Addressing Cases of Mass Conversion Disorder in Schools of Western Nepal: A Case Series

Abstract

Background: Mass conversion disorder (MCD), or functional neurological symptom disorder, involves motor or sensory
symptoms without medical explanation that impair functioning. When such symptoms spread within groups, it is termed MCD,
which can often be seen in schools and can be shaped by cultural and social dynamics. This case series examines the presentation,
shared features and health-seeking behaviours of students affected by MCD in Ghorahi municipality, Dang, Nepal.
Methods: Between June and August 2022, four public schools in Ghorahi reported MCD cases to the Health Foundation
Nepal (HFN). The rapid mental health team responded, conducting retrospective assessments through observation, physical
examination, and also interviews with students, parents and teachers. Clinical symptoms and demographic data were compiled,
standardised and descriptively analysed.
Results: Between June and August 2022, 20 female students aged 8 to 16 years (mean age 11.8 ± 1.98 years), mostly from school
grades 5 (30%) and 6 (30%), were affected across four public schools in Dang, Nepal. Headache (40%), weakness with loss
of coordination (35%), dizziness (25%), and cold periphery with numbness (25%) were major symptoms reported. Up to 80%
described experiences involving spirits, and 55% knew a family member with a similar illness. Up to 95% had previous episodes,
90% had recurrences, 35% had parents separated due to divorce, and 30% due to unemployment. None of the students’ parents
had a formal education beyond grade 10. All affected students were taken to traditional healers, and 50% also to hospitals, with
timing and order of visits varying by case. Most parents attributed the illness to spirit possession, and teachers noted the need
for training and support to address MCD cases.
Conclusions: The MCD in Dang’s public schools was influenced by cultural beliefs and family stressors. There was a high
female prevalence, repeated MCD episodes, low parental education and a preference for traditional healing, which suggests the
need for school-based mental health programmes and further research.