Conference Coverage

Mass Psychogenic Illness: Risk Factors and Treatment

Perceived exposure to an illness-causing agent and observation of others developing symptoms may induce mass psychogenic illness.


 

KANSAS CITY, MO—Mass psychogenic illness is a condition where signs and symptoms spread rapidly between members of a cohesive group. The illness may entail loss or alteration of function, and patients unconsciously manifest physical symptoms. “Our brains are wired to be empathetic and to pick up on the symptoms of others,” said Jonathan W. Mink, MD, PhD, at the 46th Annual Meeting of the Child Neurology Society. “In mass psychogenic illness, those symptoms persist, and there is that contagion from individual to individual.”

A recent occurrence of mass psychogenic illness in Le Roy, New York, suggests that news media attention and patients’ use of social media may play a role in the spread and perpetuation of symptoms. Few descriptions of mass psychogenic illness have been published in pediatric neurology journals, but prior cases may provide useful information about the condition, its risk factors, and treatment, Dr. Mink said.

Jonathan W. Mink, MD, PhD

“It has been argued whether this is a subcategory of conversion disorder. There has been some discussion of whether some of this is … factitious or malingering. I would argue that it does not really matter,” said Dr. Mink, Professor of Pediatric Neurology at the University of Rochester in New York. “What matters is that we understand that this is an entity. Exactly why [it occurs] may not be relevant to treatment.”

Teens With Tic-Like Movements

Between August 2011 and January 2012, 19 teenage students at Le Roy Junior–Senior High School developed a sudden onset of tic-like movements. Two had a prior diagnosis of a tic disorder: one had Tourette syndrome, and one had chronic motor tic disorder. Eighteen of the 19 were girls. Six of the 19 had additional symptoms (eg, syncope and paroxysmal nonepileptic attacks), and 10 had clearly identified significant life stressors. All of the patients had otherwise normal neurologic exams. The movements “were not tics,” Dr. Mink said. “They had no premonitory urge. They were not suppressible. They were not stereotyped. But they were often referred to as tic-like.”

The cases drew national and local media attention. News reports portrayed the cases as mysterious and suggested that the symptoms could have autoimmune or environmental causes. Furthermore, social media may have contributed to the spread of symptoms. “It has often been said that mass psychogenic illness, or what was formerly called mass hysteria, was conveyed by line-of-sight transmission. It was seeing the symptoms of other people,” Dr. Mink said. “Many of these girls had posted videos or detailed descriptions of their symptoms.”

Most of the patients were seen at the Dent Neurologic Institute in Buffalo. To help confirm the diagnosis, a majority of the patients also were seen at Dr. Mink’s center in Rochester.

Insights From Prior Research

In 2004, Roach and Langley described an occurrence of mass psychogenic illness among a cohort of 10 teenage girls at a school in rural North Carolina. The patients developed paroxysmal episodes that resembled epilepsy or syncope. The episodes were relatively infrequent and typically occurred between classes. Four patients underwent video-EEG monitoring, which showed that the seizures were not epileptic. Symptoms mostly resolved after a two-week holiday break from school. “More than half of them had been treated with one or more antiepileptic medications,” Dr. Mink said.

A study of environmental chemical incidents in the United Kingdom found that a substantial minority of cases could involve mass psychogenic illness. Page et al examined incidents over a 15-month period between 2007 and 2008. Of 965 total incidents, 747 were eligible for inclusion in the study, and 280 were selected randomly for detailed evaluation.

The British researchers’ criteria for diagnosing mass psychogenic illness included the presence of somatic symptoms, a preexisting social connection between two or more of the affected people, the spread of symptoms from person to person, and the attribution of symptoms by affected individuals or by their parents or caregivers to a threatening external agent of a physical or spiritual nature. Finally, the symptoms and signs were not compatible with environmental exposures that reasonably could have been expected to be present at the time.

Nineteen of the 280 incidents were classified as probable or highly probable mass psychogenic illness (six highly probable and 13 probable), which represented 7% of the incidents and 16% of incidents in which people reported symptoms that were attributed to the chemical incident. Factors that were more common among cases of mass psychogenic illness included the presence of a nonsmoke odor and occurrence in a school or health care facility.

Experimental Induction of Mass Psychogenic Illness

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