The term "Sissi syndrome" sounds clinical, but is not a recognized diagnosis. It appears neither in the ICD nor in the DSM. It originated in the late 1990s as a catchy label, linked to a well-known figure: Empress Elisabeth of Austria ("Sisi/Sissi"). Her public image—restless travel, strict diets, perfectionism, constant activity—was used to personify a supposed "female depressive type": not slow and withdrawn, but driven and internally turmoiled. This attracted attention because it challenged a stereotype: that depression always appears dull, apathetic, and passive.
What was "Sissi syndrome" supposed to describe? In short, a restlessly experienced form of suffering—inner tension, insomnia, hyperactivity, relentless striving, and high levels of self-control. The narrative suggested that some high-achieving women didn't look "depressed": They functioned, performed, and perfected—and yet felt chronically restless. Clinically, this image overlapped with concepts such as agitated depression, anxiety symptoms, eating disorder traits, or aspects of the bipolar spectrum. These patterns are real and taken seriously—just not under the label "Sissi syndrome."
Why did the term spread? Contemporary accounts link its popularity to pharmaceutical marketing and media reports around 1998. The story was powerful: an iconic empress, a modern "hidden depression," and a treatment era that sought to address unrecognized burdens. This blend of history, gender narratives, and pharmacology worked—but it was more narrative than evidence. When labels emerge from headlines rather than research careers, stereotypes (e.g., about "ambitious, overly controlled women") threaten to perpetuate themselves—and the complexity of differential diagnostics is glossed over.
What are the consequences today?
First, let's be clear: "Sissi syndrome" is not a recognized disorder. Clinicians assess agitation, insomnia, perfectionism, and drivenness based on established criteria and differential diagnosis—not using a pop-language term.
Second, empathy: The experience the label was intended to capture—"I appear functional, but I never find inner peace"—is real and common. Many feel overlooked because their suffering doesn't fit the common depression stereotype.
Third, a question: Who shapes the language of mental health—research and care, or culture and commerce? The "Sissi" story reminds us not to confuse these forces.