Ms Riya is a 16-year-old, Sikh female who is studying in 11th standard. She lives in a nuclear family with her parents and 2 sisters who brought her to the clinic. Riya’s parents reported that she was frequently fainting and there were seizure-like episodes. Along with this, her absenteeism from school increased and she was also experiencing a sad mood, anxiety and irritability.

Before the family decided to bring Riya to a hospital, they had already sought help from several faith healers and doctors for her fainting episodes. But there was no improvement in her condition. Medical investigations such as brain scans, EEG has shown no abnormality, but fainting and seizure-like episodes persisted.

She was admitted to the hospital. After a detailed assessment, history and clinical interviewing, a diagnosis of Dissociative Disorder was made. History revealed that if she was confronted with any stressful situation, she would immediately have a seizure-like episode or would faint. The episode remained for half an hour or sometimes more. She had never gotten injuries or hurt herself due to any of these episodes. For a period of   2-3 months, she had been experiencing such 4-5 episodes or sometimes more in a day. The episode is mostly preceded by a stressful situation.

A patient was educated about her condition and secondary gains were explored. It was found that she was always gathered from family members whenever she fainted or had fits-like episodes. Also, she doesn’t have to face a stressful situation anymore as she gets sick.

Family history revealed a history of epilepsy in her paternal aunt whom she had been seeing since childhood and how everyone around her treats her when she experiences a seizure.

Riya was explained about the formulation of her condition. She gradually developed an understanding of it.  Her parents were also involved in the treatment as they were asked to not react or focus on any of her symptoms when she experiences seizure like fainting episode.  As soon as parents started refraining from reacting towards her fainting, she would become over-dramatic and would shout and cry loudly and would add bodily complaints like stomach ache and leg pain. Despite these, parents continued to not pay attention to her bodily symptoms and within a month, her frequency of fainting episodes decreased to having 1 episode every 3 days. Meanwhile, her coping mechanisms were enhanced through Cognitive Behaviour Therapy.

Towards the end of treatment, she was sent for home visits and thereafter to school. She continued to come for OPD treatment and regular therapy sessions and is maintained well. Her last pseudo-seizure episode was 3 months back and has not missed school since treatment.