Case series: outbreak of conversion disorder among amish adolescent girls.
OBJECTIVE
Outbreak investigations are challenging in a cross-cultural context, and outbreaks of psychiatric disease are rare in any community. We investigated a cluster of unexplained debilitating illness among Amish girls.


METHODS
We reviewed the medical records of cases, consulted with health care providers, performed active case finding, administered open-ended and structured interviews, and met with Amish community members. A case-patient was defined as a resident of the county who was bedridden for more than 3 weeks with otherwise unexplained systemic weakness and anorexia from January 2000 to February 2002.


RESULTS
Five case-patients were identified. All were Amish girls aged 9 to 13 years. All five had debilitating voluntary motor deficits, anorexia, and weight loss. Four experienced neck weakness with inability to hold up their heads. Thorough medical evaluations failed to identify an organic etiology. All five patients met the diagnostic criteria for conversion disorder. Substantial social conflict within the Amish community preceded illness onset. Family behavioral interventions were recommended. Three months after the investigation, four of five patients demonstrated some improvement.


CONCLUSIONS
Clinicians should be aware of the potential for outbreaks of psychogenic illness and work to address the challenges of developing effective intervention strategies, particularly in the cross-cultural context.
Cassady
Joslyn D
JD
Epidemiology Program Office, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Kirschke
David L
DL
Jones
Timothy F
TF
Craig
Allen S
AS
Bermudez
Ovidio B
OB
Schaffner
William
W
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D003291:Conversion Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D012069:Religion and Psychology