User login
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. 
“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
Broderick et al in 2011 described a randomized controlled experimental induction of mass psychogenic illness. Their study included 39 healthy adults with a mean age of 42. A little more than half were women, half were college graduates, and almost 80% were Caucasian.
A control group sat in a room and engaged in quiet activity, while two psychogenic illness induction groups received a pill. One of the induction groups was shown a video (ie, the pill-plus-media group).
Researchers told participants in the pill groups that the study was designed to further evaluate the side effects of a new carrier compound for an antiviral medication. The participants were told that the compound contained only cellulose and did not produce serious side effects.
In the pill groups, confederates (one man and one woman) feigned illness (eg, nausea, dizziness, and headache) about 20 minutes after participants took the pills. Nurses attended to the confederates and to any participant who simulated or experienced symptoms, by taking their blood pressure and pulse, providing cool cloths for their foreheads, supplying bowls for potential vomiting, and sometimes putting participants with symptoms on gurneys outside the room within view of the other participants. An hour after taking the pills, the pill-plus-media group watched a public television documentary about the 1918 flu pandemic.
All three groups were assessed at baseline, at one hour, and at two hours. Participants rated their current symptoms by questionnaire, and nurses measured participants’ heart rate and blood pressure. Researchers debriefed all participants after the third assessment, and participants completed a psychosocial risk factor battery within a week of the initial experiment.
The primary outcome was symptom score. Participants in all three groups had some symptoms at baseline (eg, elevated heart rate and slight discomfort). At one hour, the control group had reduced symptoms, whereas the pill groups had increased symptom scores. At two hours, the control group still had few symptoms, but the psychogenic illness induction groups’ symptoms increased further. Symptoms did not differ between the pill-only and pill-plus-media groups, however.
An analysis of the psychosocial risk factor questionnaires found that participants’ total number of traumatic life events was positively associated with increased symptoms, but this relationship was not particularly strong. “It seems that the most important thing is … being exposed to people who are feigning symptoms or displaying symptoms in the setting of being told that there is a potential agent that might cause those symptoms,” Dr. Mink said.
Outcomes in Le Roy
Amid media coverage of the cases in Le Roy, Dr. Mink declined daily invitations to appear on television. “The last time I talked to the producer, I said, ‘You know, you would do these girls a big favor if you would just leave them alone,’” he said. “While the media attention persisted for another week, the improvement of their symptoms did coincide with reduced media attention, so one can speculate that that might have played a role.”
The patients in Le Roy received varying therapies, including cognitive behavioral therapy and supportive psychotherapy. They all received education about functional neurologic disorders. Some received pharmacothe
At last follow-up about two years ago, five of the 19 no longer had symptoms. Six of the 19 had experienced a greater than 85% improvement. A couple of patients continued to have symptoms, including the patients with a prior diagnosis of a chronic tic disorder. Two patients who had not improved sued the school district and alleged environmental toxins as the cause of their symptoms. The other patients were lost to follow up.
Treatment Principles
When treating patients with mass psychogenic illness, “First of all, you have to be an ally of your patient and not challenge the veracity,” Dr. Mink said. “For some of these girls, I think that there was some factitious component,” but this factor was not especially relevant to treatment recommendations.
“For mass psychogenic illness, reducing attention from social media groups and perhaps finding a way to disrupt the social cohesiveness of that group, at least until the symptoms can improve,” may be beneficial, he said. “Regular follow-up is helpful for all conversion disorders…. You do not want the patient to have to get worse to be able to see their doctor.”
Once neurologists have confirmed the diagnosis of mass psychogenic illness, they should “reinforce the certainty of the diagnosis” to occupational therapists, physical therapists, psychotherapists, and others on the health care team who treat these patients, Dr. Mink said. In addition,“It is important to prepare the therapist, particularly in an unusual situation like this where there has been a lot of media attention.”
—Jake Remaly
Suggested Reading
Bartholomew RE, Wessely S, Rubin GJ. Mass psychogenic illness and the social network: is it changing the pattern of outbreaks? J R Soc Med. 2012;105(12):509-512.
Broderick JE, Kaplan-Liss E, Bass E. Experimental induction of psychogenic illness in the context of a medical event and media exposure. Am J Disaster Med. 2011;6(3):163-172.
Page LA, Keshishian C, Leonardi G, et al. Frequency and predictors of mass psychogenic illness. Epidemiology. 2010;21(5):744-747.
Roach ES, Langley RL. Episodic neurological dysfunction due to mass hysteria. Arch Neurol. 2004;61(8):1269-1272.
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.
“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
Broderick et al in 2011 described a randomized controlled experimental induction of mass psychogenic illness. Their study included 39 healthy adults with a mean age of 42. A little more than half were women, half were college graduates, and almost 80% were Caucasian.
A control group sat in a room and engaged in quiet activity, while two psychogenic illness induction groups received a pill. One of the induction groups was shown a video (ie, the pill-plus-media group).
Researchers told participants in the pill groups that the study was designed to further evaluate the side effects of a new carrier compound for an antiviral medication. The participants were told that the compound contained only cellulose and did not produce serious side effects.
In the pill groups, confederates (one man and one woman) feigned illness (eg, nausea, dizziness, and headache) about 20 minutes after participants took the pills. Nurses attended to the confederates and to any participant who simulated or experienced symptoms, by taking their blood pressure and pulse, providing cool cloths for their foreheads, supplying bowls for potential vomiting, and sometimes putting participants with symptoms on gurneys outside the room within view of the other participants. An hour after taking the pills, the pill-plus-media group watched a public television documentary about the 1918 flu pandemic.
All three groups were assessed at baseline, at one hour, and at two hours. Participants rated their current symptoms by questionnaire, and nurses measured participants’ heart rate and blood pressure. Researchers debriefed all participants after the third assessment, and participants completed a psychosocial risk factor battery within a week of the initial experiment.
The primary outcome was symptom score. Participants in all three groups had some symptoms at baseline (eg, elevated heart rate and slight discomfort). At one hour, the control group had reduced symptoms, whereas the pill groups had increased symptom scores. At two hours, the control group still had few symptoms, but the psychogenic illness induction groups’ symptoms increased further. Symptoms did not differ between the pill-only and pill-plus-media groups, however.
An analysis of the psychosocial risk factor questionnaires found that participants’ total number of traumatic life events was positively associated with increased symptoms, but this relationship was not particularly strong. “It seems that the most important thing is … being exposed to people who are feigning symptoms or displaying symptoms in the setting of being told that there is a potential agent that might cause those symptoms,” Dr. Mink said.
Outcomes in Le Roy
Amid media coverage of the cases in Le Roy, Dr. Mink declined daily invitations to appear on television. “The last time I talked to the producer, I said, ‘You know, you would do these girls a big favor if you would just leave them alone,’” he said. “While the media attention persisted for another week, the improvement of their symptoms did coincide with reduced media attention, so one can speculate that that might have played a role.”
The patients in Le Roy received varying therapies, including cognitive behavioral therapy and supportive psychotherapy. They all received education about functional neurologic disorders. Some received pharmacothe
At last follow-up about two years ago, five of the 19 no longer had symptoms. Six of the 19 had experienced a greater than 85% improvement. A couple of patients continued to have symptoms, including the patients with a prior diagnosis of a chronic tic disorder. Two patients who had not improved sued the school district and alleged environmental toxins as the cause of their symptoms. The other patients were lost to follow up.
Treatment Principles
When treating patients with mass psychogenic illness, “First of all, you have to be an ally of your patient and not challenge the veracity,” Dr. Mink said. “For some of these girls, I think that there was some factitious component,” but this factor was not especially relevant to treatment recommendations.
“For mass psychogenic illness, reducing attention from social media groups and perhaps finding a way to disrupt the social cohesiveness of that group, at least until the symptoms can improve,” may be beneficial, he said. “Regular follow-up is helpful for all conversion disorders…. You do not want the patient to have to get worse to be able to see their doctor.”
Once neurologists have confirmed the diagnosis of mass psychogenic illness, they should “reinforce the certainty of the diagnosis” to occupational therapists, physical therapists, psychotherapists, and others on the health care team who treat these patients, Dr. Mink said. In addition,“It is important to prepare the therapist, particularly in an unusual situation like this where there has been a lot of media attention.”
—Jake Remaly
Suggested Reading
Bartholomew RE, Wessely S, Rubin GJ. Mass psychogenic illness and the social network: is it changing the pattern of outbreaks? J R Soc Med. 2012;105(12):509-512.
Broderick JE, Kaplan-Liss E, Bass E. Experimental induction of psychogenic illness in the context of a medical event and media exposure. Am J Disaster Med. 2011;6(3):163-172.
Page LA, Keshishian C, Leonardi G, et al. Frequency and predictors of mass psychogenic illness. Epidemiology. 2010;21(5):744-747.
Roach ES, Langley RL. Episodic neurological dysfunction due to mass hysteria. Arch Neurol. 2004;61(8):1269-1272.
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.
“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
Broderick et al in 2011 described a randomized controlled experimental induction of mass psychogenic illness. Their study included 39 healthy adults with a mean age of 42. A little more than half were women, half were college graduates, and almost 80% were Caucasian.
A control group sat in a room and engaged in quiet activity, while two psychogenic illness induction groups received a pill. One of the induction groups was shown a video (ie, the pill-plus-media group).
Researchers told participants in the pill groups that the study was designed to further evaluate the side effects of a new carrier compound for an antiviral medication. The participants were told that the compound contained only cellulose and did not produce serious side effects.
In the pill groups, confederates (one man and one woman) feigned illness (eg, nausea, dizziness, and headache) about 20 minutes after participants took the pills. Nurses attended to the confederates and to any participant who simulated or experienced symptoms, by taking their blood pressure and pulse, providing cool cloths for their foreheads, supplying bowls for potential vomiting, and sometimes putting participants with symptoms on gurneys outside the room within view of the other participants. An hour after taking the pills, the pill-plus-media group watched a public television documentary about the 1918 flu pandemic.
All three groups were assessed at baseline, at one hour, and at two hours. Participants rated their current symptoms by questionnaire, and nurses measured participants’ heart rate and blood pressure. Researchers debriefed all participants after the third assessment, and participants completed a psychosocial risk factor battery within a week of the initial experiment.
The primary outcome was symptom score. Participants in all three groups had some symptoms at baseline (eg, elevated heart rate and slight discomfort). At one hour, the control group had reduced symptoms, whereas the pill groups had increased symptom scores. At two hours, the control group still had few symptoms, but the psychogenic illness induction groups’ symptoms increased further. Symptoms did not differ between the pill-only and pill-plus-media groups, however.
An analysis of the psychosocial risk factor questionnaires found that participants’ total number of traumatic life events was positively associated with increased symptoms, but this relationship was not particularly strong. “It seems that the most important thing is … being exposed to people who are feigning symptoms or displaying symptoms in the setting of being told that there is a potential agent that might cause those symptoms,” Dr. Mink said.
Outcomes in Le Roy
Amid media coverage of the cases in Le Roy, Dr. Mink declined daily invitations to appear on television. “The last time I talked to the producer, I said, ‘You know, you would do these girls a big favor if you would just leave them alone,’” he said. “While the media attention persisted for another week, the improvement of their symptoms did coincide with reduced media attention, so one can speculate that that might have played a role.”
The patients in Le Roy received varying therapies, including cognitive behavioral therapy and supportive psychotherapy. They all received education about functional neurologic disorders. Some received pharmacothe
At last follow-up about two years ago, five of the 19 no longer had symptoms. Six of the 19 had experienced a greater than 85% improvement. A couple of patients continued to have symptoms, including the patients with a prior diagnosis of a chronic tic disorder. Two patients who had not improved sued the school district and alleged environmental toxins as the cause of their symptoms. The other patients were lost to follow up.
Treatment Principles
When treating patients with mass psychogenic illness, “First of all, you have to be an ally of your patient and not challenge the veracity,” Dr. Mink said. “For some of these girls, I think that there was some factitious component,” but this factor was not especially relevant to treatment recommendations.
“For mass psychogenic illness, reducing attention from social media groups and perhaps finding a way to disrupt the social cohesiveness of that group, at least until the symptoms can improve,” may be beneficial, he said. “Regular follow-up is helpful for all conversion disorders…. You do not want the patient to have to get worse to be able to see their doctor.”
Once neurologists have confirmed the diagnosis of mass psychogenic illness, they should “reinforce the certainty of the diagnosis” to occupational therapists, physical therapists, psychotherapists, and others on the health care team who treat these patients, Dr. Mink said. In addition,“It is important to prepare the therapist, particularly in an unusual situation like this where there has been a lot of media attention.”
—Jake Remaly
Suggested Reading
Bartholomew RE, Wessely S, Rubin GJ. Mass psychogenic illness and the social network: is it changing the pattern of outbreaks? J R Soc Med. 2012;105(12):509-512.
Broderick JE, Kaplan-Liss E, Bass E. Experimental induction of psychogenic illness in the context of a medical event and media exposure. Am J Disaster Med. 2011;6(3):163-172.
Page LA, Keshishian C, Leonardi G, et al. Frequency and predictors of mass psychogenic illness. Epidemiology. 2010;21(5):744-747.
Roach ES, Langley RL. Episodic neurological dysfunction due to mass hysteria. Arch Neurol. 2004;61(8):1269-1272.