What is Ganser syndrome?
Ganser syndrome is a 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 or made up 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 Disorder is considered mental illness because it is associated with severe emotional difficulties.
In Ganser syndrome, the individual mimics behavior that is typical of a mental illness, such as schizophrenia. Ganser syndrome was sometimes called prison psychosis because it was first observed in prisoners.
What are the symptoms of Ganser syndrome?
Those 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.
What causes Ganser syndrome?
Little is known about this unusual disorder, but it is believed to be a reaction to extreme stress. 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. If no purposeful deception is involved, the diagnosis might fall under the Somatic Symptom Disorder and Related Disorders, such as Conversion Disorder or Functional Neurological Symptom Disorder. 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. A real psychosis might include hallucinations, delusions or bizarre thinking. If true psychosis is observed, that would eliminate Factitious Disorder. If monetary gain, freedom from jail, or days off work was the target, then it would not be Factitious Disorder or other mental illness but rather malingering.
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 Factitious Disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is the standard reference book for recognized mental illnesses in the United States. Ganser syndrome is not listed as a diagnosis in the DSM-5.
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.
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- Ropper AH, Samuels MA. Chapter 56. In: Ropper AH, Samuels MA, eds. The Anxiety Neuroses, Hysteria, and Personality Disorders Adams and Victor's Principles of Neurology. 9th ed. New York: McGraw-Hill; 2009. Accessed 6/13/2013.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/11/2013...#9835