Review Article

The Phantom Syndrome

Abstract Atul Kumar Goyal,

Communication technology evolved extensively in recent years and the introduction of the featured Jyoti Saini1
smartphones considered as the critical milestone in the mobile phone history. Unlike traditional Department of Otolaryngology
phones, smartphones have the number of applications which keep the users engage to a greater and Head Neck Surgery (ENT),
extent of time like never before. Such unbroken psychological association of the individuals with Postgraduate Institute of
their smartphones has led to an emergence of a new kind of psychological problem called as the Medical Education and
phantom syndrome characterized by the frequent false feeling of ringing and vibration from the Research, Chandigarh,
smartphones. Although the phenomenon of the phantom is widespread, only a limited number of
1
Department of Biotechnology,
studies are available on it. Furthermore, most of the studies available are to exploratory nature with National Institute of
Pharmaceutical Education and
lack of standard study designs. Keeping all such aspect into the consideration, the present review
Research, Guwahati, Assam,
endeavors to extend the current scientific knowledge on phantom syndrome by providing a thorough India
understanding and new ideas for future research.

Keywords: Mental, mobile phone, psychological, ringing, vibration

Introduction seen to engage with smartphones even if

Technology, nowadays, is not just limited to
human desires but has shifted to the needs
of humanity. Such continuous influx of
technology into human life has influenced
human behavior in several ways. One of
the behaviors influenced by technology
is the way people communicate. In the
past, people tend to communicate through
letters due to geographical differences.
Mobile phone emerged as a communication
technology[1] when Motorola launched its
first mobile phone in 1973.[2] Soon after that
mobile phone becomes the most acceptable
means for communication.[3] At present,
around 66% of the world population is
using a mobile phone, and approximately
1.16  billion mobile phones user are present
in India.[2] Traditional mobile phones
include the primary features that allow
users to call or text someone and they lost
their popularity soon after the smartphones
come on the market in 2013.[3] Apart
from the conventional voice calls and text
they occupied with the other important
activities of their daily lives, and for most
of the individuals, it is impossible to go
through without their smartphones even for
an hour.[4] This utmost unbroken association
of the individuals with their smartphones
has led to the emergence of a new kind of
psychological disorder called as the phantom
syndrome characterized by a frequent false
feeling of ringing and vibration from the
smartphones. At present, there is insufficient
research available on the phantom syndrome
and most of the studies conducted so far,
lacks standard methodological designs.
Taking all these aspects into consideration,
the present narrative endeavors to extend the
current scientific knowledge on the phantom
by providing the critical understanding of the
phenomenon and by proposing directions for Address for correspondence:
Atul Kumar Goyal,
future research on the phantom syndrome. Department of Otolaryngology
and Head Neck
Search Strategy and Selection Surgery (ENT), Postgraduate
Criteria Institute of Medical
Education and Research,

messages, smartphone emerges as a tool for
entertainment, social networking, education,
business promotion, and for the related
activities. As a result of which, nowadays,
adults spent most of their leisure time on
their smartphones. Individuals are commonly
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For reprints contact: reprints@medknow.com
References for this review were identified Chandigarh ‑ 160 012, India.
E‑mail: atlgyl@gmail.com
through searches of PubMed for articles
published from 1985 to current year by
use of the terms “Phantom,” “Vibration Access this article online
and Ringing,” “Mobile Phones,” and
Website: www.indjsp.org
“Ringxiety.” Relevant articles published
DOI: 10.4103/ijsp.ijsp_63_18
were identified through searches in the
Quick Response Code:
How to cite this article: Goyal AK, Saini J. The
phantom syndrome. Indian J Soc Psychiatry
2019;35:102-7.
Received: 31-07-2018, Revised: 08-10-2018,
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
Springer Online Archives Collection. Materials resulting
from these searches and relevant references cited in those
articles were reviewed, and information from 24 articles
was incorporated in the present review. Articles published
in a language other than English were also included in the
present review.
Language, Grammar, and Plagiarism
The references were inserted using EndNote software
version  7.4 (Thomson Reuters, Toronto, Canada).
Language and grammar were checked by Grammarly
software version  6.6 (Grammarly, Inc., San Francisco,
California, United States). Plagiarism is corrected with
the help of Plagiarism Checker X software version  5.1
(Techroad Global, New York, USA). The present work was
edited by the professional proofreading and editing service
provider (doc navigator©, Chandigarh).
History
History of phantom syndrome traced backed to back in
1996 when the cartoonist Scott Adams for first referenced
such a sensation as “phantom‑pager syndrome” in his
comic strip “Dilbert.”[2] In 2003, columnist Robert D.
Jones states that our mind or body tells us the imaginary
vibrations in the belts, pockets, and even purses in his
article entitled “Phantom Vibration Syndrome” published
in the New Pittsburgh Courier.[1] The first scientific study
on the phenomenon was conducted in 2007 by a researcher
who coined the term ringxiety to describe the phantom.[4]
In early days, false feeling of ringing and vibrations from
smartphones are known by the many names such as
vibranxiety, ringxiety, fauxcellarm, and audio illusion[3]
until the term “Phantom” had made its way to Australia
when the Macquarie Dictionary’s in 2012’s declared it as
the “Word of the Year.”[1]
Etiology
Established etiology is must to design the new
prevention, management, and treatment strategies for
any given syndrome by the clinicians. So far phantom is
characterized as the hallucinations or sensation which
the brain perceives when they are not present.[5] At
present, there are no well‑established clinical criteria for
the diagnosis and treatment of the phantom syndrome.
Much international organization such as the International
Classification of Disease  (ICD)‑10,[4] American Psychiatric
Association’s  (APA), and diagnostic and statistical manual
of mental disorders  (DSM‑5) do not consider the phantom
syndrome into the disease;[3] therefore, the diagnosis of
phantom is very difficult. The standard physiological
indicators and visible signs of the discomfort which can
characterize the phantom are also not defined till date.[6]
Available research suggests that the symptoms of phantom
found similar to those occurring during the withdrawal
Indian Journal of Social Psychiatry | Volume 35 | Issue 2 | April-June 2019
from an addiction. So far phantom syndrome is known
to occur mainly in two forms, i.e.,  vibration and ringing
forms. In vibration, form individual has a false feeling that
his phone is vibrating but it does not, and the same occur
in ringing form, but in that case, the user feels the false
ringing not vibration. Either ringing or vibration or both
could be occurred in the same individual depending on the
habits of smartphones use.[1] Studies which can elucidate
the diagnostic criteria for the phantom syndrome have
paramount importance. Moreover, research on how the
phantom syndrome can be prevented, manage, or treated
could make phantom syndrome to have a well‑established
etiology which further could be considered by the
international organizations such as ICD‑11, APA, and
DSM‑5.
Incidence and Prevalence
Rothberg et  al.[5] conducted a study in 2010 on the
phantom syndrome among medical staff and found that
nearly 70% of the individuals faced phantom syndrome.
In 2012, a study among college undergraduates revealed
that almost 90% of the students had felt the phantom
vibrations. Most of the students admit that they face
symptoms every month every week and almost daily.[1]
During 2013, Michelle Drouin conducted a study among
290 undergraduate students which revealed that 89% of
the students experience phantom syndrome.[7] Another
study conducted in the same year by Lin YH reported that
78% of the individuals perceived phantom vibrations.[8] A
study conducted in 2015 at Kurukshetra university shows
that 74% of the postgraduate students experience the
phantom vibration and ringing on a weekly basis.[1] In
2017, Abolfazal investigated the prevalence of phantom
among medical students and found that 54.3% of the
students face phantom sensations[9]  [Table  1]. Overall, in
most of the studies, the phantom vibration was found to
be more common compared to the phantom ringing,[10]
and hallucination of phantom mostly occurred on a weekly
basis.[4] Majority of research conducted to date on phantom
syndrome is clustered around the medical staff and students,
Table 1: Prevalence of phantom syndrome
Reference Year Outcomes
Rothberg et al.[5] 2010 70% of the medical staff faced phantom
syndrome
Goyal[1] 2012 90% of students had felt the phantom
vibrations
Drouin et al.[7] 2013 89% of the students experience the
phantom syndrome
Lin et al.[8] 2013 78% of the individuals perceived
phantom vibrations
Goyal[1] 2015 74% of the postgraduate students
experience the phantom vibration and
ringing on a weekly basis
Mohammadbeigi 2017 54.3% of medical students face phantom
et al.[9] sensations
103
 Goyal and Saini: Phantom syndrome
the reason for which is unknown. Furthermore, conducting
studies oriented to a particular segment of population lose
validity of study outcomes on the general population. There
is always a chance of biasness if the study is repeated
with the same conditions. More diverse studies among the
various stakeholders of society are required to establish
the incidence and prevalence of phantom syndrome.
Hospital‑based studies in the psychiatry departments could
have more importance as individuals on having a feeling of
the phantom, initially tends to approach for the psychiatry
opinion.
Symptoms
Phantom found to positively correlated with the duration of
smartphone use[1] and several studies have proven that the
long‑term use of smartphones can lead to the development
of symptoms such as headache, extreme irritation, increases
in the carelessness, forgetfulness, decrease of reflexes,
clicking sound in ears,[11,12] ear warmth, ear fullness, and
ringing in the ears.[13] The further increased frequency
of smartphone users can also lead to addictive and
compulsive behavior characterized by psychological strain,
loneliness, isolation, depression,[14] poor relationships, poor
occupational, and academic performances.[15] Nomophobia
is a condition in which smartphones users feel frightened
if they lost smartphone, and in severe conditions,
nomophobia can cause the emotional discomfort in a person
characterized by the emotional changes such as anxiety,
fear, panic, and depression as well as the physical changes
such as changes in breathing, sweating, and trembling.[16]
However, to what extent phantom is contributing to each
symptom is still a matter of investigation.
Studies also suggested that the phantom syndrome at
initial stages can cause the psychological stress, anxiety,
hallucinations, depression, attention deficit, over-vigilance,
and emotional disturbance and if left unmanaged, primary
symptoms progress to advanced stages which leads to
the burnout syndrome, effective psychological disorders,
depressive psychosis, and pathological stress.[2] Among
several symptoms, stress and depression are found to be
most common in the phantom. Although earlier studies
suggest that there is no relation exists between the phantom
and the stress level,[10] many recent studies explain that
the over‑reliance on smartphones leads the individuals to
believe that they cannot function without their smartphone
and experience high‑stress levels when there is loss of
the connectivity.[1,17] A Nokia study found that the average
smartphone user checks their phone every 6.5  min,
i.e.,  150  times during the waking hours. Such kind of
behavior leads to the obsession for phone and become the
reason for anxiety when an individual is unable to check
their smartphone or entirely loss access to a smartphone.[1]
There occurs a positive feedback loop between the phantom
and the stress and depression levels. Phantom can enhance
by the stress and enhancement of stress can lead to the
104 Indian Journal of Social Psychiatry | Volume 35 | Issue 2 | April-June 2019
phantom which was evident by a study among the internship
of hospital workers which revealed that the phantom
syndrome magnitude increases with the training duration
and become low when the training ended. This may be due
to the anxiety and depression which remain high during the
initial period of training and decrease later as the training
ended because workers become more adapted to the hospital
environment.[8,10] A detailed model is needed to be designed
to study the positive feedback loop occurs in the phantom
syndrome qualitatively and quantitatively.
Sleep is necessary to recover from the fatigue and
restoration of the energy. Disturbance in sleep can
lead to increased core body temperature, decrease task
performance, and the decline in cognitive function.[18] The
severity of phantom syndrome can lead to disturbance of
biological clock, which in turn can cause fatigue and sleep
disorders. A recent study conducted among the 120 students
showed a positive correlation between the phantom
syndrome and sleep disorders. About 93% of the students
found to use smartphones before going to bed at night[19]
which could be potentially causing symptoms such as the
difficulty in sleeping, waking up from sleep, and trouble
in falling asleep again.[20] Detail research which could
establish the relationship between sleep patterns and the
phantom severity could prove helpful in the establishment
of a link between the phantom syndrome and the biological
clock/circadian rhythms.
Risk Factors
Investigators have been attempted to identify a pattern
of smartphones uses which may be associated with the
phantom syndrome. Primary factors which found to be
responsible for the phantom sensations can be summarized
in four categories including the occupation  (students,
professionals, housewives, etc.), smartphone location  (shirt
pocket, belt, pants front pocket, back pocket, bag, etc.),
smartphone carrying period  (regular, continuous, day
only, occasionally, etc.), frequency of use  (<6  h, 6–12  h,
and  >12  h), and mode of use  (ringing or vibration).
Although few earlier studies found no significant
relationship between the phantom syndrome and the
amount of the smartphone use,[4] a recent study identifies
that the symptoms of phantom directly proportional to the
number of hours that the smartphone was carried and the
frequency of the phone use.[1] The cognitive score also
found to be related with the phantom syndrome in a study
in which individuals with high scores for personal fatigue,
job fatigue, and service target fatigue found to have more
frequent episodes of the phantom. It is possible that the
limbic forebrain, hypothalamus, and brainstem that mediate
stress responses, emotional learning, and reward processing
may be involved in phantom episodes;[21] however, it is
mostly correlational research, and confounding factors
were hardly adjusted, therefore, more research needs to be
done to establish a direct link.
 Goyal and Saini: Phantom syndrome
Apart from the factors mentioned above, emotional
attachment to the smartphone revealed as another significant
risk factor for the phantom syndrome.[2] Individuals who
become attached to the contents of their smartphone, like
contacts, apps, games, and other stuff, generally have more
desire to receive notifications for their Facebook, Twitter,
and WhatsApp updates[3] which makes them more prone to
the phantom syndrome. The extraversion and agreeableness
are the types of social personalities characterized by the need
for social connectivity. Extroverts are talkative and like to
socialize. They enjoy the presence of others, and want to
be engaged. Agreeableness describes attitudes such as the
straightforwardness, altruism, and kindheartedness. People
who score high on the extraversion and agreeableness
should be more prone to the phantom as the frequency
of continuous engagement with the smartphone high
is such cases.[3] Neuroticism is another form of the
emotional stability characterized by anxiety and stress.
Neurotics individuals become paranoid very frequently
when they lose the engagement with their smartphone.[3]
Although studies on direct examination of the relationship
between the neuroticism and the phantom vibrations
found no significant correlation,[7] phantom ringing is still
needed to be a screen for the neuroticism. As opposed
to neuroticism, conscientiousness is characterized by the
strong will. There are two assumptions are conceivable in
case of the conscientious individuals: First, conscientious
individuals are dedicated toward the assigned task[22] and
may, therefore, be more alert to the incoming notifications
on phone which could increase the likelihood of phantom
phone sensations; second, due to their goal‑directness and
self‑discipline, conscientious individuals are less attentive
to the extraneous stimuli[7] which could make them less
susceptible for phantom. Another phobia of the modern age
is the nomophobia which is defined as the fear of being out
of mobile phone contact. In a recent study, it was found
that mobile phone addiction is directly associated with the
nomophobia. Clearly, the individuals with nomophobia
supposed to be more susceptible to the phantom syndrome.[23]
However, which assumption among above two will dominate
is still a matter of investigation. Conclusively, only rudiment
studies are available to date on the behavior analysis and
further focused research is required to established emotional
behavior as a risk factor for the phantom syndrome.
Management and Treatment
Few investigations in the literature attempted to explore
whether phantom can be avoided, managed, or treated.
Studies suggested that the phantom can be easily managed
by the time‑bounded use of smartphone, decrease the
possible dependency of smartphone, frequently change the
alert modes like vibration to ringing, lifestyle modifications,
counseling and guidance regarding the hallucinations and
affective aspects, use different devices, carrying smartphone
in different pockets or positions, and by avoiding the
Indian Journal of Social Psychiatry | Volume 35 | Issue 2 | April-June 2019
vibration mode of smartphones.[1,2] However, there are no
clinical criteria, or standard treatment is present and clinical
trials need to be conducted to design systemic treatment
protocol for the phantom syndrome.
Theories Explaining Mechanism
Most studies conducted so far on the phantom syndrome are
of exploratory nature, attempting to outline the prevalence
and features of the phenomena. These studies lack the
qualitative behavioral and psychological component. There
have been comparatively fewer explorations into the causes
behind the phantom and whatever theories are proposed,
lacks the systemic view. At present stage, there is no accepted
theory available for explanation of the phantom syndrome. In
the present article, we are introducing several theories based
on the existing fragmented literature on which further detailed
research could be carried out to establish them as standard
theories describing the phenomenon of the phantom.
According to signal detection theory, smartphone in the
pocket exists in two possible states as follows: either
ringing or not. Similarly, the human brain also has two
possible states as follows: the judgment that the phone is
ringing or is not. Brain, similar to match above‑mentioned
states in the correct way, i.e.,  ringing, should go with “it’s
ringing,” and no ringing should go with “it’s not ringing.”
These faithful matches called as the “true positive” and
“true negative” signal, respectively. However, in other
conditions, it is also possible that the brain mismatch the
ringing with “it’s not ringing” or mismatch the no ringing
with “it’s ringing.” These mismatches called as the “true
negative” and “false‑positive” signal, respectively. The
false‑positive signal can lead to the phantom syndrome.[1]
Sensations are repetitive memories theory prosed by
Dr.  Larry Rosen tells that the phantom sensations are
repetitive memories of previous real experiences triggers
by the present situation. The actual stimulus which mimics
the phantom is unknown; however, candidate sensations
might include the touch or sensation arise from the from
clothing, muscle contractions, or other sensory stimuli.[24]
A recent study put the evidence in support of this theory
in which students carrying the phone in their pocket felt
vibration even when the phone is switched off which may
be due to sensations from the surroundings.[1]
Theory of neuroplasticity explains that the phantom syndrome
may be due to the brain’s ability to form new connections
in response to changes in the environment. When cellphone
users regularly experience sensations, such as vibration or
ringing, their minds become wired to those sensations[24] and
lead to phantom. It works in the same way as how our brain
remains to keep adapting for the new information.
Transcutaneous electrical nerve stimulation theory proposed
by a professor of psychology at the University of Sydney
suggested that the phantom may be due to the sensation
interpreted by the nerves on the skin caused by a very small
105
 Goyal and Saini: Phantom syndrome
discharge of electricity given off by the phone when it
connects to a new tower. However, a recent study contradicts
this study in which students found to felt phantom from
pocket even when, the phone in their pocket is switched off,
or they do not have a phone in their pocket.[1]
Dopamine theory hypotheses that every text, WhatsApp,
Facebook, or Twitter notification is positively reinforced
our brains for the release of a little spurt of the dopamine.
A  dysregulated dopamine system has a central role in
psychotic symptoms such as hallucinations.[25] However, no
research‑based evidence is present in support of this theory.
Future Directions
Clinicians and researchers wonder what if it is possible
to manage the symptoms of the phantom syndrome. It is
also not known what happens when the individuals have
phantom and who’s most likely going to be affected by it.
Phantom syndrome somehow shows analogy to an auditory
hallucination[10] such as tinnitus which is a condition of
auditory phantom perception. Individuals who faced the
tinnitus experience auditory dysfunction such as hearing
loss and vertigo. However, to date, no such outcomes
have been reported by any study in case of the phantom
syndrome. However still, the phantom syndrome is an issue
that needs to be looked at as a serious problem. Clinical
information could be of great importance in treatment
planning, prognosis, and monitoring treatment outcomes,
and therefore, clinicians must design a diagnostic criterion
to diagnose the phantom syndrome.
Most of the studies, we reviewed in the present article
used self‑reported measures, and therefore, there is a
possibility of erroneous estimation of the frequency or
severity of phantom. Participants in these studies were
usually told that the study was on general behaviors related
to the smartphone usage to keep the study blinded as the
probability of biasness increased if the participants were
told the real purpose of the study. Most of the studies
conducted to date lack the robust methodology. Study
designs for phantom syndrome investigation need to be
standardized by developing appropriate statistical tools.
Moreover, there is no questionnaire available for the study
of the phantom syndrome. A  standard questionnaire needs
to be designed to assess the causes, severity, stress, and
related factor of the phantom syndrome. The questionnaire
should be based on sound theoretical background, for
example, first of all, a theoretical premise needs to be built
upon, which can be done by qualitative methodology. The
questionnaire then must be validated on a large population
to check questionnaire reliability and reproducibility.
Conclusion
New technology is a wonderful thing, but the more reliant
we become to it, the more negatively we will be affected
by it. Technology has taken over our lives in so many
106 Indian Journal of Social Psychiatry | Volume 35 | Issue 2 | April-June 2019
ways, and recently, it impacted the psychological health
in the form of the phantom syndrome. The present article
reviewed the available research available on the phantom
syndrome and pinned down the specific research ideas to
design effective prevention, management, and treatment
strategies for the phantom.
Acknowledgement
The authors are highly acknowledged to all the colleagues
who reviewed the present work.
Financial support and sponsorship
The work in the present article is financially supported by
the Junior Research Fellowship  (JRF) provided by ICMR,
New Delhi. (Grant No. 3/13/JRF ‑2015/HRD).
Conflicts of interest
There are no conflicts of interests.
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