Ganser syndrome is a rare dissociative disorder characterized by nonsensical or wrong answers to questions and other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness. The syndrome has also been called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, hysterical pseudodementia or prison psychosis.
The term prison psychosis is sometimes used because the syndrome occurs most frequently in prison inmates, where it may be seen as an attempt to gain leniency from prison or court officials. Psychological symptoms generally resemble the patient's sense of mental illness rather than any recognized category. The syndrome may occur in persons with other mental disorders such as schizophrenia, depressive disorders, toxic states, paresis, alcohol use disorders and factitious disorders. Ganser syndrome can sometimes be diagnosed as merely malingering, but it is more often defined as dissociative disorder.
The identification of Ganser syndrome is attributed to German psychiatrist Sigbert Ganser (1853–1931). In 1898, he described the disorder in prisoners awaiting trial in a penal institution in Halle, Germany. He named impaired consciousness and distorted communication, namely in the form of approximate answers (also referred to as Vorbeireden in the literature), as the defining symptoms of the syndrome. Vorbeireden involves the inability to answer questions precisely, although the content of the questions is understood.
Ganser syndrome is described as a dissociative disorder not otherwise specified (NOS) in the DSM-IV, and is not currently listed in the DSM-5. It is a rare and an often overlooked clinical phenomenon. In most cases, it is preceded by extreme stress and followed by amnesia for the period of psychosis. In addition to approximate answers, other symptoms include a clouding of consciousness, somatic conversion disorder symptoms, confusion, stress, loss of personal identity, echolalia, and echopraxia.
Cause
To date, no definitive cause or reason of the disorder has been established. The sources that classify the syndrome as a dissociative disorder or a factitious disorder conflict in their proposed aetiologies. As a result, there are differing theories as to why the syndrome develops.
Ganser syndrome was previously classified as a factitious disorder, explaining the symptoms as mimicking of what patients who do not experience psychosis believe is typical of the experience. However, the DSM-IV placed the syndrome under "Dissociative Disorders Not Otherwise Specified". There has been evidence of a strong correlation between approximate answers and amnesia, suggesting that these have an underlying dissociative mechanism.
Both Ganser's syndrome and the broader category of dissociative disorders have been linked to histories of hysteria, psychosis, conversion, multiple personality and possible feigning. Despite this, the condition's aetiology remains under question due to associations with established psychiatric disorders, as well as organic states.
According to Stern and Whiles (1942), Ganser syndrome is a fundamentally psychotic illness. As evidence, they describe the case of a woman with recurrent mania and a head injury before being submitted to treatment and the report of a man with schizophrenia who suffered from alcoholism and had recently been in prison.
Ganser syndrome is also sometimes referred to as "prison psychosis", emphasizing its prevalence among prisoners, generating discussion about whether the disorder only appears in this population. In a study of prisoners, Estes and New concluded that escaping an intolerable situation, such as being incarcerated, prompted the syndrome's key symptoms. The study touched on the malingering controversy surrounding the syndrome, as well as the stress component that often precedes the disorder.
According to consultant psychiatrist F. A. Whitlock, Ganser syndrome is a hysterical disorder, on par with Ganser's description of the disorder. Whitlock pointed to the number of cases in which Ganser syndrome was reported in settings of organic brain disease or functional psychosis as evidence of its hysterical foundations. Kraepelin and Bumke also believed the syndrome to be of a hysterical nature. Bumke thought the syndrome hysterical because amnesia for a traumatic emotional event tends to occur in hysteria more than in other disorders. The giving of approximate answers is thought to be produced in hysterical personalities.
According to Mayer-Gross and Bleuler, Ganser syndrome occurs mainly in epileptic or schizophrenic patients.