Ganser syndrome was first described by a German psychiatrist Ganser in 1898, in a patient who showed a peculiar twilight state. Ganser syndrome is defined as the presence of approximate answers, somatic conversion symptoms, clouding of consciousness, and pseudo-hallucinations. The etiology of this disease remains a subject of debate. While the DSM-IV-TR classifies Ganser syndrome under the heading of dissociative disorder, it is not listed as a diagnosis in the DSM-V.

The purpose of this paper is to review available literature on Ganser syndrome, published in Dutch, English, German, and French for examining the etiological debate, in order to gain insight into the etiology of this disorder.

The study design was a retrospective case series of all published cases since 1898. For this purpose we used the electronic databases PubMed and Embase.

Over a period of 118 years, we found 79 papers, describing 117 case reports on Ganser syndrome. It generally occurs in patients who are exposed to somatic disorders or to psychological stress, however, often in absence of a psychiatric disorder.

Ganser syndrome remains a controversial disorder in terms of its etiology. Ganser syndrome has been associated with organic disorders, as well as with stressful and intolerable life events. Based on this report, it is noteworthy that this syndrome predominantly occurs in the absence of co-morbid psychiatric disorders and is often associated with stress factors and underlying somatic diseases.

The authors have not supplied their declaration of competing interest.