Sissi Syndrome – Causes, Symptoms & Treatment

Sissi Syndrome

The term Sissi syndrome has existed since 1998 for an allegedly special form of depression. The Austrian Empress Sissi is said to have suffered from this disease. However, the existence of a special nosological form of the disease, to which the term Sissi syndrome refers, is very controversial in medicine.

What is Sissi Syndrome?

The term Sissi Syndrome was first used in an advertisement for a pharmaceutical company in 1998. The term refers to specific psychological symptoms that particularly affect women. However, it is very controversial to want to assign these symptoms to a specific disease.

In general, the symptom complex known as Sissi syndrome is characterized by depression , hyperactivity , controlled eating habits , constant restlessness and an almost delusional body cult. The term Sissi Syndrome was used in the quoted advertisement because the Austrian Empress Sissi, who lived in the 19th century, suffered from these symptoms.

The empress was depressed all her life, but did not show it publicly. Rather, she covered up her depressive mood with constant physical activity and a cult of beauty. She tried to keep her body slim and young through constant dieting and intensive physical activity. Many millions of people worldwide, especially women, suffer from similar symptoms.

However, the term Sissi syndrome is only known in German-speaking countries. The syndrome can possibly be divided into individual mental illnesses, so that the Sissi syndrome could actually be a collective term. It contains many elements of depression, but also of an eating disorder or even an obsessive -compulsive disorder .

The Sissi syndrome is defined as a special form of depression. However, it is not clear whether the depression, the eating disorder or the obsessive-compulsive disorder is the determining part of the illness.


The cause of Sissi syndrome is assumed to be a disturbance in the metabolism of neurotransmitters, especially serotonin. Serotonin is a messenger substance that plays a major role in emotional life. When there is too little serotonin, depressive moods occur. However, there are many different causes of serotonin deficiency .

What is special about Sissi syndrome, however, is that the outside world often does not notice the depressive mood of those affected. The patients cover up their depressed mood with external activity that feigns joie de vivre, but on the contrary the mood cannot brighten. Strict body control is used to try to appear young and healthy at all times.

However, it may be that the depression is not primary, but only arises as a result of attempts to compulsively build up the lack of self-confidence through diets and sporting activities. Since this cannot succeed, depression develops. Anorexia nervosa (anorexia nervosa) is a well-known clinical picture to which these symptoms apply .

Should many women with the so-called Sissi syndrome actually suffer from anorexia nervosa? Anorexia is characterized by strict body control through under-calorie eating and excessive exercise. As a result of undernourishment and malnutrition , depression always develops.

Symptoms, Ailments & Signs

The so-called Sissi syndrome is characterized by restlessness, hyperactivity and increased drive despite a depressive mood. However, the patients do not want to accept the depression and strictly reject any diagnoses in this direction. Furthermore , those affected suffer from constant mood swings , self – esteem problems and sleep disorders .

An extreme body cult with strict diets, fasting cures and eating disorders is typical. As a result, the body weight decreases more and more. In addition, the patient attempts to further reduce body weight through excessive physical activity. The exaggerated body control is intended to disguise the lack of self-confidence.

In addition to the diets, the person concerned also pursues an intensive cult of beauty and youth. All means are tried that have the reputation of keeping the body young forever. The level of suffering can increase to the point of suicide. Physical symptoms such as headaches , irritability or indigestion also occur. Malnutrition and malnutrition can lead to life-threatening conditions.

Diagnosis & disease progression

The diagnosis of Sissi syndrome can be made based on the typical symptoms. The disease is diagnosed as a mental illness, which can be defined as Sissi syndrome with regard to certain characteristics. However, it is often difficult for the doctor to identify the actual causes of the symptoms because the patients do not come to the examination because of their mental problems.


Although Sissi syndrome is considered a variant of depression, it is characterized by many characteristics that also characterize eating disorders. There can be a smooth transition between Sissi syndrome and eating disorders. The development of an unspecified eating disorder or anorexia is particularly conceivable as a complication.

The ICD-10 diagnostic system classifies all eating disorders that cannot be assigned to any described eating disorder, but still lead to suffering, as an eating disorder, unspecified. Eating disorders can lead to many physical complications, including electrolyte imbalances, organ damage, bone loss (osteoporosis), deficiency symptoms such as anemia or vitamin B12 deficiency – and many more.

Even without an additional eating disorder, Sissi syndrome can result in physical complications. Hyperactivity can lead to exhaustion, excessive exercise or fasting can promote circulatory problems. In addition, sleep disorders and other psychological complaints are possible.

Like all forms of depression, Sissi syndrome can be accompanied by suicidality. Signs include a desire to die, fantasies about one’s own death, or concrete plans and preparations. Suicidality should always be taken seriously. Those affected can contact a doctor (including their general practitioner) or therapist. In the case of urgent suicidality, help is required quickly, such as that which an acute psychiatric clinic can offer.

When should you go to the doctor?

Sissi syndrome should always be treated by a doctor. Since this is a serious psychological complaint, it should be treated immediately by a doctor to prevent further complications and symptoms. The Sissi syndrome cannot heal on its own, so the person affected is always dependent on professional medical treatment. A doctor should be consulted for Sissi syndrome if the person affected suffers from very severe mood swings.

In many cases, these fluctuations are also associated with depression, so that those affected are very disturbed. Sleeping problems also indicate Sissi syndrome if they occur over a longer period of time and do not go away on their own. Those affected suffer from an eating disorder and lose a significant amount of weight.

If these symptoms occur, a doctor must be consulted in any case. Furthermore, permanent headaches or a strong irritability of the affected person can indicate the Sissi syndrome. A psychologist can be consulted for Sissi syndrome . In many cases, however, friends and family have to point out the symptoms of the disease to those affected and persuade them to seek treatment.

Treatment & Therapy

Since a disorder of the serotonin metabolism is suspected in the so-called Sissi syndrome, the disease can be treated with drugs including the serotonin uptake inhibitor paroxetine . By the way, in connection with the advertising of this drug, the name Sissi syndrome was coined.

Paroxetine increases the concentration of serotonin in the synaptic cleft. It has a wide range of uses in psychological disorders such as depression, obsessive-compulsive disorders, panic disorders and post-traumatic stress disorders . Many of these clinical pictures could also be the basis of the so-called Sissi syndrome.

Psychosomatic treatment strategies are also important in Sissi syndrome. This includes conveying the self-knowledge of those affected that they want to suppress mental problems through excessive activities. As they learn to deal with these problems, their self-confidence grows and the healing process begins.


The best way to prevent the so-called Sissi syndrome is to develop self-confidence at an early stage. Fashion and fitness trends are often triggers for the symptoms of this condition. Those affected feel excluded from society and want to compensate for this with an excessive lifestyle. However, as early as during their upbringing, children should be given the feeling that they are full members of society and can assert their own claims.


Those affected who suffer from the “Sissi Syndrome” will almost always be dependent on expert medical treatment. Normally, no independent healing can occur. Therefore, follow-up care can only take the form of further talk therapy. The primary goal should be to build up the patients’ lack of self-confidence.

Self-knowledge of the disease can be conveyed in the form of a wide range of knowledge about possible causes and symptoms. In this way, those affected can seek medical help promptly. Joining a self-help group is also advisable. The participants can exchange ideas about similar mental problems and develop coping strategies together.

Since the “Sissi syndrome” is associated with a low serotonin level, a tryptophan-rich diet is recommended. Bananas, nuts and dried fruit contain an increased concentration of the amino acid. A carbohydrate-rich diet also ensures an increased release of the messenger substance serotonin. Last but not least, those affected should take good care of themselves.

This also includes taking breaks more often during the day and filling them with activities such as reading, listening to music or simply doing nothing. It is advisable for patients to involve people they trust if they are at risk of falling into old patterns. Whether long-term drug treatment is necessary depends on the severity of the disease and the assessment of the treating specialist.

You can do that yourself

The everyday life of a person with Sissi syndrome is often difficult. An important point regarding self-help with this disease is self-awareness. Knowing about the causes and symptoms offers the opportunity to actively counteract them.

In severe episodes, it helps those affected to incorporate a few breaks into their everyday lives. These breaks provide a balance to otherwise over-drive. They can include a variety of activities: reading a book, listening to quiet music, going for a walk, or lying on the sofa for a period of time and just doing nothing. These are just a few examples of the design of these breaks. How they are spent is ultimately an individual decision and must be decided according to one’s own preferences.

The cause of the Sissi syndrome lies in the imbalance of the messenger substance serotonin. This deficiency can be influenced by an adapted diet . People with low serotonin levels should therefore pay attention to a tryptophan-rich diet. Tryptophan is found in foods such as bananas, dried fruit and nuts. The amino acid is a precursor and is further processed in the body to serotonin. In addition, a carbohydrate-rich diet can affect the level of tryptophan in the blood. The body’s own hormone insulin is crucial here. This increases the concentration of tryptophan in the blood. Ultimately, this has an impact on a person’s serotonin levels.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.