Ganser Syndrome: Causes, Symptoms & Treatment

Patients with Ganser syndrome respond to simple questions and requests for action with maladaptive behavior. The syndrome was long considered a simulated disorder in law enforcement, but is now recognized as a dissociative conversion disorder. Treatment is proving difficult and involves behavioral therapy as well as medication administration.

What is Ganser syndrome?

Dissociative conversion disorder is a transient psychosomatic disorder. Affected individuals suffer from disturbances in bodily functions that are temporally related to a psychologically stressful event. Ganser syndrome is classified as a dissociative conversion disorder. It is a rare disorder in psychiatry. Affected persons answer simple questions inconsistently or even incorrectly, giving the impression of dementia. Incorrect action sequences also characterize the clinical picture. The disorder was first described in 1897 by the German psychiatrist S. J. M. Ganser, who gave the disorder its name. The first cases of Ganser’s syndrome were observed within the penal system and were related to the desire for a declaration of insanity. In this context, the syndrome was initially thought to be an artificial disorder that merely served to simulate mental illness. However, Ganser syndrome is now recognized as a real, psychiatric disorder and is found as such in the ICD-10.

Causes

The causes of Ganser syndrome have not yet been determined. Because the syndrome was first observed in the penal system, the disorder was long thought to be a deliberate attempt at deception with the goal of declaring insanity. Despite the recognition of the syndrome as a real illness, psychiatrists and psychologists still consider its possible simulation character when making a diagnosis. The distinction between a real illness and a deliberately simulated illness is extremely difficult, especially in the case of Ganser’s syndrome. Sometimes brain-organic damages can lead to a similar clinical picture. A purely psychologically caused Ganser’s syndrome is usually preceded by a significantly stressful event, which has shaken the soul life of the affected person extraordinarily strongly. This causal relationship justifies the classification of the syndrome as a dissociative conversion disorder.

Symptoms, complaints, and signs

Patients with Ganser syndrome give incorrect answers to simple questions. For example, when asked what color the sun is, they answer “green.” They answer the question about the current day with a season, and calls to action are incorrectly executed. Other cognitive impairments and behavioral problems are not present. In addition to the typical answering by, Ganser, the first describer, claims to have noticed a fluctuating clouding of consciousness, sensory disturbances such as analgesia, tingling sensations or even paralysis and acoustic as well as visual pseudohallucinations in the patients. Childish limp affect, depression, agitation, memory lapses, and visual field impairment may be present. In addition, echopraxia as well as pseudoepileptic seizures are considered typical symptoms. The acute symptoms usually last only a short time and are not remembered later by the patient. Often the affected persons are considered “stupid” by their environment. For this reason, academic, professional and social failure is a frequent consequence. Social isolation can occur as a complication. Meanwhile, according to case reports, more and more children suffer from symptoms of the syndrome.

Diagnosis and course

Ganser syndrome requires extensive diagnostic testing. Psychiatric or psychological assessment is usually not sufficient for a definite diagnosis. Neurologic examinations and imaging of the brain are required to rule out brain-organic damage as the cause of the cognitive impairment. Once physical causes have been ruled out, a psychiatrist or psychologist must make the distinction from a simulated disorder. The differential diagnostic differentiation from clinical pictures such as schizophrenia is also required as part of the diagnosis. This task turns out to be a tightrope walk. The prognosis for patients with Ganser syndrome is relatively unfavorable, as the phenomenon is difficult to treat. Due to Ganser’s syndrome, there are serious psychological complaints and complications.These occur mainly in the social environment, as the patient is often excluded from social life and can no longer actively participate in it. This leads to depression and an aggressive mood in the patient. Disturbances of consciousness and concentration also occur. Especially in children, Ganser’s syndrome can lead to teasing and bullying, thus extremely reducing the quality of life. It is not uncommon for those affected to appear to outsiders as not intelligent, which is why there is an increase in psychological complaints. Other behavioral abnormalities also occur, and it is not uncommon for certain regions of the body to become paralyzed. The treatment of Ganser’s syndrome proves to be very complicated and long-term. It also does not lead to success in every case, so that the patient may have to spend his entire life with the symptoms. Certain wrong behaviors are treated in therapies. However, the development of the child is also limited, so that symptoms may occur in adulthood. Life expectancy itself is not affected by Ganser syndrome.

Complications

Serious psychological complaints and complications result from Ganser syndrome. These occur mainly in the social environment, as the patient is often excluded from social life and can no longer actively participate in it. This leads to depression and an aggressive mood in the patient. Disturbances of consciousness and concentration also occur. Especially in children, Ganser’s syndrome can lead to teasing and bullying, thus extremely reducing the quality of life. It is not uncommon for those affected to appear to outsiders as not intelligent, which is why there is an increase in psychological complaints. Other behavioral abnormalities also occur, and it is not uncommon for certain regions of the body to become paralyzed. The treatment of Ganser’s syndrome proves to be very complicated and long-term. It also does not lead to success in every case, so that the patient may have to spend his entire life with the symptoms. Certain wrong behaviors are treated in therapies. However, the development of the child is also limited, so that symptoms may occur in adulthood. Life expectancy itself is not affected by Ganser syndrome.

When should you see a doctor?

People who respond inappropriately to instructions and requests for action from their peers or close relatives need medical attention. If simple questions cannot be answered correctly despite existing knowledge, this is considered unusual and should be assessed by a medical professional. If the affected person stands out due to his behavior because it is off his norm, it is recommended to initiate a check-up visit with a physician. If the person appears to be mentally incompetent and mentally deficient, a therapist should be consulted to clarify the abnormalities. If the patient repeatedly exhibits behavior similar to that of dementia patients, there is reason for concern. Forgetfulness, disorientation, and a lack of credible incompetence in everyday situations should be investigated and medically treated. Persistent or repeated cognitive impairment, memory impairment, and mood swings are indications that should be discussed with a physician. If there are changes in consciousness, disturbances in sensation, or internal agitation, a physician is needed. If there are hallucinations, paralysis, or disturbances of sensation in the body, a physician should be consulted. If the affected person complains of limitations in the field of vision or if these are noticed by relatives, a visit to the doctor should be made. If pseudoepileptic seizures occur repeatedly and the affected person has no memory of them, a physician should be consulted.

Treatment and therapy

Ganser syndrome is treated with psychological care. Causal treatment is sought; however, causal therapy proves difficult. One much-used option is cognitive behavioral therapy. Behavioral therapy treatment steps are based on learning theory. Behavioral therapy regards disordered behavior as learned and aims to unlearn it during therapy.The behavior therapist aims to replace the patient’s conspicuous ways of thinking and behaving with appropriate ways of thinking and behaving, and to open up a new perspective on the person’s own behavior. Reinforcement of desirable behavior and elimination of undesirable or inappropriate behavior are central goals of any behavior therapy. Patients with Ganser’s syndrome understand questions and requests for action very well, but behave inappropriately despite their basic understanding of what is being asked of them. This connection is what makes behavior therapy work. If they fundamentally did not understand questions and requests, their behavior in the situation could not be corrected. In most cases, the causal treatment approach is combined with a symptomatic therapy approach. Sufferers often exhibit severe agitation, which gets in the way of behavioral therapy. Conservative medication treatment steps are usually pursued to mitigate the patient’s agitation. The short-term administration of lorazepam has become common in this context. To resolve the disorder in the long term, the therapist must identify the causative situations and stimuli for the misbehavior. The patient is confronted with these stimuli until desensitization is achieved.

Outlook and prognosis

The prognosis of Ganser syndrome depends on the initiation of adequate treatment for the condition. In many cases, there is no patient insight into the disease. As a result, despite abnormalities and peculiarities of behavior, a physician is not consulted or therapy is refused. In addition, the difficulty of the disease lies in the correct diagnosis. The presence of this mental disorder is often misjudged for a long time. If therapy is sought, there is a good chance of alleviating the existing symptoms. Nevertheless, the treatment is usually very difficult and complex. The dropout rate is high because the necessary measures are extensive and in many cases the patient is not convinced that the problems are due to his behavior. For him, the cause is to be found in the environment or in the behavior of other people. Likewise, there is often a lack of sufficient cooperation from the patient within the therapy. Ganser’s syndrome requires a long-term treatment, which must take place over the entire life of most affected persons. The goal is not complete freedom from symptoms. The focus is on gradually improving the quality of life and reducing interpersonal conflicts. Cognitive changes are necessary so that an improvement of the overall situation can take place. Relapses are not uncommon in this process.

Prevention

Because the exact causes of Ganser syndrome are thought to be broad, it is difficult to fully prevent the syndrome. A stable psyche may be a prophylactic. Prophylactic psychotherapy can be described as a preventive measure to some extent.

Aftercare

In most cases, there are no special aftercare options available to the person affected by Ganser syndrome. In this case, the patient is dependent on comprehensive treatment for this disease, although a complete cure cannot be guaranteed. However, if Ganser’s syndrome is completely cured, a recurrence must be prevented. The life expectancy of the patient is not reduced by this disease. Ganser’s syndrome is usually treated by a psychologist or by a therapist. In many cases, the support of family or friends is also necessary and very helpful to speed up the healing process. Likewise, outside persons usually have to point out the symptoms of this disease to the affected person and persuade him or her to undergo therapy. Not infrequently, Ganser’s syndrome is also treated with the help of medication. It is important to take the medication regularly, and the correct dose must be adjusted by a doctor. In cases of doubt, a doctor should always be consulted. The treatment of the syndrome can also take place in a special clinic. Should the Ganser syndrome occur again, it must be treated again by a doctor. A self-healing cannot occur thereby.

This is what you can do yourself

The treatment of Ganser’s syndrome usually proves to be difficult, so that the means of self-help are also very limited in this case.Regular and careful intake of medications prescribed by the doctor must be ensured. Likewise, interactions with other medications should always be observed if other medications are also being taken. In the case of Ganser’s syndrome, it is extremely important not to punish the patient for his misbehavior. In this case, friends and relatives in particular must be considerate of the symptoms of the syndrome and explain to the patient why his behavior is a misbehavior. Also, various ways of thinking that might be wrong must be set right by outsiders. As a rule, the treatment is carried out by confronting the patient with unpleasant stimuli and situations. This confrontation can also take place in the patient’s own home with familiar people, which may accelerate the healing process. However, these behavioral exercises should always be discussed with the treating physician or therapist in order to avoid misbehavior. If the affected person seems agitated, empathetic conversations with the closest and most familiar people are very helpful in this regard.