SalemNews.com, Salem, MA

Local News

January 30, 2013

Two schools of thought on unexplained hiccups

DANVERS — With more than a dozen students reportedly exhibiting unexplained vocal tics or hiccups at Essex Agricultural and Technical High School, some look to a psychiatric cause called mass psychogenic illness that can be related to stress. Others say it could be a rare case of a strep infection leading to an autoimmune reaction.

Local and state health officials have declined to speculate but are investigating. School officials are cooperating with experts in trying to find a cause, and Danvers Public Health Director Peter Mirandi has said he has no confirmed cases.

Dr. Edward Hart, a pediatric neurologist at North Shore Medical Center, has not examined any of the students at the approximately 450-student agricultural and vocational school, but said it appears that “mass hysteria or conversion disorder” may be at work.

It was the same diagnosis of the doctor who examined a group of high school girls at Le Roy High School in upstate New York last year who came down with debilitating tics. As in that case, there seems to be a line drawn among those who see the issue as a psychiatric disorder, not easily explained or treated, and those who see the matter in light of a rare condition in which a strep infection leads to an autoimmune reaction in the brain, resulting in tics or other behaviors.

“Subconscious mechanisms can take over in the absence of a biological or organic cause and propagate it,” Hart said. He thinks clusters of students coming down with the same symptoms are examples of conversion disorders, rather than the cause of a bacteria or a virus.

Hiccuping, the involuntary contraction of the diaphragm followed by a “hic” sound, is also called singultus. Hart said anyone can make a hiccup sound voluntarily.

However, in the case of more than a dozen students coming down with bouts of hiccups, “in no way are they malingering, they are not doing it on purpose,” Hart said.

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