What causes my attacks?

Non-epileptic attacks (NEAs) are a mechanism which the brain uses to ‘shut down’ when it is overloaded. They are similar to an automatic reflex response to triggers inside or outside the body. During NEAs parts of the brain stop working together properly. The causes and triggers of NEAs are different reasons in different people.

NEAs can be linked to emotions or stress, but the causes are not always obvious. Most NEAs are an unconscious mechanism, which protects the brain against overwhelming distress. NEAs can be triggered by a wide range of situations, emotions, physical sensation, thoughts or memories. People are not always aware of these triggers. Often it feels like their attacks are happening ‘out of the blue’.

In some ways, what happens in NEAs is similar to what happens when a computer 'freezes' - for instance because you have opened too many programs at the same time or because you are trying to open a file that is too large for your computer: the light on the screen may still be on and you may still be able to type but you cannot control the computer fully. You may have to reboot the computer before it starts to work again more normally.

Each individual NEA may 'work' for the brain - by stopping the person from experiencing distress they would otherwise have become aware of. This means that the brain is a little more likely to respond again in the same way when there is a risk of going into 'distress mode' next time. This is one of the reasons why an initial NEA may turn to a disorder where people have NEAs again and again. However, there are also other factors which help to turn a 'one off' attack into a longer lasting problem. These include being incorrectly diagnosed with epilepsy, inappropriate treatment with antiseizure medications, the social isolation which often results from having attacks, depression and anxiety.

Research has shown that non-epileptic attack disorder (NEAD) is more likely to develop in people who have risk factors for this problem - just like high blood pressure may increase your risk of having a heart attack. Usually, several things have to come together for NEAD to develop. There are a number of reasons why a person may be particularly vulnerable to developing NEAs. These can include inherited factors and childhood experiences. Often NEAs start when people face difficulties in adulthood. These difficulties could be unexpected life events (such as someone’s death or an accident), health problems or personal dilemmas (like situations in which there does not seem to be a good way forward). 

Below is a diagram, which shows you how these factors could act together.