No precise factors will always cause Truman syndrome, but there are certain cultural conditions that must be met in order for this illness to occur. First and foremost, the affected person must live in a culture where the concepts of surveillance and performance exist. Most cultures have some concept of a person or thing who may watch over humans, but only some cultures foster the idea that actual recording or documentation by a group of people or government is a possibility. The person in question must also have a predisposition to delusions or be put in a situation that makes him or her think in a delusional manner. Only when these conditions have been met can Truman syndrome occur, and though they do not guarantee a specific path for delusions, they can be thought of as a kind of cause.
The first thing that a person must understand when looking for the cause of Truman syndrome is that each individual case may have a unique cause. Essentially, the cause of this condition is always a delusional state, which may be brought on by any number of mental illnesses. Some people with only a mild history of paranoia and delusions might be highly susceptible to this type of belief without acting on any of the suspicions related to the syndrome. This can allow the illness to go on secretively for years, obscuring the initial cause.
Social causes of Truman syndrome relate to the specific idea that someone is being watched and recorded in some manner. This idea has shown up in books, movies, and other media, which often explains how the delusional person came to hold this belief in the first place. It is not true that these stories cause this illness directly, but for an idea like this to evolve naturally is more rare than for it to result from suggestion.
There is one case in which a false type of Truman syndrome might occur. If in fact a person close to the victim is planting ideas in his or her head or the victim was raised to believe that the conditions of surveillance were true, then this might present as a false version of the syndrome. This version would be false because the idea was planted maliciously over time by another human being and thus could not represent a true delusion. Although the results of this type of psychological abuse might be the same as the internally inspired illness, this manifestation has a clear and obvious cause.
