A letter to the editor on the ISIS syndrome

The Islamic State of Iraq and Syria (ISIS) was regarded as the most serious contemporary terrorist threat to international security. It suggests that ISIS is a particular example of a radical group formed by the combination of psychological needs, an ideological narrative, and a networking process [2]. ISIS, also known as the Islamic State of Iraq and al-Sham (the old name of Syria), is a radical Sunni Muslim organization whose major goal is to rebuild the Islamic state or caliphate in Iraq, Syria, Israel, Jordan, Palestine, and parts of Turkey [1].

Research into the investigation of psychological disturbances of those who engage and affiliate with terrorist personnel or groups is limited, and it is particularly rare in the case of ISIS affiliates. A study conducted by Kizilhan and NollHousong (2018), indicated that the formerly abducted former ISIS child soldiers show a significantly high prevalence of PTSD (48.3%), somatic disturbances (50.6%), depressive disorders (45.6%), and anxiety disorders (45.8%). The authors also state that self-esteem was significantly low [3] but a declaration about uncommon symptoms has never been reported. Author Darya Ahmed in 2021 conducted a study among ISIS psychiatric patients (For the first time, actual ISIS-affiliated patients were directly recruited for research purposes) entitled “Observation of Rare Psychosocial and Mental Health Symptoms in ISIS Psychiatric Patients: A Pilot Study Among ISIS Affiliates” published in the journal of Global Psychiatric Archives in 2022 to examine the rare psychosocial signs, the author revealed that despite the fact that ISIS patients were suffering from psychiatric disorders such as PTSD and MDD, also a set of uncommon psychological indications, including 16 unusual psychosocial symptoms, were identified among ISIS psychiatric patients. which are considered to be unique to them due to their manifestation and causes for these unusual symptoms, as compared to the similar symptoms of other mental diseases that has proposed to call this finding "ISIS syndrome". To the findings of his study, self-doubt, alienation, inferiority complex, poor self-expression, intense dread, social skepticism, distrust, lowest self-esteem and confidence, change in identities, and massive social withdrawal, and the rest of the 16 rare symptoms (Table 1) were among the atypical psychological signs among ISIS psychiatric patients compared to the control group. All of these signs have a potential link to identities and affiliations [1]. This letter aims to draw the attention of the global scientific community to the phenomenon of ISIS syndrome and consider for further investigation through the lens of general mental and psychosocial principles.

Table 1 ISIS patients with unusual psychological symptoms, and possible causes

NO.	ISIS Syndrome signs	Causes of unusual signs
1	Low self-esteem, feelings of inadequacy and worthlessness, and a sense of loss, grief, despair, unhappiness, and sorrow.	This has to do with sentiments of betrayal, as well as dread and shame at how they were treated as ISIS members and criminals.
2	Changing identities, they try to obscure themselves by keeping and concealing from people; in this sense, they use a scarf as a disguise in public places, including during treatment sessions.	This is due to societal stigma, preconceptions, and discrimination, as well as apprehension and shame about their past.
3	Stay vigilant and resist being arrested, humiliated, kidnapped, or degraded by individuals or armed forces.	This sensation is linked to feelings of protection and security, as well as the dread of being identified as a former ISIS member.
4	Consistent fear of being exposed for threatening, assaulting, and retaliating against the community.	This sensation is linked to feelings of protection and security, as well as the dread of being identified as a former member of ISIS.
5	Pessimists have the lowest degree of resilience and well-being since they feel helpless, hopeless, and that no one cares.	This symptom is typical in practically all psychiatric patients, but in ISIS cases, it refers to a loss of power, authority, and dignity, which leaves them without hope and unable to think about the future.
6	Passive personalities are unable to assert even their most fundamental rights.	because of social stigma and stereotypes, as well as feelings of humiliation, worthlessness, and undervaluation as a result of their identity
7	Long-standing skepticism and overall suspicion of others.	This is not a set idea, as paranoid delusions do, but rather a dread of their identities and the way others regard them, making them feel more exposed to harassment, intimidation, and arrest.
8	Aggression, outbursts, and impulsivity	They are hypersensitive and quickly insulted due to their sense of being guarded and distrustful, as well as stereotypes and prejudice.
9	Suicide ideation and self-destructive behaviour.	Because they have lost everything in life, including dignity, power, and authority, as well as any hope for the future.
10	Isolation and withdrawal from everyone and everything, including limited access to public venues like hospitals and community centers.	This is due to prejudice, stereotyping, and stigmatization, not because of lingering traumatic occurrences. Fear of community and how others treat them as ISIS members, on the other hand.
11	Self-blaming, self-flagellation, and a sense of being cut off from reality and trapped in nightmares.	due to guilt, a shattered sense of dignity, and a life in a precarious position due to a lack of assets
12	Nightmares, insomnia, and sleep problems are all common.	Rather than the other cases, their nightmares feature war-related signals, weapon sounds, and occasionally dreams of incarceration, degradation, and humiliation.
13	They are ignorant, wounded inside, lonely, and disconnected from society.	This perception was based on a comparison between their previous and current circumstances, in which they had power, authority, and property but no longer did.
14	Extreme feelings of social panic and social stigma.	This symptom is caused by a sense of unlikeness, dissimilarity, and how people perceive them as adversaries, rather than a fear of becoming the focus of attention, as persons with social anxiety disorder do.
15	Stay at home as much as possible and only go outside at special times.	Feeling insecure and uncomfortable.
16	There is an excessive amount of family worry among people with male children and adolescents.	because they believe that having a male teenager, makes them more subject to being imprisoned, murdered, and armed by the community.

To conclude, ISIS syndrome is an important social, mental, and psychological phenomenon and more studies are needed; a little is known about ISIS affiliates’ mental and psychological problems, particularly ISIS syndrome. The persisting reappearance of terrorist groups and their activities gives a unique opportunity for researchers to investigate the phenomena of ISIS syndrome, particularly for humanitarian organizations that work on psychosocial needs [4] on social cohesion, reconstruction, and integration of ISIS families and captives into society.