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CASE SERIES
Year : 2022  |  Volume : 31  |  Issue : 2  |  Page : 346-349  Table of Contents     

The devil molested me: A case series of incubus syndrome from North India


1 Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
2 Department of Psychiatry, Government Medical College and Hospital, Haldwani, Uttarakhand, India

Date of Submission02-Oct-2021
Date of Acceptance25-Nov-2021
Date of Web Publication02-Aug-2022

Correspondence Address:
Dr. Robin Victor
Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Bhaniawala, Dehradun - 248 140, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipj.ipj_207_21

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   Abstract 


Incubus syndrome is a disorder typically seen in females where she reports that a male demon lies upon her and engages in sexual activity with her. While the concept of incubus is typically based on Western folklore a limited number of case reports are present on this topic more from India. There is a diverse opinion among the authors related to this disorder where some link this to psychotic disorders while some to sleep disorders. Here we report a case series of females who were suffering from psychotic disorder and over time developed incubus syndrome. We also the role of cultural factors and superstition in the formation of these disorders and the role of antipsychotic medication and modified electroconvulsive therapy in its treatment.

Keywords: Devil, incubus, psychosis, schizophrenia


How to cite this article:
Victor R, Avinash P, Rohatagi R, Aulakh AS. The devil molested me: A case series of incubus syndrome from North India. Ind Psychiatry J 2022;31:346-9

How to cite this URL:
Victor R, Avinash P, Rohatagi R, Aulakh AS. The devil molested me: A case series of incubus syndrome from North India. Ind Psychiatry J [serial online] 2022 [cited 2022 Dec 2];31:346-9. Available from: https://www.industrialpsychiatry.org/text.asp?2022/31/2/346/352803




   Introduction Top


Incubus Syndrome is a psychopathological disorder in which a person, especially females, have a strong delusion that they have been sexually approached at night by a devil/demon.[1] The concept of incubus has been present since ancient times where it was believed that Incubus or a Demon lies upon the females and engages in sexual activity with them. De Clerambault, pointed that this illness is related to the delusion of erotomania, which is characterized by a strong sexual desire which has primary and secondary forms. The primary form is characterized by a sudden abrupt onset of delusions in clear consciousness without any hallucinations and without any change in the form and flow of chronicity of delusion. The secondary form is described as having transient delusions during a full-blown psychosis or during the prodromal phase of a psychotic illness. Hallucinations are often associated with it. The underlying psychiatric illness is usually schizophrenia or a paranoid disorder.[2] Later, it was classified as a form of secondary erotomania.[3] This syndrome is commonly seen in the young age group of the thirties. This manifestation is also sometimes associated with in sleep paralysis, narcolepsy, posttraumatic stress disorder, and panic attack.[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.


   Case Reports Top


Case Report 1

A 45-year-old female was brought to the hospital with complaints of anger outbursts mostly in the morning, muttering to self, suspiciousness (that someone is controlling her and watching her), decreased sleep, and tingling sensation in the genital region (clitoris) since past 1 month. She was a known case of schizophrenia from the past 20 years and was taking medications irregularly.

The patient complained that the sensation came when she saw unknown males around her and believed that they were somehow touching her genitals which would make tingling sensation although they were physically away from the patient. She reportedly started abusing unknown males and later also believed that her husband is also stimulating her genitals making tingling sensation in her clitoris without touching it manually. She attributed that her husband had powers by which he could make any female clitoris tingle. She also had the delusion of infidelity towards her husband. Due to this delusion, she started sleeping separate from her husband in the adjacent room. During further interview, she reports that this tingling sensation once started almost lasted for 2-3 h and she was unable to do any other work and had to lie down in the bed. She also said that while sleeping at night she would feel the hand of unknown men touching her genitals and sometimes a male phallus touching her genitals. She would often wake up from sleep but would not find anyone around. Her husband reported that while sleeping she used to have pelvic thrusting movements and there was no self-genital stimulation. She did not report any orgasm with tingling sensation neither does she report pleasure with it on contrary she was distressed. Based on the history diagnosis of schizophrenia with incubus delusion was made.

There was no history suggestive of any other medical, psychiatric, psychological, and neurological- or sleep-related illness. Her basic investigations such as complete blood count, liver and renal function test, thyroid profile, and computed tomography (CT) scan head were done and all were normal. Her general physical examination including genital examination by a gynecologist was unremarkable.

Based on the available information she was started on risperidone 4 mg/day and tingling sensation disappeared within a week after which she was discharged. On the next follow-up after 1 month, she was maintaining well on the above treatment.

Case report 2

A 35-year-old married female presented with continuous illness for the last 10 years exaggerated for the last 8 months. She had complains of intermittent screaming episodes, extreme fearfulness, hearing voices not heard by others (especially someone abusing her), suspiciousness towards family members and abusive aggressive outbursts towards family members. On further interviewing the patient, she said that there were episodes when she could feel someone touching from her feet towards the upper body (especially her breast and genitals) which scared the patient and she used to shout after this. She also reported that during sleep she could feel the weight of someone on her upper body and could feel male phallus inside her vagina and she was unable to move during these episodes in sleep. On waking up she felt as if it had actually happened. On asking that whether the males were known to her or not she responds that some were known and some were unknown (some shadow with horns on the head). The known member was her father-in-law, due to which she avoided and even slapped her father-in-law when he tried to talk to her. This belief of her was unshakable amounting to delusion. Every day she used to wake up terrified and feared to go to sleep. She did not report any pleasure out of this, rather was distressed and had suicidal ideas due to this. There was no history suggestive of any other medical, psychiatric, psychological, and neurological- or sleep-related illness.

Her basic investigations such as complete blood count, liver, and renal function test, thyroid profile, and CT scan head were done and all were normal. She was diagnosed with schizophrenia. She was started on aripiprazole 10 mg/day which was gradually increased to 30 mg/day. She responded well to treatment and symptoms of incubus syndrome decreased over a period of 1 month to the extent that she only feels heaviness over the chest sometimes in dreams and does not feel any other sensation.

Case report 3

A 39-year-old married female presented to the OPD with husband with complaints of headache all throughout the day, mild in intensity, in the whole head as if someone has kept a stone on her head followed by intermittent episodes of unresponsiveness lasting for 5-15 min. These symptoms occurred from the last 6 months and the patient had visited many doctors but to no relief. On detailed interview patient-reported inter-personal stressors between her and her husband and that her husband visited her once a month as he was doing job in another city. For the last 6 months, patient reports that during sleep she was being inappropriately touched over breasts and genital area which followed by the feeling of sexual intercourse which would happen daily. She believed that different persons of varied height and weight had sexual intercourse with her, leading her to multiple orgasms each night. On waking up she used to feel fatigued and disgusted. She feared going back to sleep and because of this over a period of time developed low mood and suicidal ideas. These episodes even happened when her husband was sleeping with her. On asking her husband confirmed of these episodes where the patient would wake up screaming multiple times at night and would fear going back to sleep. The patient was convinced that someone had done black magic on her because of which the devil used to send demons to had sexual intercourse with her. Patient's conviction about these experiences was amounting to delusion and she also had visited many faith healers also but to no relief. Based on her history, the diagnosis of persistent delusional disorder was made. There was no history suggestive of any other medical, psychiatric, psychological, and neurological- or sleep-related illness. Her basic investigations such as complete blood count, liver and renal function test, thyroid profile, and CT scan head were done and all were normal.

She was put on oral aripiprazole 20–30 mg/day for 2-3 weeks but showed minimal improvement. She was then treated with modified electroconvulsive therapy (mECT). After 4 cycles mECT she showed significant improvement in her symptoms. She was discharged on haloperidol 20 mg and she maintained well till date.


   Discussion Top


The concept of incubus or a “demonic lover” has been present since ancient times. Typically the incubus comes over a female at night while she is asleep and engages in sexual activity with her. The female counterpart of incubus is known as succubus.[4]

The data regarding the illness are limited and in almost all the cases that were reported the patient is suffering from some form of psychosis (either schizophrenia or delusion disorder).[6] A case report by Varadharajan 2021 et al. mentions incubus syndrome in a case of Psychosis not otherwise specified (psychosis NOS).[7] While reviewing through the literature we also found that this syndrome has also been referred to as “phantom lover” syndrome.[8] Raschka[1] has reported this disorder as a variant of erotomania where the person has a belief that some known/unknown person is intensely in love with them. Pande[9] reported the presence of incubus syndrome with coexistent Capgras delusion.

Some of the authors have attributed this disorder to a state of sleep paralysis and nightmares.[4] The exact mechanism of this remains unclear. The earliest reports of incubus syndrome were made by a Dutch physician in 1664 where the females reports being raped by a demon and their body paralyzing in such acts.[4]

While the concept of incubus syndrome is mainly western its presence in the Indian subcontinent is not uncommon. Many case reports and series have been published from the Indian subcontinent in almost all of these cases the patient has some form of psychosis.[6],[7],[10] Similar to these reports all our cases were females and two of them had schizophrenia while one had the delusional disorder.

Some cases of incubus syndrome have been reported with sleep disorders/parasomnias especially sleep paralysis where the person is not able to move his/her body. This state of “atonia” has been described to occur usually at an age of 30 years and associate with narcolepsy, panic disorder, or post trauamatic stress disorder. None of our patient reported any such disturbances and almost all had the delusional unshakable belief of being molested by demon at night. All our patients were treated with antipsychotics and showed adequate response again linking the phenomenology of incubus to psychosis. One of the patients who did not show adequate response to antipsychotic was treated via mECT. A previous case report from India had shown the effectiveness of ECT in a patient with schizophrenia having incubus syndrome.[10] One of our patients attributed these symptoms to black magic while another one had visited many faith healers before presenting to us highlighting the role of cultural belief and superstition in formation of this disorder.

Our case series is a humble attempt to add to the limited literature on incubus syndrome, especially from north India.

Declaration of patient consent

The authors declare that they have obtained consent from patients. Patients have given their consent for their images and other clinical information to be reported in the journal. Patients understand that their names will not be published and due efforts will be made to conceal their identity but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Raschka LB. The incubus syndrome. Variant of erotomania. Can J Psychiatry 1979;24:549-53.  Back to cited text no. 1
    
2.
Jordan HW, Howe G. De Clerambault syndrome (erotomania): A review and case presentation. J Natl Med Assoc 1980;72:979-85.  Back to cited text no. 2
    
3.
Calil LC, Terra JR. The De Clèrambault's syndrome: A bibliographic revision. Braz J Psychiatry 2005;27:152-6.  Back to cited text no. 3
    
4.
Cox AM. Sleep paralysis and folklore. JRSM Open 2015. doi:10.1177/2054270415598091.  Back to cited text no. 4
    
5.
Blom JD, Mangoenkarso E. Sexual hallucinations in schizophrenia spectrum disorders and their relation with childhood trauma. Front Psychiatry 2018;9:193.  Back to cited text no. 5
    
6.
Grover S, Mehra A. Incubus syndrome: A case series and review of literature. Indian J Psychol Med 2018;40:272-5.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Varadharajan N, Bascarane S, Menon V. Atypical incubus syndrome: A case report. Indian J Psychiatry 2021;63:203.  Back to cited text no. 7
  [Full text]  
8.
Greyson B, Akhtar S. Erotomanic delusions in a mentally retarded patient. Am J Psychiatry 1977;134:325-6.  Back to cited text no. 8
    
9.
Pande AC. Co-existence of incubus and Capgras syndromes. Br J Psychiatry 1981;139:469-70.  Back to cited text no. 9
    
10.
(PDF) INCUBUS IN SCHIZOPHRENIA. Available from: https://www.researchgate.net/publication/332181801_INCUBUS_IN_SCHIZOPHRENIA. [Last accessed on 2021 Sep 13].  Back to cited text no. 10
    




 

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