileptic phenomena often thought to be instances of dissociation, such as amnesia, postictal fugue, behavioural automatisms, auras and hallucinations, should not be regarded as dissociative at all. I have also argued, however, that depersonalization and derealization occurring in the context of epilepsy can be regarded as genuinely dissociative, in the sense that they involve an altered state of consciousness characterized by disengagement from the self or environment. I have also presented evidence indicating that nonepileptic attacks should be considered a dissociative phenomenon, in this case involving a temporary disruption in behavioural control and subjective awareness despite intact neuropsychological functioning. Although certain aspects of epilepsy are dissociative, therefore, they do not involve the same type of dissociation as that underlying nonepileptic attacks.

If the dissociation concept is to prove useful in this area, much greater precision, both conceptual and methodological, is required. Researchers and clinicians should be explicit about which definition of dissociation they are referring to and efforts should be made to construct measures of dissociation that are, unlike the

DES, 'phenomenon-pure'. Assessing the reversibility of nonepileptic amnesia, which may prove invaluable as an aid to differential diagnosis in this area, provides one illustration of the potential utility of such an endeavour.

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