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Try out PMC Labs and tell us what you think. Learn More. Background: Sexual hallucinations are probably the most neglected types of hallucination, even in psychiatric settings. They are often spectrophilia definition 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 spectrophilia definition 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 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.
: Of the 30 patients interviewed, 13 reported sexual hallucinations, yielding a 1-year prevalence rate of 0. Of the hallucinating patients, All patients who experienced sexual hallucinations reported a history of childhood trauma, of which In addition, 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. Sexual hallucinations are probably the most neglected types of hallucination, even in psychiatric settings.
This may be due to the fact that the sexual modality falls outside the five basic sensory modalities i. Another reason may be that patients suffering from sexual hallucinations spectrophilia definition likely to feel embarrassed to talk about these phenomena.
Alternatively, health professionals may expect their patients to be embarrassed and, hence, refrain from asking about them. Moreover, when other types of hallucination provide sufficient reason to initiate pharmacological treatment as in the presence of distressing auditory hallucinations the need to explore the presence of sexual hallucinations may appear superfluous to clinicians.
Thus, there appear to be various reasons why these phenomena tend to go unnoticed and are considered very rare. However, we believe this is more a case of their being unreported or unexplored as few systematic studies on this topic have been conducted, implying that sound prevalence rates of sexual hallucinations are still lacking. Clinical practice indicates that these types of hallucination can be extremely burdening.
Based on our experience at a secluded nursing ward for patients diagnosed with schizophrenia spectrum disorders, we know that patients sometimes report the taste of sperm in their mouths, describe the bewildering sensation of being changed into a person of the opposite sex, or experience random orgasmic feelings which seriously disrupt their ability to function, especially in social situations. Although not all sexual hallucinations have such a dramatic spectrophilia definition, the latter example may serve to underline the importance of the need to pay appropriate medical attention to these underreported and virtually unexplored phenomena.
In the last decade, childhood trauma has become firmly established as a risk factor for hallucinations of the verbal auditory type i. To investigate whether this might also hold spectrophilia definition for sexual hallucinations, we screened all patients newly admitted to two nursing wards of our psychiatric hospital to establish the presence of sexual hallucinations and childhood trauma. From this clinical sample we describe 13 cases and provide data on the prevalence and frequency of sexual hallucinations in this group, the phenomenological characteristics of the hallucinations, the levels of ensuing distress, and associations with childhood sexual trauma.
Some recommendations are also made for further research and clinical practice. From July through Junewe requested all psychiatrists and psychiatric residents in the service of two nursing wards for patients diagnosed with a schizophrenia spectrum disorder at Parnassia Psychiatric Institute The Hagueto refer any patients whom they might suspect at that moment of experiencing sexual hallucinations i.
Patients were considered eligible for inclusion when they experienced one or more of these hallucinations. Other inclusion criteria were age 18—65 years, and a DSM-IV diagnosis of schizophrenia or a related psychotic disorder, as established by the treating psychiatrist.
After oral and written explanation of the study, written informed consent was obtained from all participating patients. All interviews were carried out by spectrophilia definition psychiatric resident E. During the interviews, and on the basis of the patients' medical files, demographic data were collected regarding age, gender, marital status, level of education, and clinical diagnosis.
In addition, two questionnaires were administered. The first one was a tailor-made, semi-structured questionnaire specifically deed for the present purpose Data Sheet 1which contained 27 questions about the presence of sexual hallucinations and delusions during the past 2 weeks, the nature of the delusions if presentthe phenomenological characteristics of the hallucinations if presentand ensuing levels of distress.
The second questionnaire was the short form of the Childhood Trauma Questionnaire [CTQ-SF; 6 ], which was employed to explore possible relations between reported sexual hallucinations and any childhood adversities, if present. The CTQ-SF is a validated self-report questionnaire [also for psychotic disorders, see 7 ] which contains 25 questions to assess the presence and severity of five different types of childhood trauma, i. Each trauma category is assessed with the aid of five statements for which participants select a level of frequency, i.
These responses are then coded on a 5-point Likert scale. Total CTQ-SF scores range from 25 towith each individual abuse subscale ranging from 5 to 25, and higher scores indicating more severe types of abuse. Data were analyzed using SPSS version Descriptive statistics were calculated for each variable of interest. Chi quadrate tests and Fisher's exact test were used to assess the association between sexual hallucination and childhood trauma.
Logistic regression was used to analyse these associations, and correct for different confounders between childhood traumatic experiences and sexual hallucinations. During the 2-year inclusion phase, a total of 2, admissions took place at the two nursing wards. With almost half of the patients being admitted more than once sometimes as often as 10 times a yearthe total of individual patients was Of these, 42 5. Eight of these patients refused to participate, and four were discharged before they could be included.
The remaining 30 3. Of these, 19 The mean age of the participants was 39 SD 12; range of 19—64 years; spectrophilia definition participants None of the participants had a diagnosis of substance abuse disorder, although some of them did occasionally use alcohol, cannabis or other illicit substances.
Of the 30 participants, 13 Of the remaining 17 Based on these data, the 1-year prevalence of sexual hallucinations in our clinical sample was 0. Tactile sexual hallucinations were reported most frequently, i. Among them, seven Both visual and verbal auditory hallucinations with an explicit sexual content were experienced by five participants Remarkably, six participants Percentage of patients experiencing s exual hallucinations, per sensory modality. Color codings indicate the presence of multimodal hallucinations in up to five sensory modalities. As some of the participants experienced hallucinations in more than one sensory modality, the total spectrophilia definition is higher than Some examples of qualitative descriptions of the sexual hallucinations were as follows.
One participant described that it felt as if her skin and genitals were being touched while there was no-one around. As a consequence, she attributed these tactile hallucinations to a ghost. In addition, she described sexually charged electrical shocks applied to the genitals, breasts, and anus. Another participant experienced fingers running over his body which he, too, attributed to a ghost.
The sensation of being penetrated and sexually abused was mentioned by several patients, as were visual images of people having sexual intercourse. Two participants reported nightly visits by an intruder who climbed upon them to have sexual intercourse with them i. In addition, one of these two participants reported continuous day-time sexual hallucinations.
One participant spectrophilia definition experienced auditory hallucinations reported a voice commanding him to visit his partner for the purpose of initiating sexual intercourse. Another participant heard a voice urging him to masturbate, while yet another one reported hearing random orgasmic sounds. Of the hallucinating participants, eight Associated emotions were fear, anger, helplessness, depression, and shame. Only one patient 7.
Of the 30 participants, 26 Sexual abuse was the most common variant, reported by 16 of the participants Men and women had comparable scores: No ificant differences were found between men and women on the various subscales of the childhood trauma scores. In the subgroup of participants who experienced sexual hallucinations, all 13 reported at least one form of childhood trauma.
Regarding sexual trauma, 10 of them No ificant differences were found between the two groups for any of the other forms of childhood trauma. An odds ratio OR of 8. Rates for various types of childhood trauma as reported by patients experiencing sexual hallucinations, vs. In this clinical sample of acutely admitted patients diagnosed with a schizophrenia spectrum disorder, spectrophilia definition 1-year prevalence of 0. However, very few studies are available for a direct comparison, since none of the 10 large-scale epidemiological surveys of hallucinations carried out in the general population singled out sexual hallucinations as a separate category [for an overview see 9 ], and clinical surveys of sexual hallucinations are rare.
Thus, even though most studies were performed in a clinical setting and among population groups comparable to our own, older prevalence rates range from 0. This may be due to methodological differences, since the older studies did not always provide case definitions, not all studies explicitly stated whether they focused on the present-state or lifetime presence of sexual spectrophilia definition, and not all studies indicated whether or not their patients were randomly recruited.
As a consequence, the reported prevalence of sexual hallucinations of the latter sample cannot be accepted at face value. The most recent survey of sexual hallucinations, by Thompson et al. After recruiting 92 patients from an Australian outpatient facility for young individuals aged 15—24 years at ultra-high risk for psychosis, Thompson and colleagues found that 6.
Although the authors do not state whether the visual and auditory hallucinations were experienced by different individuals, the prevalence of sexual hallucinations in their outpatient sample of individuals with attenuated psychotic symptoms appears to be 0. This, too, is a relatively high rate compared with our findings, especially considering the much broader definition of sexual hallucinations that we used covering seven rather than three sensory modalities and the fact that our participants were more severely ill.
As a consequence, we consider the rate that we established as very conservative. Historically, descriptions of sexual hallucinations have been very rare. For millennia, the only exception seems to have been the incubus phenomenon, i. The condition has been known since Antiquity and, up until the nineteenth century, was attributed to metaphysical beings such as demons or fallen angels Other descriptions dating back to Antiquity are those of rare instances of satyriasis and nymphomania, i.
During the nineteenth century, Parish 17 briefly described sexual hallucinations in the context of hysteria, in cases where nitrous oxide was administered, and referencing Boerhaave intoxications with Atropa belladonna and Datura stramonium. Bleuler 18 merely remarks that tactile and somatic hallucinations in the context of schizophrenia often start out as genital sensations, while von Krafft-Ebing 19in his Psychopathia Sexualisdescribes a man who, under the influence of large quantities of Indian hemp i.
From the s onwards, various case spectrophilia definition and modest case series have been published on sexual hallucinations in the context of hypoparathyroidism 20schizophrenia 21 — 24mental retardation 25narcolepsy 2627epilepsy 2829and the use of anesthetics 30 ,Spectrophilia definition
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Sexual Hallucinations in Schizophrenia Spectrum Disorders and Their Relation With Childhood Trauma