Ganser syndrome: examining the aetiological debate through a systematic case report review

Background and Objectives: The aetiology of the syndrome described by Ganser in 1898 has been the subject of disagreement. Proposed causes include hysteria, psychosis and stress. In addition, the presence of the syndrome in association with medical conditions raises the possibility of an organic aetiology. The authors have explored the aetiology by reviewing identified case reports published in English. Methods: 94 case reports were obtained by searching medical databases and by conducting a hand search for possible references. This is the largest systematic review of which the authors are aware. Results: The review indicates that the syndrome generally occurs in instances where the individual is faced with stress, especially in those with premorbid vulnerabilities. Individuals who had affective, psychotic as well as organic conditions were found to manifest the condition. However, whilst comorbid mental illness is present in some instances, the Ganser syndrome complex was found to occur commonly in the absence of other mental illnesses. Conclusions: The absence of a comorbid mental illness in the majority of cases may suggest a specific aetiological mechanism which supports the argument that Ganser syndrome should be ranked as a distinct nosological entity along with some other rare psychiatric disorders.