Sexual Hallucinations in Schizophrenia Spectrum Disorders and Their Relation With Childhood Trauma

Abstract

Background: Sexual hallucinations are probably the most neglected types of hallucination, even in psychiatric settings. They are often multimodal in nature, and their prevalence rate is unknown. For other types of hallucination, notably auditory hallucinations, childhood trauma is an important risk factor. However, whether this also applies to sexual hallucinations is unexplored.Objective: To establish the prevalence rate of sexual hallucinations in a clinical sample of patients diagnosed with a schizophrenia spectrum disorder, to describe their phenomenological characteristics, and to estimate their relationship with childhood trauma.Methods: After screening 778 patients diagnosed with a schizophrenia spectrum disorder, 42 were considered eligible for inclusion by their treating physician or psychiatrist. Thirty of these patients were interviewed to assess the presence of sexual hallucinations, using a tailor-made questionnaire and the short form of the Childhood Trauma Questionnaire.Results: Of the 30 patients interviewed, 13 reported sexual hallucinations, yielding a 1-year prevalence rate of 0.017 in this clinical sample. Of the hallucinating patients, 46.2% reported multimodal hallucinations, with involvement of up to five sensory modalities. All patients who experienced sexual hallucinations reported a history of childhood trauma, of which 76.9% involved sexual trauma (OR 8.7). In addition, 61.5% of the patients reported high levels of distress.Conclusion: In patients diagnosed with a schizophrenia spectrum disorder, sexual hallucinations warrant appropriate medical attention. They are not as rare as traditionally thought, and their relationship with childhood trauma is overwhelming. Therefore, we recommend that clinical attention be paid to the psychotic and traumatic symptoms of these patients, as well as to the somatic conditions that may underlie them. For clinical and research purposes, we propose a classification of sexual hallucinations in accordance with the sensory modalities involved. As sexual hallucinations are also experienced in the context of temporal lobe epilepsy, narcolepsy, persistent genital arousal disorder, intoxications and other somatic conditions, further research in transdiagnostic populations seems warranted. In line with the current practice of providing trauma-focused treatment for trauma-related auditory hallucinations, we recommend that future studies explore the effectiveness of this type of treatment for sexual hallucinations.

The Diagnostic Spectrum of Sexual Hallucinations

“…91,92 Other reasons for expecting sexual hallucinations in borderline personality disorder are (1) the relatively high prevalence of sexual trauma, with rates varying from 26% to 71%, (2) the strong association between (sexual) trauma and sexual hallucinations in other patient groups, 1 and (3) the repeated and consistent finding that individuals with borderline personality disorder also experience other types of hallucinations, with prevalences ranging from 13% to 60%. 1,12,29,[93][94][95] These findings are at odds with the traditional views that hallucinations are rare in borderline personality disorder and that at their worst they are of a fleeting and self-limiting nature. And yet the studies cited indicate that hallucinations in this group are phenomenologically indistinguishable from those experienced by people with a schizophrenia spectrum disorder, that certainly not all of them are of a fleeting nature, and that the burden they may cause is often high.…”

“…Moreover, three studies revealed strong associations with previous (sexual) trauma, with odds ratios up to 8.7, meaning that the chance of developing sexual hallucinations was almost nine times higher for psychotic patients with a trauma history than for those without. 1,12,31 In conformity with the dopamine hypothesis, antipsychotics are the treatment of choice for sexual hallucinations in the context of schizophrenia spectrum disorders-which in 43% of the cases described (n = 14) led to full recovery, in 50% to partial recovery, and in 7% to a refractory state. In therapy-resistant cases, clozapine (or clozapine-plus) may be considered, even though we did not find any reports on this for sexual hallucinations as such.…”

“…And yet in clinical practice they rarely receive the attention they deserve. 1 Common examples are the sensation of being touched in erogenous zones, being stimulated sexually, being penetrated, and experiencing unbidden orgasms. Hallucinated sexual sensations may be unimodal or multimodal in nature, and need not involve the genital organs per se.…”

The devil molested me

“…[ 4 ] Childhood trauma has been associated as a predictable risk factor for Incubus Syndrome. [ 5 ] We here present three case reports of females who were suffering from psychotic disorder and presented with delusions and hallucinations related to incubus syndrome.…”

An unusual case of delusional disorder

“…Delusions of sex change are reported to be in 20 of patients with schizophrenia and are found more commonly in unmarried male schizophrenia patients. [ 3 ] Our patient was also male. “Pseudotranssexual” delusions are of four types namely “delusions of no longer being of one's own sex, delusions of being neuter, delusions of belonging to both sexes simultaneously, and delusions of belonging to the opposite sex.” Our patient belonged to the last category.…”