Conversion disorder: An epidemic spread by sight

More than a dozen teenage girls in upstate New York are suffering from inexplicable tics. Is it all in their minds?

Two cheerleaders in a small, upstate town were among the first of at least 16 victims to suffer from inexplicable tics.
(Image credit: moodboard/Corbis)

How did this outbreak start?

In October, several cheerleaders at a high school in Le Roy, a town of 7,600 in western New York, began exhibiting unexplained symptoms similar to those of Tourette's syndrome — facial spasms, involuntary arm swings, stuttering, and sudden verbal outbursts. The ranks of sufferers soon swelled to at least 16 girls, along with a teenage boy and a 36-year-old woman. At first, the cases baffled doctors and caused frightened speculation among parents, who blamed rare strep infections, side effects from a vaccine against the human papilloma­virus, and toxins left by a chemical spill near the school four decades ago. Environmental activist Erin Brockovich was even called in to investigate. But tests have so far ruled out all environmental and infectious causes. The leading theory now is that the girls suffer from what is known as "conversion disorder."

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Why are girls more susceptible?

There are several possible reasons. Girls are socialized to suppress stress, rather than act out aggressively, causing it to manifest in otherwise unexplained physical symptoms. During adolescence, girls also have an acute desire to belong to a group, which can add to their stress and make them especially attentive to social cues. "Teenage girls are very susceptible to drama and each other's moods," says clinical psychologist Nancy Molitor. And women are more likely to seek medical treatment than men, which may skew the numbers involved in mass outbreaks.

Were the girls in Le Roy under stress?

The girls have repeatedly claimed that they were normal, happy teenagers before their symptoms appeared. But Dr. Jennifer McVige, a local pediatric neurologist, says that all 10 of the girls she saw "had something big that happened" in their lives prior to the outbreak, whether it was a divorce, a sick parent, abuse, or other emotionally upsetting event. It has also emerged that three of the girls suffered from tic disorders prior to the outbreak, which doctors say could have unconsciously influenced the other patients; those who came down with symptoms posted videos of themselves twitching on Facebook, which other girls viewed before developing the same symptoms themselves. Nonetheless, several of the girls' parents, and many other people in the Le Roy community, are skeptical about the diagnosis of conversion disorder, and have called for more tests aimed at finding possible environmental and medical factors.

Are they getting better?

Reports indicate that they are. Symp­toms have disappeared altogether for several girls, and others are being treated with a combination of anti-anxiety drugs, cognitive-behavioral therapy, and counseling. Doctors report that their conditions have steadily improved, particularly after videos of the girls twitching were removed from TV stations' websites and social media. "These girls will get better," says Mechtler. "We have to give them time and space."

The susceptibility of cheerleaders

It hasn't escaped researchers' notice that cheerleaders often figure in cases of mass psychogenic outbreaks. Four of the first girls to exhibit symptoms in Le Roy were on the cheerleading squad. In 2002, 10 girls began suffering unexplained seizures at a school in rural North Carolina; half were cheerleaders. And in 1952, scores of members of a Louisiana cheerleading squad mysteriously fainted in quick succession at a football game. Experts theorize that because cheerleaders are considered popular, outbreaks are more likely to begin with them than with classmates of lower status. There's also a theory that cohesive groups, particularly those that wear matching uniforms and excel at synchronized movements, might be more susceptible to mass suggestion. But that's as close as social psychologists have gotten to figuring out why, as social critic Caitlin Flanagan recently wrote, "it is the cheerleaders and not the linebackers who come down with tics and stuttering."