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 pharmacotherapy for coexisting anxiety, and treatment of coexisting anxiety or depression coincided with patient improvement as well.
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.”
