Self-referential processing and emotion regulation in epilepsy: Associations with affective symptom burden

BACKGROUND: Emotion regulation and self-referential processing are core constructs in mental health, yet their interaction remains unexplored in epilepsy. Given the high prevalence of anxiety and depression in this population, this study investigates their interplay in people with epilepsy (PWE) and its association with affective symptomatology. METHODS: 23 PWE and 34 healthy controls (HC) completed the Self-Referential Encoding Task (SRET), the Emotion Regulation Questionnaire (ERQ), Affective Style Questionnaire (ASQ), Beck Depression Inventory-II (BDI-II), and Generalized Anxiety Disorder-7 (GAD-7). While PWE were recruited as a clinically representative sample irrespective of affective symptoms, only HC without psychiatric conditions were included, maximizing ecological validity. RESULTS: PWE showed significantly higher depressive and anxiety symptoms and longer SRET reaction times for positive and negative adjectives, while endorsement rates, memory performance, and emotion regulation strategies did not differ between groups. Exploratory analyses revealed more numerous significant correlations among affective symptoms, emotion regulation, and self-referential processing in PWE than HC. CONCLUSION: Self-referential processing and emotion regulation are more strongly linked to affective symptoms in PWE than HC. This suggests that psychiatric comorbidities, rather than epilepsy per se, drive cognitive-affective dysregulation. Emotion regulation capacities appear largely intact. Prolonged SRET reaction times likely reflect increased cognitive-affective load, although contributions from psychomotor slowing or antiseizure medication effects cannot be ruled out. The tighter coupling of emotion regulation and self-referential processing in PWE may reflect compensatory mechanisms under elevated affective burden. Given the exploratory nature of several analyses, findings require replication in larger, independent samples.