Sexual hallucination in a woman with schizophrenia spectrum disorder: A very rare clinical presentation

Introduction:

Sexual hallucinations are an exceptionally rare phenomenon within the schizophrenia spectrum, often overlooked due to stigma, underreporting, and diagnostic challenges. These hallucinations, usually tactile in nature, may cause extreme psychological distress and impairment.

Aims and Objectives:

This report aims to highlight a rare case of distressing sexual hallucinations in a woman with schizophrenia spectrum disorder and outline clinical implications for assessment and management.

Case:

A 24-year-old married woman presented with recurrent episodes of tactile hallucinations involving an invisible male figure engaging in forced sexual activity during semi-awake states. These episodes lasted 10–15 minutes, occurred several times per week, and caused fear, shame, and severe functional decline. She also reported persecutory delusions, second-person auditory hallucinations, insomnia, and social withdrawal for three months. Medical, neurological, and gynecological examinations were unremarkable. No history of abuse or substance use was reported.

Result:

The patient met DSM-5 criteria for schizophrenia spectrum disorder. Treatment was initiated with risperidone (4 mg/day) and clonazepam (0.5 mg/day). Within four weeks, sexual hallucinations markedly reduced, and overall functioning improved. At eight weeks, hallucinations ceased entirely, and delusional intensity significantly declined.

Conclusion:

This case underscores the need for clinicians to inquire sensitively about sexual hallucinations, as patients may hesitate to report them due to cultural and personal shame. Early recognition and antipsychotic treatment can result in significant improvement. Further research is needed to better understand the phenomenology, neurobiology, and optimal management of these rare hallucinations.

Dr. Muhammad Sayed Inam is an Associate Professor of Psychiatry at Sylhet MAG Osmani Medical College, Bangladesh. He is a clinician, researcher, author, and trainer with multiple publications in international journals, including Cambridge University Press and BJPsych Open. He has presented scientific work at major global conferences hosted by APA, RCPsych, and RANZCP. He is known for his humanitarian psychiatric services and mental health outreach in rural Bangladesh.