Monday, December 11, 2006

Sex With Fish

Great title, eh? I started out with "My Favorite Delusions" but I just had to change it based on a case I heard about today. Face it, one of the reasons we go into psychiatry is because our patients can be fascinating. Or more specifically, their delusions can be fascinating. At times it can be tough to sort out non-bizarre delusions from reality, but the truly bizarre ones can be very complex and interesting.

In prison the most common isolated delusion I see is the contamination delusion. An inmate will believe that people are putting something into his food. He will go into great detail to point out something about the food that doesn't look or smell right, or will have some type of somatic symptom that he believes is proof that something has been done to him. In addition to giving medication, you can temporarily relieve anxiety by giving the inmate only food in unopened packages and this can help while you're waiting for the medication to kick in.

Being close to our nation's capitol we also sometimes get folks with politician-related delusions. They get arrested while travelling to Washington to confront the "devil-worshippers" controlling the government, or to get in touch with their "relatives" who happen to live in the White House. (Bush and Clinton would be surprised to learn how many patients they've fathered.) Presidential threateners are rare, but do show up occasionally. I understand the Secret Service even has a team that functions as something of an assertive community outreach program to ensure that threateners get their medications in the community.

But in addition to that, I've got a few other favorites:

Olfactory reference syndrome

This is the belief that one has a foul body odor. It's not a true hallucination in the sense that it is a smell that is associated with an idea, rather than just a perception. People will associate the smell with a body part which can lead them to excessive or repetitive washing or bathing. People with this delusion sometimes feel compelled to isolate themselves from others or to repeatedly apologize to others for their smell.

Capras syndrome

Also called imposter's syndrome, it's the belief that familiar acquaintances have been replaced by imposters. Think "Invasion of the Body Snatchers".

Fregoli syndrome

This is the inverse of the Capgras delusion. With Fregoli syndrome people believe they are being followed or stalked by someone who changes shape or form to look like others. If any of you have seen the Denzel Washington movie "Fallen" you can get an idea of what Fregoli syndrome would be like.


This is the belief that one's penis is disappearing or shrinking into one's body. This is not to be confused with kuru, a degenerative neurological disease caused by prions transmitted by cannibalism.

So what got me on this delusional theme today? I heard about a case of someone who believed he was having sex with fish. I will never look at the Little Mermaid in quite the same way again. I can only hope he's practicing safe sushi.