Ganser syndrome: its most frequent symptoms and causes

In the medical and psychological literature we find mentions of Ganser syndrome, a very rare mental disorder that is characterized by symptoms such as approximate answers to simple questions, complex hallucinations, and phenomena convertives.

In this article we will analyze the causes and symptoms of Ganser syndrome.

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What is Ganser syndrome?

Ganser syndrome is a very rare clinical picture that was first described in 1898. The name given to this phenomenon comes from its discoverer: the German psychiatrist Sigbert Ganser. We also find the terms “hysterical pseudodementia”, “pseudodementia syndrome” and “prison psychosis”.

The latter name refers to the fact that Ganser's syndrome has been identified with a higher frequency than usual in prison populations. In most of these cases, the symptoms are most likely an attempt to be treated better by prison staff or other inmates.

The most characteristic symptom of Ganser syndrome is the pararesponses

or approximate answers; these are unsuccessful answers but relatively close to the truth that are given to simple questions. The rest of the signs of this picture include conversion phenomena, echophenomena and apparent alterations of consciousness, among others.

The few prevalence studies available indicate that Ganser's syndrome occurs more common in males than females, in a ratio of 3:1. The mean age of diagnosis would be slightly above 30 years, although it sometimes occurs in children. However, very little is known about this phenomenon due to its extreme infrequency.

Possible causes and psychological hypotheses

Ganser's syndrome has traditionally been classified in the category of factitious disorders, which are characterized by faking illness to achieve a “patient role”. The other typical phenomenon of this class is the munchausen syndrome, in which the person feigns illness or psychological trauma in order to obtain social reinforcement.

In this sense, factitious disorders can be distinguished from malingering. In the vocabulary of clinical psychology and other related disciplines, the term "simulation" is used to refer to cases in which that an illness or a mental disorder is feigned with an objective other than obtaining the sick role, such as economic benefit.

is extended understanding Ganser syndrome as a dissociative disorder, so it would be more similar to phenomena like depersonalization, derealization and dissociative amnesia. Dissociative experiences consist of separations of cognitive processes (including consciousness) that arise as a reaction to stress.

However, currently the most accepted explanation of the causes of Ganser's syndrome defines it as a psychotic character disorder. In this sense, it is worth noting the association of this clinical picture with the schizophrenia, intoxication by alcohol and other psychoactive substances and severe depressive disorders.

Main symptoms and signs

Pararesponses, conversion symptoms, alterations of consciousness and the pseudo hallucinations are the four most defining features of Ganser syndrome. It is also important to highlight the ecophenomena, which occur with some frequency in this clinical context, and the high levels of stress and anxiety detected in these people.

1. Approximate answers or paraanswers

The pararesponses consist of answers relatively close to reality that are given to questions that are easy to answer. In many cases, Ganser's syndrome is conceptualized around this peculiar manifestation; in fact, the DSM-IV manual places the approximate answers at the core of the criteria for the diagnosis of the condition.

2. Somatic conversion symptoms

Conversion consists of the presence of physical symptoms, such as pain or sensory and motor deficits, in the absence of an organic cause identifiable. Conversion disorder is currently questioned; the DSM-5 includes it in the category “somatic symptom disorders”, which also includes factitious disorder, among others.

3. Altered level of consciousness

The two symptoms related to the level of alertness, and therefore to consciousness, that appear most commonly in Ganser's syndrome are the feeling of mental confusion and loss of personal identity. In general, people with this clinical picture may have difficulties reacting to environmental stimuli and processing them.

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4. complex hallucinations

People with Ganser syndrome frequently report very elaborate hallucinations and in any of the sensory modalities. Given that hallucinations in psychiatric disorders such as schizophrenia are usually auditory and simple, this type of story can serve as a clue in the diagnosis of this rare syndrome.

• Related article: "Hallucinations: Definition, Causes, and Symptoms"

5. Ecophenomena

Ecophenomena or ecosymptoms are imitation or repetition behaviors that occur without the subject's voluntary control. The environmental stimuli that are reproduced can be actions (echopraxia), verbalizations (echolalia) or facial expressions (economy), among others.

• Related article: "Echolalia: what it is, causes and related disorders"