Psychiatric comorbidities linked to self-harm and suicide risk in seizure-like disorder study

Adults diagnosed with psychogenic nonepileptic seizures (PNES) at a tertiary academic medical center in Lebanon showed a strikingly high burden of self-harm and suicide-related behaviors, according to a retrospective chart review published in BMC Psychiatry. Among 90 adult patients whose electronic health record data spanned November 1, 2018 to August 11, 2025, 50 patients—55.6% of the sample—met criteria for what the researchers call the suicidality continuum, a composite measure combining nonsuicidal self-injury, passive death wish, active suicidal ideation, suicide plan, and suicide attempt. Thirty percent of patients had documented active suicidal ideation, and 30% had a documented suicide attempt.

The study’s authors note that data on the psychiatric correlates of suicide-related behaviors in PNES have remained limited, particularly in settings affected by multiple crises, such as Lebanon. The retrospective design drew on a standardized data-collection sheet covering demographic characteristics, psychiatric and neurological comorbidities, medication use, neuroimaging findings, and variables related to self-harm and suicide-related behaviors.

The sample was predominantly female, at 83.3%, with a median age of 32 years. Psychiatric comorbidities were highly prevalent across the cohort. To identify which conditions were independently linked to the suicidality continuum, the team used multivariable logistic regression.

Three diagnostic categories emerged as independently associated with the composite outcome. Mood disorders carried an odds ratio of 4.61 (95% confidence interval 1.64–12.92, p = 0.004), meaning patients with these disorders had roughly four to five times the odds of meeting the suicidality continuum criteria compared with those without them, after adjustment. Trauma- and stressor-related disorders showed an odds ratio of 4.78 (95% CI 1.04–21.99, p = 0.045), and Cluster B personality disorders showed an odds ratio of 4.72 (95% CI 1.08–20.61, p = 0.039). The wide confidence intervals, particularly for the latter two categories, reflect the modest sample size and indicate considerable statistical uncertainty around these estimates.

Beyond the primary composite outcome, the researchers ran exploratory sensitivity analyses that treated active suicidal ideation, suicide attempt, and suicide plan as separate outcomes, using the same covariates as the primary model. In these analyses, mood disorders were associated with active suicidal ideation (OR = 3.33, 95% CI 1.08–10.28, p = 0.036), while Cluster B personality disorders were associated with suicide attempt (OR = 4.71, 95% CI 1.36–16.36, p = 0.015). The authors describe these analyses as exploratory, and the findings suggest that different psychiatric comorbidities may relate differently to specific points along the spectrum of self-harm and suicide-related behavior rather than to a single aggregated measure.

The study team—Salim Ballouz, Antoine Sader, Alfred Chabbouh, and Rita Khoury—conclude that patients with PNES in this Lebanese sample exhibited a high burden of self-harm and suicide-related behaviors, and that psychiatric comorbidities were associated both with the broader composite and with specific suicide-related outcomes. They argue this underscores the importance of systematic suicide risk assessment and integrated psychiatric care in the management of PNES.

Several caveats frame the findings. The study is a retrospective chart review at a single tertiary center, so it captures associations recorded in clinical documentation rather than prospectively assessed outcomes, and its 90-patient sample limits statistical precision, as the wide confidence intervals show. As an observational analysis, it identifies associations between psychiatric diagnoses and the suicidality continuum; it does not establish that any comorbidity causes suicidal behavior. The composite outcome also groups behaviors of differing severity, from nonsuicidal self-injury to suicide attempt, which the sensitivity analyses partially address by modeling individual outcomes separately.

Even with those limitations, the reported figures are notable: more than half of the patients met the composite criteria, and nearly a third had documented active suicidal ideation or a suicide attempt. For clinicians, the authors conclude that the findings underscore the importance of systematic suicide risk assessment and integrated psychiatric care in the management of PNES.

Subject of Research: Psychiatric comorbidities associated with self-harm and suicide-related behaviors in adults with psychogenic nonepileptic seizures

Article Title: Psychiatric correlates of self-harm and suicide-related behaviors in psychogenic nonepileptic seizures: a retrospective chart review from Lebanon

Article References: Ballouz, S., Sader, A., Chabbouh, A., & Khoury, R. (2026). Psychiatric correlates of self-harm and suicide-related behaviors in psychogenic nonepileptic seizures: a retrospective chart review from Lebanon. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08814-3

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08814-3

Keywords: psychogenic nonepileptic seizures, suicidality, self-harm, suicidal ideation, suicide attempt, mood disorders, trauma- and stressor-related disorders, Cluster B personality disorders, retrospective chart review, Lebanon, psychiatric comorbidity, suicide risk assessment