The Phantom Syndrome: Review Article
The Phantom Syndrome: Review Article
The Phantom Syndrome: Review Article
messages, smartphone emerges as a tool for References for this review were identified Chandigarh ‑ 160 012, India.
E‑mail: [email protected]
entertainment, social networking, education, through searches of PubMed for articles
business promotion, and for the related published from 1985 to current year by
activities. As a result of which, nowadays, use of the terms “Phantom,” “Vibration Access this article online
adults spent most of their leisure time on and Ringing,” “Mobile Phones,” and
Website: www.indjsp.org
their smartphones. Individuals are commonly “Ringxiety.” Relevant articles published
DOI: 10.4103/ijsp.ijsp_63_18
were identified through searches in the
Quick Response Code:
This is an open access journal, and articles are distributed
under the terms of the Creative Commons Attribution-Non How to cite this article: Goyal AK, Saini J. The
Commercial-ShareAlike 4.0 License, which allows others to phantom syndrome. Indian J Soc Psychiatry
remix, tweak, and build upon the work non-commercially, as
2019;35:102-7.
long as appropriate credit is given and the new creations are
licensed under the identical terms. Received: 31-07-2018, Revised: 08-10-2018,
For reprints contact: [email protected] Accepted: 29-10-2018
102 © 2019 Indian Journal of Social Psychiatry | Published by Wolters Kluwer - Medknow
Goyal and Saini: Phantom syndrome
authors’ files, in Google Scholar, Research Gate, and from an addiction. So far phantom syndrome is known
Springer Online Archives Collection. Materials resulting to occur mainly in two forms, i.e., vibration and ringing
from these searches and relevant references cited in those forms. In vibration, form individual has a false feeling that
articles were reviewed, and information from 24 articles his phone is vibrating but it does not, and the same occur
was incorporated in the present review. Articles published in ringing form, but in that case, the user feels the false
in a language other than English were also included in the ringing not vibration. Either ringing or vibration or both
present review. could be occurred in the same individual depending on the
habits of smartphones use.[1] Studies which can elucidate
Language, Grammar, and Plagiarism the diagnostic criteria for the phantom syndrome have
The references were inserted using EndNote software paramount importance. Moreover, research on how the
version 7.4 (Thomson Reuters, Toronto, Canada). phantom syndrome can be prevented, manage, or treated
Language and grammar were checked by Grammarly could make phantom syndrome to have a well‑established
software version 6.6 (Grammarly, Inc., San Francisco, etiology which further could be considered by the
California, United States). Plagiarism is corrected with international organizations such as ICD‑11, APA, and
the help of Plagiarism Checker X software version 5.1 DSM‑5.
(Techroad Global, New York, USA). The present work was Incidence and Prevalence
edited by the professional proofreading and editing service
provider (doc navigator©, Chandigarh). Rothberg et al.[5] conducted a study in 2010 on the
phantom syndrome among medical staff and found that
History nearly 70% of the individuals faced phantom syndrome.
History of phantom syndrome traced backed to back in In 2012, a study among college undergraduates revealed
1996 when the cartoonist Scott Adams for first referenced that almost 90% of the students had felt the phantom
vibrations. Most of the students admit that they face
such a sensation as “phantom‑pager syndrome” in his
symptoms every month every week and almost daily.[1]
comic strip “Dilbert.”[2] In 2003, columnist Robert D.
During 2013, Michelle Drouin conducted a study among
Jones states that our mind or body tells us the imaginary
290 undergraduate students which revealed that 89% of
vibrations in the belts, pockets, and even purses in his
the students experience phantom syndrome.[7] Another
article entitled “Phantom Vibration Syndrome” published
study conducted in the same year by Lin YH reported that
in the New Pittsburgh Courier.[1] The first scientific study
78% of the individuals perceived phantom vibrations.[8] A
on the phenomenon was conducted in 2007 by a researcher
study conducted in 2015 at Kurukshetra university shows
who coined the term ringxiety to describe the phantom.[4]
that 74% of the postgraduate students experience the
In early days, false feeling of ringing and vibrations from
phantom vibration and ringing on a weekly basis.[1] In
smartphones are known by the many names such as
2017, Abolfazal investigated the prevalence of phantom
vibranxiety, ringxiety, fauxcellarm, and audio illusion[3]
among medical students and found that 54.3% of the
until the term “Phantom” had made its way to Australia
students face phantom sensations[9] [Table 1]. Overall, in
when the Macquarie Dictionary’s in 2012’s declared it as
most of the studies, the phantom vibration was found to
the “Word of the Year.”[1]
be more common compared to the phantom ringing,[10]
Etiology and hallucination of phantom mostly occurred on a weekly
basis.[4] Majority of research conducted to date on phantom
Established etiology is must to design the new syndrome is clustered around the medical staff and students,
prevention, management, and treatment strategies for
any given syndrome by the clinicians. So far phantom is
Table 1: Prevalence of phantom syndrome
characterized as the hallucinations or sensation which
Reference Year Outcomes
the brain perceives when they are not present.[5] At
Rothberg et al.[5] 2010 70% of the medical staff faced phantom
present, there are no well‑established clinical criteria for
syndrome
the diagnosis and treatment of the phantom syndrome. Goyal[1] 2012 90% of students had felt the phantom
Much international organization such as the International vibrations
Classification of Disease (ICD)‑10,[4] American Psychiatric Drouin et al.[7] 2013 89% of the students experience the
Association’s (APA), and diagnostic and statistical manual phantom syndrome
of mental disorders (DSM‑5) do not consider the phantom Lin et al.[8] 2013 78% of the individuals perceived
syndrome into the disease;[3] therefore, the diagnosis of phantom vibrations
phantom is very difficult. The standard physiological Goyal[1] 2015 74% of the postgraduate students
indicators and visible signs of the discomfort which can experience the phantom vibration and
characterize the phantom are also not defined till date.[6] ringing on a weekly basis
Available research suggests that the symptoms of phantom Mohammadbeigi 2017 54.3% of medical students face phantom
found similar to those occurring during the withdrawal et al.[9] sensations
the reason for which is unknown. Furthermore, conducting phantom which was evident by a study among the internship
studies oriented to a particular segment of population lose of hospital workers which revealed that the phantom
validity of study outcomes on the general population. There syndrome magnitude increases with the training duration
is always a chance of biasness if the study is repeated and become low when the training ended. This may be due
with the same conditions. More diverse studies among the to the anxiety and depression which remain high during the
various stakeholders of society are required to establish initial period of training and decrease later as the training
the incidence and prevalence of phantom syndrome. ended because workers become more adapted to the hospital
Hospital‑based studies in the psychiatry departments could environment.[8,10] A detailed model is needed to be designed
have more importance as individuals on having a feeling of to study the positive feedback loop occurs in the phantom
the phantom, initially tends to approach for the psychiatry syndrome qualitatively and quantitatively.
opinion.
Sleep is necessary to recover from the fatigue and
Symptoms restoration of the energy. Disturbance in sleep can
lead to increased core body temperature, decrease task
Phantom found to positively correlated with the duration of performance, and the decline in cognitive function.[18] The
smartphone use[1] and several studies have proven that the severity of phantom syndrome can lead to disturbance of
long‑term use of smartphones can lead to the development biological clock, which in turn can cause fatigue and sleep
of symptoms such as headache, extreme irritation, increases disorders. A recent study conducted among the 120 students
in the carelessness, forgetfulness, decrease of reflexes, showed a positive correlation between the phantom
clicking sound in ears,[11,12] ear warmth, ear fullness, and syndrome and sleep disorders. About 93% of the students
ringing in the ears.[13] The further increased frequency found to use smartphones before going to bed at night[19]
of smartphone users can also lead to addictive and which could be potentially causing symptoms such as the
compulsive behavior characterized by psychological strain, difficulty in sleeping, waking up from sleep, and trouble
loneliness, isolation, depression,[14] poor relationships, poor in falling asleep again.[20] Detail research which could
occupational, and academic performances.[15] Nomophobia establish the relationship between sleep patterns and the
is a condition in which smartphones users feel frightened phantom severity could prove helpful in the establishment
if they lost smartphone, and in severe conditions, of a link between the phantom syndrome and the biological
nomophobia can cause the emotional discomfort in a person clock/circadian rhythms.
characterized by the emotional changes such as anxiety,
fear, panic, and depression as well as the physical changes Risk Factors
such as changes in breathing, sweating, and trembling.[16]
Investigators have been attempted to identify a pattern
However, to what extent phantom is contributing to each
of smartphones uses which may be associated with the
symptom is still a matter of investigation.
phantom syndrome. Primary factors which found to be
Studies also suggested that the phantom syndrome at responsible for the phantom sensations can be summarized
initial stages can cause the psychological stress, anxiety, in four categories including the occupation (students,
hallucinations, depression, attention deficit, over-vigilance, professionals, housewives, etc.), smartphone location (shirt
and emotional disturbance and if left unmanaged, primary pocket, belt, pants front pocket, back pocket, bag, etc.),
symptoms progress to advanced stages which leads to smartphone carrying period (regular, continuous, day
the burnout syndrome, effective psychological disorders, only, occasionally, etc.), frequency of use (<6 h, 6–12 h,
depressive psychosis, and pathological stress.[2] Among and >12 h), and mode of use (ringing or vibration).
several symptoms, stress and depression are found to be Although few earlier studies found no significant
most common in the phantom. Although earlier studies relationship between the phantom syndrome and the
suggest that there is no relation exists between the phantom amount of the smartphone use,[4] a recent study identifies
and the stress level,[10] many recent studies explain that that the symptoms of phantom directly proportional to the
the over‑reliance on smartphones leads the individuals to number of hours that the smartphone was carried and the
believe that they cannot function without their smartphone frequency of the phone use.[1] The cognitive score also
and experience high‑stress levels when there is loss of found to be related with the phantom syndrome in a study
the connectivity.[1,17] A Nokia study found that the average in which individuals with high scores for personal fatigue,
smartphone user checks their phone every 6.5 min, job fatigue, and service target fatigue found to have more
i.e., 150 times during the waking hours. Such kind of frequent episodes of the phantom. It is possible that the
behavior leads to the obsession for phone and become the limbic forebrain, hypothalamus, and brainstem that mediate
reason for anxiety when an individual is unable to check stress responses, emotional learning, and reward processing
their smartphone or entirely loss access to a smartphone.[1] may be involved in phantom episodes;[21] however, it is
There occurs a positive feedback loop between the phantom mostly correlational research, and confounding factors
and the stress and depression levels. Phantom can enhance were hardly adjusted, therefore, more research needs to be
by the stress and enhancement of stress can lead to the done to establish a direct link.
Apart from the factors mentioned above, emotional vibration mode of smartphones.[1,2] However, there are no
attachment to the smartphone revealed as another significant clinical criteria, or standard treatment is present and clinical
risk factor for the phantom syndrome.[2] Individuals who trials need to be conducted to design systemic treatment
become attached to the contents of their smartphone, like protocol for the phantom syndrome.
contacts, apps, games, and other stuff, generally have more
desire to receive notifications for their Facebook, Twitter, Theories Explaining Mechanism
and WhatsApp updates[3] which makes them more prone to Most studies conducted so far on the phantom syndrome are
the phantom syndrome. The extraversion and agreeableness of exploratory nature, attempting to outline the prevalence
are the types of social personalities characterized by the need and features of the phenomena. These studies lack the
for social connectivity. Extroverts are talkative and like to qualitative behavioral and psychological component. There
socialize. They enjoy the presence of others, and want to have been comparatively fewer explorations into the causes
be engaged. Agreeableness describes attitudes such as the behind the phantom and whatever theories are proposed,
straightforwardness, altruism, and kindheartedness. People lacks the systemic view. At present stage, there is no accepted
who score high on the extraversion and agreeableness theory available for explanation of the phantom syndrome. In
should be more prone to the phantom as the frequency the present article, we are introducing several theories based
of continuous engagement with the smartphone high on the existing fragmented literature on which further detailed
is such cases.[3] Neuroticism is another form of the research could be carried out to establish them as standard
emotional stability characterized by anxiety and stress. theories describing the phenomenon of the phantom.
Neurotics individuals become paranoid very frequently
According to signal detection theory, smartphone in the
when they lose the engagement with their smartphone.[3] pocket exists in two possible states as follows: either
Although studies on direct examination of the relationship ringing or not. Similarly, the human brain also has two
between the neuroticism and the phantom vibrations possible states as follows: the judgment that the phone is
found no significant correlation,[7] phantom ringing is still ringing or is not. Brain, similar to match above‑mentioned
needed to be a screen for the neuroticism. As opposed states in the correct way, i.e., ringing, should go with “it’s
to neuroticism, conscientiousness is characterized by the ringing,” and no ringing should go with “it’s not ringing.”
strong will. There are two assumptions are conceivable in These faithful matches called as the “true positive” and
case of the conscientious individuals: First, conscientious “true negative” signal, respectively. However, in other
individuals are dedicated toward the assigned task[22] and conditions, it is also possible that the brain mismatch the
may, therefore, be more alert to the incoming notifications ringing with “it’s not ringing” or mismatch the no ringing
on phone which could increase the likelihood of phantom with “it’s ringing.” These mismatches called as the “true
phone sensations; second, due to their goal‑directness and negative” and “false‑positive” signal, respectively. The
self‑discipline, conscientious individuals are less attentive false‑positive signal can lead to the phantom syndrome.[1]
to the extraneous stimuli[7] which could make them less
susceptible for phantom. Another phobia of the modern age Sensations are repetitive memories theory prosed by
is the nomophobia which is defined as the fear of being out Dr. Larry Rosen tells that the phantom sensations are
of mobile phone contact. In a recent study, it was found repetitive memories of previous real experiences triggers
that mobile phone addiction is directly associated with the by the present situation. The actual stimulus which mimics
nomophobia. Clearly, the individuals with nomophobia the phantom is unknown; however, candidate sensations
might include the touch or sensation arise from the from
supposed to be more susceptible to the phantom syndrome.[23]
clothing, muscle contractions, or other sensory stimuli.[24]
However, which assumption among above two will dominate
A recent study put the evidence in support of this theory
is still a matter of investigation. Conclusively, only rudiment
in which students carrying the phone in their pocket felt
studies are available to date on the behavior analysis and
vibration even when the phone is switched off which may
further focused research is required to established emotional
be due to sensations from the surroundings.[1]
behavior as a risk factor for the phantom syndrome.
Theory of neuroplasticity explains that the phantom syndrome
Management and Treatment may be due to the brain’s ability to form new connections
Few investigations in the literature attempted to explore in response to changes in the environment. When cellphone
whether phantom can be avoided, managed, or treated. users regularly experience sensations, such as vibration or
Studies suggested that the phantom can be easily managed ringing, their minds become wired to those sensations[24] and
by the time‑bounded use of smartphone, decrease the lead to phantom. It works in the same way as how our brain
possible dependency of smartphone, frequently change the remains to keep adapting for the new information.
alert modes like vibration to ringing, lifestyle modifications, Transcutaneous electrical nerve stimulation theory proposed
counseling and guidance regarding the hallucinations and by a professor of psychology at the University of Sydney
affective aspects, use different devices, carrying smartphone suggested that the phantom may be due to the sensation
in different pockets or positions, and by avoiding the interpreted by the nerves on the skin caused by a very small
discharge of electricity given off by the phone when it ways, and recently, it impacted the psychological health
connects to a new tower. However, a recent study contradicts in the form of the phantom syndrome. The present article
this study in which students found to felt phantom from reviewed the available research available on the phantom
pocket even when, the phone in their pocket is switched off, syndrome and pinned down the specific research ideas to
or they do not have a phone in their pocket.[1] design effective prevention, management, and treatment
strategies for the phantom.
Dopamine theory hypotheses that every text, WhatsApp,
Facebook, or Twitter notification is positively reinforced Acknowledgement
our brains for the release of a little spurt of the dopamine.
The authors are highly acknowledged to all the colleagues
A dysregulated dopamine system has a central role in
who reviewed the present work.
psychotic symptoms such as hallucinations.[25] However, no
research‑based evidence is present in support of this theory. Financial support and sponsorship
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