Psychogenic blackouts are blackouts or fainting spells that occur because of stress and anxiety, not because of a directly observable physical cause. However, just because these psychogenic blackouts have a psychological cause does not mean they are not genuine or faked. People diagnosed with psychogenic blackouts do actually black out and experience an event that can be similar to having a seizure or passing out.
Psychogenic Blackouts: Signs and Symptoms
Psychogenic blackouts are hard to distinguish from other causes of blackouts, like seizures and fainting. Many symptoms are the same, and the only way to diagnose a psychogenic blackout is by ruling out other potential causes of the event.
A psychogenic blackout is typically characterized by passing out and becoming unconscious and unresponsive while still having a heartbeat and breathing. Sometimes convulsions may also occur and appear similar to a seizure. Some symptoms that may occur immediately before or after a psychogenic blackout include:
- Blurred Vision
- Chest Pain
- Eyes that are closed or flickering
- Numbness and tingling of arms and legs
- High emotional stress
If someone passes out for an unexplained reason, they should be quickly treated and examined for other potential causes of blacking out before considering psychogenic blackout, even if they have these symptoms.
Psychogenic Blackouts: Syncope
Psychogenic blackouts should not be confused with syncope, another form of blackout. Syncope is a temporary loss of consciousness when blood flow to the brain is insufficient. Unlike psychogenic blackouts, syncope has a physical cause.
There are many different potential causes of syncope, including:
- Standing in one position for a prolonged period
- Some blood pressure medicines
- Abnormal heart rhythm
Psychogenic Blackouts: Stress and Anxiety
Stress and anxiety are the most common causes of psychogenic blackouts. This can be due to chronic stresses, such as being foreclosed on or having someone close to you pass away.
Psychogenic blackouts are, however, more commonly associated with a single stressful event. Events like speaking in public, seeing blood or traumatic injury, having one’s blood drawn or watching a baby be born are events where people commonly pass out, but not due to decreased circulation in the brain. Passing out in these circumstances is often a type of psychogenic blackout.
Psychogenic Blackouts: Epilepsy
Another condition that may be confused with psychogenic blackouts is epilepsy. Epilepsy is a disorder that results in repeated seizures. Often there is no discernible cause of epilepsy. The seizures the epilepsy causes, however, may have a trigger like a flashing light or pattern of lights.
Seizures occur when electrical signals in the brain misfire, firing altogether instead of in a normal pattern. This can result in symptoms, including passing out, becoming still and unresponsive while appearing awake or convulsing. Epilepsy is a disorder that causes seizures without any explainable cause. Epilepsy may mimic psychogenic blackouts but is caused by abnormal brain activity. Someone with a diagnosis of psychogenic blackouts will have normal brain activity with the episodes they experience, even if they appear to be having a seizure.
Psychogenic Blackouts: Substance Abuse
Blacking out or having a seizure while misusing a substance often occurs when someone is binging on alcohol or drugs. Blackouts due to substance abuse can result in passing out, having seizures or even having a gap in memory.
Blackouts from substance abuse are different from psychogenic blackouts as they have a physical cause. Blackouts from substance abuse can occur when substances interact with brain receptors, changing how they send signals. They can also occur when the substance suppresses normal body functions, leading to decreased blood flow to the brain.
Psychogenic Blackouts: What To Do
If you believe you or someone you know may be having a psychogenic blackout, it is best to assume it isn’t psychogenic blackout disorder. The only way to diagnose a psychogenic blackout is to rule out all other potential causes. There must be very good, solid reasons beyond just the symptoms.
It is better to assume there is a physical cause for a blackout than to ignore what could be a seizure, syncope or a substance-related blackout.
If you are with someone who has a blackout, there are several steps you should take:
- Ensure the person is safe: Move them to a secure location if they are at risk for injury, and position them on their side if they are unconscious.
- Call 911: If someone passes out for any reason, you should call 911 and get emergency help. It is typically better to overreact than underreact.
- Give Narcan if it may be necessary: Narcan can instantly reverse the symptoms of an opioid overdose and save that person’s life. Narcan has almost no side effects, so you should administer it if there is any possibility an overdose has occurred.
- Stay with them until help arrives: Someone who has blacked out may require CPR, be at risk of getting injured while unconscious or become disoriented and confused when they wake, requiring help. You should stay with them until emergency help and treatment arrives.
Treatment Options, Including Co-occurring Substance Abuse
The treatment options for psychogenic blackouts focus on reducing the underlying cause of the stress and anxiety that leads to these episodes. This may mean lifestyle changes, avoiding particular situations, or treating an underlying mental health condition that worsens stress and anxiety.
Treating a mental health disorder is much more complicated if the person also has a substance abuse problem. This combination is known as dual diagnosis or co-occurring disorders and requires specialized treatment of both conditions simultaneously to have the best chance of success.
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Arrhythmia Alliance, AF Association & STARS. “Psychogenic Blackouts.” 2022. Accessed September 13, 2022.
American Heart Association. “Syncope (Fainting).” 2022. Accessed September 13, 2022.
National Institute on Alcohol Abuse and Alcoholism. “Interrupted Memories: Alcohol-Induced Blackouts.” March 2021. Accessed September 13, 2022.
American Association of Neurological Surgeons. “Epilepsy.” 2022. Accessed September 13, 2022.
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