CASE DISCUSSION Severe Caregiver Distress Precipitating Dissociative Seizures in a Patient with Intellectual Disability and Epilepsy: Diagnostic and Therapeutic Hardships Pravallika Madhavapuri 1 • Karthick Subramanian 1 • Preeti Kandasamy 1 Received: 1 June 2016 / Accepted: 3 September 2016 Ó Springer India Pvt. Ltd. 2016 Abstract Comorbid psychiatric diagnoses increase the caregiver burden in patients with intellectual disability (ID). There is scarce literature on the dynamics between caregiver distress and psychopathology in persons with ID, especially regarding the dissociative disorders. We present the case of a young female with cerebral palsy, ID, epilepsy and psychosis where conflict with caregivers due to their emotional over-involvement precipitated dissociative sei- zures. We performed Antecedent-Behavior-Consequence (ABC) analysis which helped in identifying negative expressed emotions in the caregivers. An integrated psy- chosocial intervention brought significant reduction in the dissociation which facilitated the overall therapeutic pro- cess. Adverse emotional turmoil due to expressed emotions from caregivers can precipitate dissociative events in patients with ID. Dissociative seizures in a patient with ID and epilepsy may pose diagnostic challenges and can hamper therapeutic response which can be overcome by behavior analyses and integrated psychosocial interventions. Keywords Intellectual disability Á Caregiver distress Á Expressed emotions Á Dissociation Á Psychosocial intervention Introduction Comorbid psychiatric diagnoses often obscure the clinical profile of persons with intellectual disability (ID) [1]. Overlooking dual diagnosis in ID can hamper adequate care and treatment [1, 2]. Multiple comorbid diagnoses and the consequent morbidity in persons with ID can lead to greater caregiver burden [3–5]. Epilepsy, cerebral palsy, psychosis and anxiety disorders are common comorbidities in ID [6, 7]. Women with comorbid ID and epilepsy tend to report greater distress and display poor coping skills [8]. However, literature is scarce in identifying the varied and atypical expressions of anxiety in individuals with ID. Few studies have noted that paroxysmal seizure-like events occur in persons with ID due to behavioral, physiological and rarely due to psychogenic causes [9, 10]. We present how negative expressed emotions precipitated new-onset dissociative seizures and generated a diagnostic dilemma in a woman previously diagnosed with ID, comorbid epilepsy and psychosis. We also demonstrate how simple methods such as an Antecedent-Behavior-Consequence (ABC) analysis can aid in early diagnosis and how prompt addressing of expressed emotions in caregivers through psychosocial interventions can ameliorate problem behav- iors in an individual with ID. Case Presentation Miss J, a 24-year-old woman with paraplegic cerebral palsy, mild intellectual disability and seizure disorder was taking anti-epileptic drugs (AEDs) regularly for 14 years. Her Intelligent Quotient (IQ) was 68. She also had comorbid psychosis characterised by auditory hallucina- tions and was taking Risperidone 3 mg/day for 2 years. & Karthick Subramanian karthick.jipmer@gmail.com 1 Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanvanthri Nagar, Puducherry 605006, India 123 J. Psychosoc. Rehabil. Ment. Health DOI 10.1007/s40737-016-0060-y