# The Relationship Between Functional Seizures, Dissociation, and Gender Dysphoria: A Case Report and Review

## TL;DR

This paper explores how mirror-gazing might trigger functional seizures in a non-binary individual with gender dysphoria.

## Contribution

It presents a novel case linking mirror-induced distress to psychogenic seizures in a non-binary patient.

## Key findings

- A non-binary patient experienced PNES episodes only when using the bathroom and seeing their reflection.
- Restricting bathroom access and using a bedside commode eliminated further PNES episodes.
- Mirror-gazing may act as a trigger for dissociation and PNES in individuals with gender dysphoria.

## Abstract

Psychogenic non-epileptic seizures (PNES), also known as functional seizures, clinically mimic seizure-like activity without the presence of brain wave abnormalities on electroencephalogram (EEG). PNES, among other functional neurological disorders, demonstrates an increased prevalence among transgender and non-binary individuals, particularly those with ongoing gender dysphoria. It is established that PNES episodes can be triggered by states of severe distress and that mirror-gazing may cause distress in individuals with gender dysphoria. Herein, we review the available research on the pathophysiology of PNES. We also describe a 16-year-old non-binary patient with gender dysphoria, initially admitted following a suicide attempt, who experienced multiple PNES episodes upon entering their bathroom. Once bathroom access was restricted and the patient was supervised with a bedside commode, they experienced no further episodes on the unit. With no other potential triggers identified, we hypothesized that the patient’s symptoms were evoked by their reflection in the bathroom mirror, causing such great distress that it resulted in dissociation and PNES. This is a case of mirror-gazing potentially inducing PNES in a non-binary patient.