What percentage of syncope episodes are psychogenic in nature?

Psychogenic syncope accounts for approximately 1-5% of all syncope cases. These episodes, also known as psychogenic pseudosyncope, are not true syncope as they don't involve actual cerebral hypoperfusion but rather represent a psychological response that mimics fainting. The diagnosis is often challenging and requires careful exclusion of other causes of syncope, particularly cardiac and neurological conditions. Psychogenic syncope typically occurs in younger individuals and may be associated with underlying psychiatric disorders such as anxiety, depression, or conversion disorder. Episodes often have atypical features compared to true syncope, including longer duration, absence of pallor, rapid recovery without confusion, and sometimes unusual movements that don't match typical neurological patterns. Management primarily involves addressing the underlying psychological factors through cognitive behavioral therapy, psychotherapy, or psychiatric medications when appropriate. It's important to approach patients with suspected psychogenic syncope compassionately, as the symptoms are real to them even though they stem from psychological rather than physiological causes.