Not everyone likes the explanation, but many doctors believe conversion disorder is what's behind the twitching that has stricken the teenage girls of Le Roy, NY. In other words, the mysterious involuntary spasms are a physical manifestation of stress. Considering the mini-epidemic struck only the most popular teenage girls -- and only the girls -- this seems like a bizarre explanation. Popular cheerleaders have less stress than bullied losers, right? Parents thought it might have to do with the environment or maybe some sort of virus -- a 19th century mental disorder spread by mass hysteria sounds too squishy. "It’s a very hard pill for me to swallow — what are we, living in the 1600s?” one of the girls' guardians told The New York Times Magazine's Susan Dominus, who has a cover story on the ordeal in this week's issue.

But, just because conversion disorder feels archaic, that doesn't mean it's not the affliction to blame. It's what many doctors believe caused the outbreak, reports Dominus. And, comparing what Dominus collected from doctors to the Diagnostic Statistical Manual (aka, DSM-IV), which has the standard criteria for psychological disorders including conversion disorder, we see the Le Roy girls' have all the symptoms. Below we have all six of the criteria for conversion disorder from the DSM-IV and then the girls' symptoms via Dominus. It matches up, just as doctors said. 

Physical Manifestations

DSM-IV: "One or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurologic or other general medical condition."

Le Roy Girls: "Her chin was jutting forward uncontrollably and her face was contracting into spasms. She was still twitching a few weeks later when her best friend, Thera Sanchez, captain of one of the school’s cheerleading squads, awoke from a nap stuttering and then later started twitching, her arms flailing and head jerking," writes Dominus, as she explains just two of the victims' plights. 

Stress Related Causes

DSM-IV: "Psychological factors are judged, in the clinician's belief, to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit. A diagnosis where the stressor precedes the onset of symptoms by up to 15 years is not unusual."

Le Roy Girls: Though many tell Dominus these girls lead relatively happy lives, some digging confirmed that of the five girls she interviewed, not one had a stable relationship with their fathers. And, it wasn't hard for some parents to see their kids as balls of stress. "I know she has a huge heart, and she’s wound tight," one mother told Dominus. 

Involuntary (Not Made Up) Symptoms 

DSM-IV: "The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering)."

Le Roy Girls: These don't seem like voluntary, made up responses. “If they were faking it, I’d like to know how they can cause it,” Dave Watson, guardian for one of the affected cheerleaders told Dominus. “It’s not like any one movement is more exaggerated than the next. It’s pretty damn consistent. I’d like someone to explain to me how they could walk around all day and do it consciously.”

It's Not Some Other Medical Condition

DSM-IV: "The symptom or deficit, after appropriate investigation, cannot be explained fully by a general medical condition, the direct effects of a substance, or as a culturally sanctioned behavior or experience."

Le Roy Girls: There are other theories about what got these girls sick. Such as possible contamination and a rare strain of strep. Soil sampling ruled out the former, and some girls have gotten treatment for the latter. "Trifiletti revealed on 'Dr. Drew' that all nine of the girls he tested showed evidence of either strep exposure or exposure to the organism associated with pneumonia," writes Dominus. But that's not proof. "Results were far from conclusive, and he would need to study the levels of antibodies in their blood over time to know more, but he said there was enough evidence to get them started on antibiotics and anti-inflammatories," she continues. 

It's Debilitating In Emotional and Physical Ways

DSM-IV: "The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation."

Le Roy Girls: Since the spasms happen without warning, they certainly get in the way of things. Just one anecdote: 

The “Dr. Drew” interview was broadcast live from Thera’s home. Several minutes into a discussion with a medical expert, the camera suddenly cut back to Thera. “Oops,” Drew Pinsky said. “Thera is having a little bit of a reaction there. Thera, are you O.K.?” She had slid slowly to her mother’s lap and then onto the floor. “Is her airway O.K.?” Pinsky asked. “Do you need me to call the paramedics?” 

Other Things It Can't Be: Pain, Sexual Dysfunction, or Another Mental Disorder

DSM-IV: "The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder."

Le Roy Girls: As the article explains, the symptoms happen all the time and has nothing to do with sex. And, though the girls may have had some latent stress, they were described as generally happy. “A lot of these kids were just, you know, having a happy, normal life.” one of the mothers said. "My daughter hasn’t had any trauma,” she said. “She was just happy, going along. She was as happy as can be."

The DSM-IV definition of diseases is of course not the be-all end-all of diagnoses. And, the girls on antibiotics for strep have gotten better. But the Le Roy girls fall under these metrics and the symptoms and diagnoses also match up with what doctors found.