A cross-sectional study of current and lifetime sexual hallucinations and delusions in Lebanese patients with schizophrenia: frequency, characterization, and association with childhood traumatic experiences and disease severity

Abstract

Background Till that date, a sparse body of research has been dedicated to perusing psychotic symptoms of sexual type, particularly in psychiatric populations. Our study’s objective was to delineate psychotic symptoms with a sexual content, namely sexual delusions and hallucinations, among inpatients diagnosed with schizophrenia in Lebanon, and scrutinize their relationships with the severity of schizophrenia symptoms and childhood abusive events. Methods We conducted structured interviews with 167 chronic schizophrenia patients, who completed the Questionnaire for Psychotic Symptoms with a Sexual Content, the Child Abuse Self-Report Scale, and the Positive and Negative Syndrome Scale. Results 36.5% and 50.3% of the participants screened positive for current and lifetime episodes of sexual delusions and/or hallucinations, respectively. Alcohol drinking (aOR (adjusted odds ratio)current = 2.17; aORLifetime = 2.86) and increased psychological (aORcurrent = 1.09; aORLifetime = 1.09) and sexual (aORcurrent = 1.23; aORLifetime = 1.70) abuse were significantly associated with higher chances of experiencing current and lifetime sexual hallucinations and/or delusions. Additionally, an increased severity of schizophrenia symptoms (aOR = 1.02) was significantly associated with higher chances of current sexual hallucinations and/or delusions, whereas having a university level of education compared to primary (aOR = 0.15) was significantly associated with lower odds of current sexual hallucinations and/or delusions. Conclusion In sum, our findings suggest that sexual psychotic symptoms are prevalent in chronic schizophrenia patients, providing support for their associations with antecedents of childhood traumatic experiences, illness severity, and substance use disorders. They endorse the vitalness of preventive measures against abuse, in order to circumvent such phenomenological outcomes. Our study offers the first data on sexual hallucinations and delusions in a non-Western psychiatric population, thus allowing clinicians and researchers to draw featural comparisons across different cultural settings.

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.…”

“…Blom and Mangoenkarso 1 found a one-year prevalence of 1.7% in 778 clinical patients, while Small and colleagues 28 reported a rate of 4% for 50 recently hospitalized patients. In a group of 167 chronically hospitalized patients, Gerges and colleagues 29 recently found a current rate of 21%, and in a similar group of 113 patients, Lyketsos and colleagues 30 earlier computed a current rate of 19.5%. In their study, Gerges and colleagues 29 mention a lifetime prevalence of 30.5%, whereas five decades earlier in a similar but entirely female population, Gittleson and Dawson-Butterworth 25 found a lifetime prevalence of 44% for genital hallucinations.…”

“…In a group of 167 chronically hospitalized patients, Gerges and colleagues 29 recently found a current rate of 21%, and in a similar group of 113 patients, Lyketsos and colleagues 30 earlier computed a current rate of 19.5%. In their study, Gerges and colleagues 29 mention a lifetime prevalence of 30.5%, whereas five decades earlier in a similar but entirely female population, Gittleson and Dawson-Butterworth 25 found a lifetime prevalence of 44% for genital hallucinations. According to Lebovitz and colleagues, 31 of 40 voice hearers receiving treatment at an outpatient clinic, 53% reported that the utterances had a sexual content, while an unknown proportion also experienced bodily sexual hallucinations.…”

Exploring the association between lifetime traumatic experiences and positive psychotic symptoms in a group of long-stay patients with schizophrenia: the mediating effect of depression, anxiety, and distress

“…Not to forget the role of culture in severe mental illnesses such as schizophrenia which requires adequate attention and continued research [ 55 ]. An anterior Lebanese study aimed to delineate psychotic symptoms with sexual content, along with their relationships with the severity of schizophrenia symptoms and childhood abusive events [ 56 ]. They found that 36.5 and 50.3% of the participants screened positive for current and lifetime episodes of sexual delusions and/or hallucinations, respectively [ 56 ].…”

“…An anterior Lebanese study aimed to delineate psychotic symptoms with sexual content, along with their relationships with the severity of schizophrenia symptoms and childhood abusive events [ 56 ]. They found that 36.5 and 50.3% of the participants screened positive for current and lifetime episodes of sexual delusions and/or hallucinations, respectively [ 56 ]. Another cross-sectional study examined a sample of Lebanese patients with schizophrenia to identify clinical risk factors for aggressiveness including child abuse.…”