Ganser Syndrome
What is Ganser syndrome?
Ganser syndrome is a type of factitious disorder, a mental illness in which
a person acts as if he or she has a physical or mental illness when in truth, he or she
has caused the symptoms. People with factitious disorders act this way because of an
inner need to be seen as ill or injured, not to achieve a concrete benefit, such as
financial gain. They are even willing to undergo painful or risky tests and
operations in order to obtain the sympathy and special attention given to people
who are truly ill. Factitious disorders are considered mental illnesses because
they are associated with severe emotional difficulties.
Ganser syndrome is a type of factitious disorder in which the person mimics
behavior that is typical of a mental illness, such as schizophrenia. Ganser
syndrome is sometimes called prison psychosis because it was first observed in
prisoners.
What are the symptoms of Ganser syndrome?
People with Ganser syndrome have short-term episodes of odd behavior similar
to that shown by people with serious mental illnesses. The person might appear
confused, make absurd statements, and report hallucinations (the experience of
sensing things that are not there; for example, hearing voices). A classic
symptom of Ganser syndrome is vorbeireden, or approximate answers, in
which the person gives nonsense answers to simple questions. A person with this
disorder might report physical problems, such as an inability to move part of the
body, called hysterical paralysis. Loss of memory (amnesia) for the events that
occurred during an episode is common.
What causes Ganser syndrome?
Little is known about this unusual disorder, but it is believed to be a
reaction to extreme stress. Another factor that might contribute to Ganser
syndrome is a desire to avoid responsibility or an unpleasant situation. Physical problems
also might cause symptoms of Ganser syndrome. These
include alcoholism, head injury, Tourette's syndrome, stroke, and
frontal-temporal lobe dementia.
Most people with this disorder also have a personality disorder, usually
antisocial personality disorder or histrionic personality disorder. Antisocial
personality disorder is characterized by irresponsible and aggressive behavior
that often involves a disregard for others and an inability to abide by society’s
rules. People with antisocial personality disorder are sometimes referred to as
"sociopaths" or "psychopaths." For people with histrionic
personality disorder, sustaining self-esteem depends on the approval of others and
does not arise from a true feeling of self-worth. These patients have an overwhelming
desire to be noticed, and often behave dramatically or inappropriately to get
attention.
How common is Ganser syndrome?
Ganser syndrome is very rare. Most of the available reports are individual
case reports, many of which were reported on incarcerated patients. It is stated by
some that the syndrome is more common in men (80 percent) than in
women and most often occurs in the late teens and early adult years. This male
dominance might most likely be influenced by the fact that the ratio of males to
females in the prison system is quite high, and often reflects a greater
minority representation.
How is Ganser syndrome diagnosed?
Diagnosing Ganser syndrome is very challenging, not only because some
measure of dishonesty is involved but also because it is very rare. In addition,
doctors must rule out any possible physical problems—such as stroke, dementia, or head
injury—as the cause of the symptoms before considering a diagnosis of Ganser
syndrome.
If the health care provider finds no physical reason for the symptoms, he or
she might refer the person to a psychiatrist or psychologist -- mental health professionals who are
specially trained to diagnose and treat mental illnesses. Psychiatrists and
psychologists use a thorough history, physical, laboratory, imagery, and
psychological assessment tools to evaluate a person for Ganser syndrome. The
doctor bases his or her diagnosis on the exclusion of actual physical or mental
illness, and his or her observation of the patient’s attitude and behavior.
Questions to be answered include:
- Do the patient's reported
symptoms make sense in the context of all test results and assessments?
- Do we have collateral information
from other sources that confirm the patient's information? (If the patient
does not allow this, this is a helpful clue.)
- Is the patient willing to take
the risk for more procedures and tests than you would expect?
- Are treatments working in a
predictable way.
The doctor then determines if the patient’s
symptoms point to Ganser syndrome as outlined in the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which is
the standard reference book for recognized mental illnesses in the United
States.
How is Ganser syndrome treated?
The first goal of treatment is to be sure the person does not hurt himself
or herself, or others. The person might need to be hospitalized if the symptoms
are extreme and/or if the person could be dangerous. In most cases, the symptoms
of Ganser syndrome go away once the stress that triggered the episode is
settled.
Supportive psychotherapy (a type of counseling), and monitoring for safety
and a return of symptoms are the main elements of therapy for Ganser syndrome.
Medicine usually is not used, unless the person also suffers from depression,
anxiety, or a personality disorder.
What are the complications of Ganser syndrome?
Amnesia, or loss of memory, of events that occurred during episodes of the
syndrome is the most common complication. Some people with Ganser syndrome will
suffer a period of depression following a Ganser syndrome episode.
What is the prognosis (outlook) for people with Ganser syndrome?
Recovery usually occurs within days, especially if the stress that triggered
the disorder is resolved.
Can Ganser syndrome be prevented?
There is no known way to prevent this disorder.
©
Copyright 1995-2005 The Cleveland Clinic Foundation. All rights reserved
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