The document summarizes a study that explored the experiences of patients diagnosed with psychogenic syncope via cardiac services. Six semi-structured interviews were conducted with patients diagnosed with or having probable psychogenic syncope. The results identified several themes around feelings of disconnection between mind and body, ongoing uncertainty without direction from services, and a loss of identity from feeling different than others. Participants described a daily struggle to understand sensations and make sense of collapsing episodes. The study suggests adopting the term "dissociative syncope" and providing more holistic care, education, and support for patients.

1. People’s experience of psychogenic syncope
following diagnosis.
Hansen, Bente. S., Frizelle, D., Morley*, C., Department of Psychological Health and Well Being, University of Hull, United Kingdom, *Department of
Cardiology, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom
Background
Within cardiology, psychogenic syncope (PS) is classed as a non-
traumatic loss of consciousness, and diagnosed as ‘psychogenic’
without a drop in blood pressure, although loss of postural tone,
rapid onset, and complete recovery occurs similar to cardiac
related syncope (European Society of Cardiology Guidelines, [ESC],
2009). PS may be diagnosed via a process of exclusion of cardiac
cause.
PS diagnosed via cardiology is not well investigated compared to
non-epileptic attack disorder (NEAD) or psychogenic non-
epileptic seizures (PNES), diagnosed via neurology speciality.
No research to date has explored the experiences of patients
who receive their diagnosis of PS via cardiac services
Research Question: What are the experiences of people diagnosed
with psychogenic syncope?
The aim of this study was to explore the experiences of patients
diagnosed with PS in order to better understand the condition,
identify needs, and highlight possible interventions.
Methodology
Results were analysed using Interpretative
Phenomenological Analysis (IPA).
The study utilised six semi-structured interviews, with people
previously diagnosed with or having a probable psychogenic
syncope diagnosis, received via a cardiology service pathway.
Participants were female, 18-65 years old (Mean age = 35.5
years old, SD = 1.9). Demographics and ‘The Hospital Anxiety
and Depression Scale’ (HADS, Zigmond & Snaith, 1983) were
employed prior to interview to describe the sample in analysis.
The interviews were on average 60 minutes, and guided by the
‘Brief Illness Perception Questionnaire’ (BIPQ, Broadbent, 2006).
Analysis followed guidelines from Smith, Flowers, and Larkin
(2009). Four independent researchers read transcripts to
maintain analysis quality.
A total of 31 patients (26 females and 5 males) were invited to
participate; 25 declined, cancelled or ‘did not attend’.
Results
The experience of blackouts appeared to adversely impact on participants on a daily basis; overshadowing every aspect of their lives.
The themes relating to the participant’s experiences appeared to be homogeneous throughout the data. Participants’ accounts
highlighted a strong sense of disconnection between the mind and body. An ongoing ‘battlefield’ evolved in relation to a feeling of
chaos around the lack of a means to represent the condition. In parallel an overarching sense of uncertainty emerged with a loss of
identity through feeling different from others. A full or partial dissociative experience in ‘collapsing’ or ‘blacking out’ was described
across participants with a sense of ‘getting nowhere’, without direction from services. Participant’s profiles appeared to indicate that
depression was normal, which may be explained by supportive social environments (Valente, et al., 2009). However, raised anxiety
levels were present at the point of interview, which supports literature (Karterud et al. 2009).
Uncertainty
BattlefieldIdentity
Disconnected
Figure 1. An illustration of inter-relational
thematic dimensions identified in this study
Conclusions
The insight into peoples’ experience of PS highlighted a daily struggle to reconstruct a sense of self and to make sense of sensations,
and symptoms around collapsing. It appears imperative to individuals diagnosed with PS that a more holistic perspective is
engendered throughout the healthcare system. To initiate this, a clear explanatory model of PS that improves communication to
patients and across disciplines for patient intervention, may be needed. The author suggests that a way to generate a socially
legitimate and inclusive perspective of PS may firstly, and simply, be by changing the various terms for PS to ‘dissociative syncope’.
Subsequently, this may empower people and their families in the process of recovery and acceptance of the diagnosis. Interventions
for this patient group could draw on emotion-based and compassion-focused therapy, psycho-education, peer support, CBT, and
mindfulness. Research with this patient group is necessary to establish efficacious interventions.
References: European Society of Cardiology (2009). The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology. Guidelines for the diagnosis and management of Syncope (2009). European Heart Journal, 30: 2631-2671; Broadbent E., Petrie K.J.,
Main, J., & Weinman, J. (2006). The Brief Illness Perception Questionnaire. Journal of Psychosomatic Research, 60, 631-637; Karterud, H.N., Knizek, B.L., & Nakken, K.O. (2009). Changing the diagnosis from epilepsy to PNES: Patients' experiences and understanding of their new diagnosis.
British Epilepsy Association, 1059-1311; Smith, Flowers & Larkin, (2009). Interpretative Phenomenological Analysis, theory, method and research. London: SAGE Publications Ltd. Valente, M.A.F., Ribeiro, J.L.P., & Jensen, M.P. (2009). Coping, depression, anxiety, self-efficacy and social support:
impact on adjustment to chronic pain. Escritos de Psicología, 2, 3, 8-17.
Corresponding author: hansenpsychology@gmail.com
PS
Dissociative
‘Experience’
“Every abstract picture of the world is as impossible as a blueprint of
a storm… Don't be ashamed because you're human: be proud! Inside
you, vaults behind vaults open endlessly. You will never be finished,
and that's as it should be” (Tranströmer, 2006, p.191)
Table 1. Summary of main findings
Superordinate themes Subordinate themes
Disconnection Mind-body separation (6)*
Uncertainty Scared (6)
Dissociative The ‘cul de sac’ of collapse (6)
Three (wise) monkeys (6)
Battlefield Fighting (4)
Identity Abnormal (5)
The shelved self (4)
*No. of accounts in which the themes emerged