Year : 2021  |  Volume : 63  |  Issue : 2  |  Page : 203--204

Atypical incubus syndrome: A case report

Natarajan Varadharajan, Sharmi Bascarane, Vikas Menon 
 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Correspondence Address:
Natarajan Varadharajan
Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry

How to cite this article:
Varadharajan N, Bascarane S, Menon V. Atypical incubus syndrome: A case report.Indian J Psychiatry 2021;63:203-204

How to cite this URL:
Varadharajan N, Bascarane S, Menon V. Atypical incubus syndrome: A case report. Indian J Psychiatry [serial online] 2021 [cited 2021 Jun 12 ];63:203-204
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“Incubus” as per mythological beliefs refers to a male demon who rapes women during sleep.[1] Incubus syndrome reported in literature is usually noticed in patients with schizophrenia or along with other delusions in a delusional disorder.[2],[3],[4],[5] To our knowledge, patients having incubus phenomenon alone without any other psychotic symptoms have never been reported. We report a 45-year-old female who presented with a history of strange sexual experiences occurring during sleep for the past 4 years. Having separated from her husband, she had been living alone for the past 14 years.

Initially, she reported of someone having sexual intercourse with her every night during sleep. She woke up in fear (about 1 h after falling asleep) and to her surprise, no one was around. She clearly described feeling the pressure of someone lying on her and the to and fro motion of phallus in her vagina. Due to disturbed sleep at night, she tried sleeping during the daytime, but these symptoms endured, nearly every day. She spent a huge amount of money on visiting faith healers and even changed her religion to stop them but in vain. She remained preoccupied and distressed with these beliefs throughout the day. To relieve this distress, she self-medicated with over-the-counter sedative-hypnotic agents but to no avail. Probing further, she was convinced that it was a deceased's spirit who was indulging in sexual acts with her. She described the deceased as a young guy, who during his brief stay in her home, had made sexual advances toward her multiple times, and hence had to be sent back to his parents. A few months later, she heard that he committed suicide. The reason was unknown and no one blamed her for it, despite which she felt guilty and responsible for his death. Her symptoms started a week after his death.

There was no history suggestive of any other comorbid psychiatric diagnosis (posttraumatic stress disorder, schizophrenia, depression, narcolepsy, cognitive deficits, and other substance abuse) or organicity. All the basic investigations and computed tomography of brain were normal. Parasomnias were ruled out by history, and hence polysomnography was not done. We diagnosed her with psychosis not otherwise specified (NOS) as per Diagnostic and Statistical Manual-5 and initiated her on tablet olanzapine and titrated it to 10 mg/day. She reported complete improvement of symptoms in a month. She is on regular follow-up for the past 3 months and continues to be asymptomatic.

All incubus syndrome patients reported in the literature have been diagnosed with either schizophrenia[3] or delusional disorders.[4],[5] Furthermore, this patient suffers from a variant of erotomania like phantom lover syndrome but occurring during sleep.[6] Hence, a diagnosis of psychosis NOS (atypical incubus syndrome) was made. Complete resolution of symptoms with olanzapine points to an underlying psychotic illness.

Careful history must be sought to rule out the presence of other psychotic symptoms and parasomnias. Cultural aspects of the incubus phenomenon merit further evaluation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.


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