Mass Psychogenic Illness

Contagious psychogenic symptoms resulting in epidemics have erupted periodically since the original descriptions of the dancing manias of the Middle Ages (Sirois 1982). They have been investigated by epidemiologists (Cole et al. 1990) and sociologists (Bartholomew 1990), as well as by psychiatrists and other physicians. Various terms have been used or proposed for this phenomenon, including mass hysteria and epidemic hysteria. Mass psychogenic illness is the term currently favored for describing the phenomenon.

Characteristics of an epidemic include a relatively closed social system, the presence of some underlying tension (e.g., start of the school year), and the development of symptoms in index cases in response to a stimulus (e.g., exposure to nontoxic fumes), with a rapid spread of symptoms via sight or sound to others, who then become similarly afflicted. The probability for modeling will be enhanced if the index case is a leader of the group affected or held in high esteem by peers. Most symptoms, such as nausea and dizziness, can be accounted for by anxiety and hyperventilation (Small et al. 1991). Symptoms tend to wane with dispersal of the group and recur with restoration of the group setting. Publicity and attention generated by the media may intensify the epidemic, as does the presence of emergency equipment such as ambulances and unnecessarily prolonged and detailed medical evaluations (Selden 1989).

Although most outbreaks of mass psychogenic illness have been described in women, particularly adolescent girls, an epidemic in male military recruits suggests that the setting may be more important than sex (Struewing and Gray 1990).

The phenomenon of mass psychogenic illness overlaps with other disorders such as sick building syndrome, fashionable illness, and somatization (Ford 1997b; Rothman and Weintraub 1995). A contemporary version, reflecting our electronic global village, is the influence of mass media personalities (e.g., Oprah Winfrey or Phil Donahue), whose discussions of various illnesses and symptoms may prompt some patients to seek treatment for vague subjective symptoms (Ford 1997b; Shorter 1995).

The treatment of mass psychogenic illness is relatively simple and straightforward. Gamino et al. (1989) reported success with separating the most symptomatic patients from the rest of the group and treating symptomatic patients in a calm, reassuring manner with words that suggested improvement rather than implied danger or more symptoms. Struewing and Gray (1990) noted that keeping nonaffected members of the group busy with a task may help reduce the contagion effect. Education of members of the group and their families as to the benign nature of the "epidemic" may help reduce anxiety and the probability of recurrence when the group reunites (Cole et al. 1990). Amin et al. (1997) reported that with an episode of epidemic hysteria in a women's college dormitory, the techniques of rapidly separating affected women and avoiding any media publicity were effective in rapidly quelling the epidemic. These authors observed that the large majority of affected women had rapid symptom relief in response to symptomatic supportive treatment, and those few women who had persistent symptoms were characterized by a history of psychiatric problems or significant medical illness.