Epidemic Hysteria: School Outbreaks 1973–1993

Abstract

Objective: Increased reporting of outbreaks has brought more familiarity with the syndrome but no more accurate knowledge about the nature and mechanisms of such episodes. As it has become an area for an expanding field of competitive explanations, the review is intended to find any additional epidemiological cues and any clarification about methods of investigating such outbreaks. Methods: The retrieval of data was organized upon a choice to have a homogeneous sample rather than a comprehensive one. Newspapers and sociological sources were left out. A Medline search with cross-referencing was conducted to select the outbreaks limited to the standard school type. Reports were examined from two points of view: the descriptive epidemiological parameters and the mode of reporting the outbreaks. Results: Forty-five episodes were studied. A historic shift in the manifest presentation is apparent: larger groups are involved for a shorter time. A period at risk has been identified: the last 2 months of the school calendar. The peak age of affected children is 12. A downward age spread is present in 14/20 episodes where suitable information is provided. Methods of reporting were classified into four categories: descriptive (n = 24), public health reports (n = 7), case-control (n = 7), case study (n = 7). Diagnosis of exclusion for environmental contamination is still a prevalent mode of reporting but does not make the outbreak intelligible. Conclusion: (1) A two-step approach is suggested: a simple environmental check for short and uneventful outbreaks; an intensive case study for any episode with long duration or recurrence. (2) Two hypotheses for future testing are proposed: a hypothesis of arousal, probably of a benign, age-specific, and sexual nature, in short simple cases; a hypothesis of conflict in the long or recurrent ones.

Characteristics of Adolescents Affected by Mass Psychogenic Illness Outbreaks in Schools in Nepal: A Case-Control Study

“…However, the findings have been inconclusive. Three reviews ( 2 , 77 , 78 ) concluded that case-control studies, in general, have not yielded useful results and that studies assessing personality factors in school outbreaks using the Minnesota Multiphasic Personality Inventory and Eysenck Personality Inventory were inconsistent. It is important to note, however, that cognitive failures, fantasy proneness, and emotional contagion were correlated with the measure of dissociative experiences and behaviors.…”

“…In this paper, we present the first systematic case-control study of correlates of mass psychogenic illness (MPI) in an adolescent school population. MPI, also known by other names, including mass hysteria, mass sociogenic illness, mass conversion disorder, hysterical contagion, and medically unexplained epidemic illness, has been defined as the acute onset and rapid spread of constellations of symptoms suggestive of an organic/neurological illness but without an identifiable pathogen or medical cause, and which are therefore assumed to be of psychogenic origin ( 1 , 2 ). The symptoms and mechanisms of spread of MPI may vary across social and cultural settings ( 3 – 6 ).…”

“…Researchers have identified several characteristic features of MPI that are often applied to differentiate between MPI and other epidemics, including: lack of plausible pathophysiological explanation for the presenting symptoms; rapid spread and rapid remission of symptoms; occurrence mainly among young females; transmission of illness through visual and/or auditory exposure; and presence of stress associated with an actual or rumored catastrophic event ( 1 , 2 , 24 ). However, there are no pathognomonic diagnostic features because exceptions are found for all identified characteristics ( 25 ).…”

Occupational Mass Psychogenic Illness: A Transcultural Perspective

“…He also notes that these episodes do not appear political or related to any obvious female repression, which so conspicuously typify occupational outbreaks. Sirois (1994) analysed 45 recent school outbreaks, noting that girls near puberty and menarche are most frequently affected, and a large majority occurs at the end of the school year and is associated with galas, graduation shows and similar gatherings. Sirois believes that, as yet unspecified, mechanisms associated with sexual arousal may trigger conversion reactions of a benign and age-specific nature (Sirois, 1994(Sirois, , 1997.…”

Epidemic Hysteria: A Dialogue with Robert E. Bartholomew

“…It might be true when protest is the issue. However, a recent review of school outbreaks yields some epidemiological clues that might be interpreted otherwise [13]. Forty-five outbreaks covering a 20-vcar span were reviewed.…”