A case report of mass conversion disorder associated with a local spirit narrative in Dhankuta, Eastern Nepal

Mass psychogenic illness (MPI), also known as mass conversion disorder, is a condition where groups of individuals develop physical symptoms without an identifiable organic cause, often influenced by underlying psychosocial and cultural factors. In rural and semi-urban areas, such episodes are often misunderstood and attributed to supernatural beliefs.

We report an outbreak of MPI in a secondary school in Dhankuta, Eastern Nepal, affecting 25/170 adolescent girls aged 13-19 over a span of 6 weeks. The index episode involved four girls simultaneously experiencing crying, collapsing, and abnormal movements during a mathematics class. Subsequent cases followed a similar pattern, often triggered by academic stress, strict discipline, and circulating rumors of a young girl's rumored death near the school premises. A structured intervention - including psychoeducation, individual and group counseling, and changes in school policy - resulted in a marked decline in cases within 5 days. At the 3-month follow-up, only 6/25 continued to exhibit occasional symptoms, and no new cases were reported.

This case emphasizes the interplay between psychological vulnerability, academic pressure, and sociocultural beliefs in the development and propagation of MPI. The exclusive involvement of adolescent females aligns with global patterns in similar outbreaks. The effectiveness of non-pharmacological interventions, including psychoeducation and school-based reforms, supports previous literature and highlights the importance of community-specific mental health strategies.

MPI remains a significant public health concern in low-resource settings, particularly among adolescent populations. Culturally sensitive psychosocial interventions, coupled with stakeholder education and supportive school environments, are essential for effective management and prevention.