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

Psychogenic nonepileptic seizures (PNES) are associated with substantial psychiatric comorbidities and elevated suicide risk. However, data on psychiatric correlates of suicide-related behaviors among patients with PNES remain limited, particularly in settings affected by multiple crises. We conducted a retrospective chart review of 90 adult patients diagnosed with PNES at a tertiary academic medical center in Lebanon, using electronic health record data collected between November 1, 2018 and August 11, 2025. Demographic characteristics, psychiatric and neurological comorbidities, medication use, neuroimaging, and variables related to self-harm and suicide-related behaviors were extracted using a standardized data-collection sheet. The primary outcome, the suicidality continuum (SC), was operationalized as a composite of self-harm and suicide-related behaviors, including nonsuicidal self-injury, passive death wish, active suicidal ideation, suicide plan, and suicide attempt. Multivariable logistic regression was used to examine factors associated with the SC. Exploratory sensitivity analyses examined active suicidal ideation, suicide attempt, and suicide plan as separate outcomes using the same covariates as the primary model. The sample was predominantly female (83.3%), with a median age of 32 years. Psychiatric comorbidities were highly prevalent. Fifty patients (55.6%) met criteria for the SC; 30.0% had active suicidal ideation and 30.0% had a documented suicide attempt. Mood disorders (OR = 4.61, 95% CI 1.64–12.92, p = 0.004), trauma- and stressor-related disorders (OR = 4.78, 95% CI 1.04–21.99, p = 0.045), and Cluster B personality disorders (OR = 4.72, 95% CI 1.08–20.61, p = 0.039) were independently associated with SC. In exploratory sensitivity analyses, mood disorders were associated with active suicidal ideation (OR = 3.33, 95% CI 1.08–10.28, p = 0.036), whereas Cluster B personality disorders were associated with suicide attempt (OR = 4.71, 95% CI 1.36–16.36, p = 0.015). Patients with PNES in this Lebanese sample exhibited a high burden of self-harm and suicide-related behaviors. Psychiatric comorbidities were associated with the broader composite SC and with specific suicide-related outcomes, underscoring the importance of systematic suicide risk assessment and integrated psychiatric care in PNES management.