Jerusalem syndrome

Overview

Jerusalem syndrome is a rare psychological phenomenon in which individuals visiting Jerusalem experience religiously themed obsessive ideas, delusions, or psychosis. It most often affects tourists with no prior history of mental illness, although it can also occur in individuals with underlying psychiatric conditions. The syndrome is characterized by intense religious preoccupations and a belief that one has a divine mission or identity. Most cases resolve shortly after the individual is removed from the environment of Jerusalem.

Causes

The exact cause of Jerusalem syndrome is not fully understood, but it appears to be linked to the city's intense spiritual and religious significance. The syndrome may be triggered by the psychological impact of being in a place of profound historical and religious importance, especially among individuals who are already psychologically vulnerable. In some cases, the syndrome is a manifestation of an underlying psychiatric disorder, such as schizophrenia, bipolar disorder, or delusional disorder. Researchers have categorized Jerusalem syndrome into three types:

• Type I: Individuals with prior psychotic illnesses who travel to Jerusalem

• Type II: Individuals with idiosyncratic ideas related to Jerusalem, not clearly psychotic but unusual

• Type III (classic): Individuals with no prior psychiatric history who develop psychosis upon visiting Jerusalem

Symptoms

Symptoms of Jerusalem syndrome typically appear suddenly and may include:

• Intense religious obsessions or preoccupations

• Delusions of having a religious identity (e.g., believing oneself to be a biblical figure)

• Compulsive religious rituals, such as preaching, singing hymns, or wearing robes

• Disorganized thoughts and speech with religious content

• Paranoia or confusion

• Insomnia, anxiety, and agitation

• Social withdrawal or erratic public behavior

Diagnosis

Jerusalem syndrome is diagnosed based on clinical psychiatric evaluation. Important elements in the diagnostic process include:

• Detailed psychiatric assessment, including mental status examination

• Review of medical and psychiatric history

• Assessment of the timing of symptom onset in relation to arrival in Jerusalem

• Exclusion of other psychiatric disorders, substance use, or neurological causes

• Observation of the patient’s behavior in a neutral setting away from religious stimuli

Treatment

Treatment of Jerusalem syndrome depends on the severity of the symptoms and the underlying cause. In most cases, removing the individual from Jerusalem and placing them in a calm, supportive environment leads to rapid improvement. Treatment options may include:

• Supportive psychotherapy to help reorient the individual

• Short-term hospitalization for individuals with severe psychotic symptoms

• Antipsychotic or anxiolytic medications if needed

• Referral to psychiatric care in the individual’s home country for long-term follow-up if necessary

Prognosis

The prognosis for Jerusalem syndrome is generally good, especially in individuals with no prior history of mental illness. Most affected people recover completely within a few days after leaving Jerusalem and do not require long-term psychiatric treatment. However, in individuals with pre-existing psychiatric disorders, symptoms may persist and require ongoing management. Recurrence is rare unless the person returns to the triggering environment.