The symptoms are physical, distressing, uncontrollable — and all-too-real. But the underlying cause is psychological. That’s what conversion disorder is.
And that, too, was the exact diagnosis given by a New York doctor to the 12 teenage girls he treated recently who had developed—virtually overnight—neurological tics, verbal outbursts and other Tourette’s-like symptoms.
Some of the girls are improving and back in school at New York’s LeRoy High School, while others continue to worsen, says one of two girls who appeared on the Today Show to discuss their plight.
After the sudden outbreak several months ago, the school was immediately tested for all kinds of environmental toxins, but none was discovered, the Le Roy Central School District says.
Infectious and communicable diseases had also been ruled out, says a doctor with the New York State Department of Health.
A battery of tests have ruled out medical disorders, diseases and environmental factors, says neurologist Laszlo Mechtler of the Dent Neurologic Institute in Buffalo, New York, who treated all but one of the 12 girls.
The problem was conversion disorder, he says.
When stress or anxiety manifest in an individual as physical symptoms—including twitching, paralysis or loss of some other function—it’s called a conversion disorder, Mechtler tells the Health Blog.
But when it happens to many people at the same time, it’s mass psychogenic illness or MPI, he says.
Usually MPI happens in close-knit communities like schools and factories when there’s a report or fear of a chemical exposure, toxin or virus. Suddenly, people are reporting dizziness, fainting, coughing or sneezing, he says.
What is conversion disorder?
“It’s a term used so rarely that most of us haven’t heard of it,” notes USA Today’s health writer, Sharon Jayson. “Even mental health professionals say they have read about it in textbooks rather than seen it up close,” she adds.
Conversion disorder, found in the family of somatoform disorders, happens when patients experience physical symptoms—numbness or loss of sensation in a body part, seizures, tingling or crawling sensations—that have no explanation.
Lab tests don’t find any underlying physical or “organic” cause to explain the symptoms and factors like infection, communicable disease and drugs don’t seem to explain the symptoms.
“Conversion disorder is characterized by problems with voluntary motor or sensory function that suggest a neurological or other general medical condition but aren’t fully consistent with known biological causes or explanations,” says David Fassler, a child and adolescent psychiatrist at the University of Vermont in Burlington.
He says such outbreaks are more common in women and are associated with stress or anxiety.
The symptoms of a conversion disorder include the loss of one or more bodily functions, including:
• Inability to speak
• Diagnostic testing does not find any physical cause for the symptoms.
The NIH warns that, “Some doctors falsely believe that conversion disorder isn’t a real condition, and may tell patients the problem is all in their head.”
“However, these conditions are real. They cause distress and cannot be turned on and off at will,” it points out.
It’s in the community
Clinical psychologist Nancy Molitor of Wilmette, Ill., who treats adolescents, says the disorder tends to occur in “close-knit communities where everybody knows everybody.
When she encounters a patient with conversion disorder, “I would want to know about what’s going on in the community culturally and religiously and socially,” she says.
“You have to be in that environment. This is a unique situation, and it’s unusual,” Dr. Mechtler tells USA Today.
This is why he says the publicity surrounding the case doesn’t mean teenage girls around the United States will start exhibiting similar symptoms, he reassures audiences.
“These young ladies are individuals who come from a small community. One may have had a significant symptom, and it was like a wildfire,” he adds.
“Teenage girls are very susceptible to drama and each other’s moods,” psychologist Molitor adds.
Why it happens
Somatoform disorders in general are poorly understood, and no clear theory exists to explain how psychological issues can manifest as physical ones.
Some scientists have looked into what’s going on the brains of people with the disorder. One study suggests that part of what’s happening is that sufferers seem to be experiencing as involuntary the movements that are actually occurring through the brain’s voluntary motor systems. But how this happens is still largely a mystery.
It’s also unclear how triggers ranging from stress to environmental toxins to vaccines could set off such a shift.
According to the U.S. National Library of Medicine, conversion disorder symptoms may occur because of a psychological conflict, with symptoms usually starting abruptly after a stressful experience.
People are more at risk for a conversion disorder if they also have a medical illness, dissociative disorder, or a personality disorder.
In the medical community, it’s widely accepted that the physical symptoms of conversion disorder are thought to be an attempt to resolve the conflict the person feels inside.
For example, a woman who believes it’s not acceptable to have violent feelings may suddenly feel numbness in her arms after becoming angry enough to want to hit someone.
Instead of allowing herself to have violent thoughts about hitting someone, she may experience the physical symptom of numbness in her arms.
Mass psychogenic illness
When conversion disorder occurs in a larger group, it’s called “mass psychogenic illness,” says Mechtler.
A mass psychogenic illness happens when a group of people that share an environment—like a class or a factory or office—gets similar physical symptoms at the same time
Sufferers of MPI can exhibit symptoms similar to conversion disorder—dizziness, numbness, nausea, hyperventilation, nausea, and headache—but MPI outbreaks are says to occur after an “environmental trigger,” for instance, exposure to toxins, viruses, or vaccines.
Like conversion disorder, MPI involves symptoms that have no underlying physical cause, and females suffer from it much more frequently than males.
Not the first
This isn’t the first time that a group of people has been diagnosed simultaneously with these somatoform disorders.
There were 23 clusters of MPI investigated in Taiwan in late 2009 through early 2010, as a national school vaccination program against H1N1 flu was being implemented and the flu vaccine was being administered to school children, according to this study published in the journal Eurosurveillance.
At one middle school, seven percent of the 692 kids vaccinated reported “adverse events marked by dizziness, nausea and weakness,” within two hours of vaccination. They believed their symptoms were caused by the vaccine, but physical and lab exams found no organic cause of the symptoms. The kids recovered quickly and were discharged from the hospital.
In 2004, ten girls at a North Carolina school developed attacks of seizures, fainting, and hyperventilation—eventually found to be caused by conversion disorder.
In another case, 14 female high-school students in Florida suddenly developed stridor, or high-pitched coughs usually associated with croup in infants.
And in 2007, a group of female students and a teacher reported inexplicable twitching similar to what has been seen in upstate New York. That, too, was chalked up to MPI.
After getting permission from several families, doctors chose to speak out about the situation to stop misinformation and allay fears, says Dr. Mechtler.
The Internet has been abuzz with rumors as to what might be going on with the LeRoy girls: Some thought it was a side effect of a vaccine, others suspected it was PANDAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, a lesser known disorder linked to Strep infection. Lab tests ruled out the two ailments.
Since the LeRoy students began experiencing symptoms with no apparent environmental trigger, doctors suggest the source is stress, anxiety, or other psychiatric issues.
Treatment focuses on any underlying stress, mood disorders and anxiety and involves talk therapy and in some cases, medication. “Part of the treatment is reassuring the patients and families that they do not suffer from an organic neurological disease,” Dr. Mechtler also says.
Dr. Mechtler says 11 of the 12 girls are making progress after being treated by Dr. Jennifer McVige, a fellow at Dent, under his supervision. “We are optimistic they will come out of it,” Mechtler says. “They need to get a little space,” he says. “They need normality.”
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