Mass hysteria, explained: 'Conversion disorder' isn't code for 'faking'

A group of high school girls, several of them cheerleaders, suddenly begin exhibiting strange neurological symptoms. The state health department is called in to investigate but can find no evidence of possible environmental contaminants that might explain the schoolmates’ puzzling illness.

TODAY

Thera Sanchez, left, and Katie Krautwurst are two of 12 girls at their upstate New York school who have been plagued by mysterious Tourette's-life symptoms. One neurologist says the cause is conversion disorder.

New York, 2012? Try North Carolina, 2002.

“[The current case] is like déjà vu all over again,” Dr. E. Steve Roach tells TODAY.

Roach, chief of neurology at Nationwide Children’s Hospital in Columbus, Ohio, co-authored a paper in 2004 that described “episodic neurological dysfunction due to mass hysteria” at a rural North Carolina high school.

He says he’s struck by the similarities between the 2002 outbreak of what appeared to be seizures in that North Carolina school and the ongoing outbreak of motor and vocal tics among a dozen girls at LeRoy Junior-Senior High School in upstate New York. Half of the 10 girls in North Carolina had been or were cheerleaders, as is at least one affected girl from LeRoy. And in both cases, state health department officials said they could find no environmental cause.

Dr. Laszlo Mechtler, a neurologist in Amherst, N.Y., who has evaluated some of the LeRoy girls, told TODAY he has diagnosed them with “conversion disorder,” a neurological condition in which psychological conflict or stress is unconsciously converted into physical symptoms that can include blindness, inability to speak or numbness.

People with conversion disorder aren’t malingerers pretending to be sick to avoid work, like the kid who holds a thermometer up to a radiator to fake a fever and get out of taking a math test, Roach says.

“Even though we don’t fully understand conversion disorder, it is not the same thing as faking,” he says. Take someone who complains about not being able to feel anything in his or her arm. If they really have conversion disorder, Roach says, “you could take a hat pin and stick it in their arm and they wouldn’t flinch.”

When conversion disorder occurs simultaneously in multiple members of a group, it is referred to as mass hysteria or mass psychogenic illness. While rare, mass psychogenic illness is more common in females and typically starts in older girls and then spreads to younger girls, “which happens to have been the case in the New York situation,” says psychologist and TODAY contributor Dr. Gail Saltz.

Teenage girls may be more susceptible to mass hysteria, but no one is immune. Although it's different from conversion disorder, some men in certain Asian and African countries have been documented suffering from the mass psychiatric panic known as koro, or the fear that the penis is shrinking. One well-known outbreak was the 1967 “Singapore Penis Panic,” which had hundreds of men in Singapore rushing to hospitals in the dire belief that their penises were shrinking away to nothing.

Another type of mass hysteria is caused by anxiety, Roach says. One case happened back in 1998, when a Tennessee high school teacher said she noticed a “gasoline-like” smell in her classroom and shortly afterward developed a headache, nausea, dizziness and shortness of breath. The school was evacuated, and 186 students and staff reported similar symptoms, according to this report in The New England Journal of Medicine. More than three dozen spent the night in the hospital. No cause ever was found.

Saltz emphasized that she is not involved in diagnosing or treating the affected girls from upstate New York. There are numerous other possible explanations for tics, she says, ranging from hypothyroidism to the use of legal and illegal drugs.

Conversion disorder can be effectively treated with psychotherapy, and, in the case of mass illness, by separating the affected individuals, Saltz says. (In North Carolina, Roach says, the outbreak dissipated over winter break.)

When he diagnoses a young patient with conversion disorder, Roach says, “we’re able to sit down with the family and say to them: We have really good news. We’ve determined that your child hasn’t had a stroke or doesn’t have a brain tumor. This is really severe stress.”

Yet, he says, some parents react with anger or disappointment when told their child has conversion disorder and not some life-threatening condition. “There seems to be this intrinsic resistance to any hint that people have a psychological component of their illness.”

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