Most bizarre Psych Disorders Part 2

Hello, people! Welcome back to the blog. Hope everyone had a great weekend. I’ll tell you, anyone who doesn’t believe in global warming doesn’t live here in SoFla, because it was a warm one. It sure doesn’t feel like two weeks until Christmas. Anyway, I guess we should get to the shrinky stuff. Two weeks ago, I introduced you to some of the scariest mental disorders out there, and we talked about apotemnophilia, where people have the desire to amputate a healthy, functional limb, Capgras delusion, where people believe that the people in their lives have been replaced with duplicate imposters that are hell bent on harming them, Diogenes syndrome, better known as hoarding, and factitious disorder, where people go to great lengths to fake symptoms of real illness. This week, we’re going to continue the discussion, and things are going to get way weirder- and scarier- so buckle up, folks.

Alice in Wonderland Syndrome

Alice in Wonderland is total fantasy, but one of Alice’s more bizarre experiences shares its characteristics with a very scary and all too real neurological disorder. Also known as Todd Syndrome, Alice in Wonderland Syndrome (AIWS) is characterized by transient, episodic distortions of visual perception, phenomena known as metamorphopsias. There’s a scrabble word for you. Just as Alice grows too tall for the house in Wonderland, people with AIWS may see their body parts or other objects as larger or smaller than they really are, hear sounds louder or quieter than they actually are, and even lose their sense of time and velocity. They may also experience derealization and depersonalization, which are shrinky terms for mental states where you feel detached from your surroundings and where you lose your sense of self identity, respectively. 

There are three main types of AIWS, which are divided according to how the person’s perception is distorted.

Type A involves sensory distortion of oneself, and in this type, the most common issue is people feeling as though their body parts are changing size.

Type B causes more visual distortions of the surrounding environment, and includes episodes of micropsia, where objects appear too small; macropsia, where objects appear too big; metamorphopsia, where height and width of objects appear inaccurate; pelopsia, where objects appear too close; and teleopsia, where objects appear farther away than they actually are. 

Type C is a mix of types A and B. A person with Type C AIWS can perceive both the image of their own body, and that of other people or things around them, to be changing. 

AIWS can affect perception of every sense: sight, hearing, touch, and time. As you can imagine, it’s a terrifying disorder, sort of like an LSD trip without the euphoria, but thankfully it’s considered fairly rare, with fewer than 200 “clinical” cases described in the literature, meaning cases requiring medical attention. That said, I also read that “non-clinical” AIWS- meaning fleeting, transient cases not requiring medical attention- have been described in up to 30 percent of the general population. That doesn’t sound so rare to me, right? And by the way, anytime I see my body parts changing size right before my very eyes, I think I’d require medical attention. Just sayin. 

While the exact cause or etiology is still unknown, it’s most often associated with migraine, head trauma, brain tumor, fever, drug use, certain types of epilepsy, and certain infectious diseases, especially Epstein-Barr virus and varicella-zoster virus. It’s also theorized that it can be caused by abnormal amounts of electrical activity, resulting in abnormal blood flow to those parts of the brain that are responsible for visual perception and processing. Encephalitis, which is inflammation of the brain, often caused by infection or an allergic reaction, is the most common cause of AIWS in children, while in adults, migraine is the most common cause. Prognostically, AIWS in and of itself is generally considered relatively harmless, but clearly that depends on the underlying pathology. 

Alien Hand Syndrome

Any South Park fans here? If so, you may recognize this syndrome… Cartman claimed he suffered from this in the episode with Pancake Head. But true alien hand syndrome is a frightening neurological disorder where a discrepancy develops between one’s intentions and actions of a hand or limb, causing that hand to seemingly act on its own free will. Sometimes one leg is affected, though this isn’t as common. During these episodes, the affected hand feels foreign to its owner, as it carries out its unintentional tasks. Sometimes referred to as Dr. Strangelove syndrome, Strangelovian hand, or anarchic hand, alien hand can affect children, but usually occurs in adults.

Alien hand syndrome can be caused by several factors. Some people develop this after a stroke, brain trauma, or tumor. It’s sometimes associated with cancer, neurodegenerative diseases like Alzheimer’s Disease and Creutzfeldt-Jakob Disease, and brain aneurysms as well. It’s often linked to anything that separates or affects communication between the two hemispheres of the brain, usually a division or an issue with the corpus callosum, which divides the brain hemispheres and allows for communication between the two sides. Surgeries to treat epilepsy sometimes affect the brain in this way. Lesions have also been found in the anterior cingulate cortex, posterior parietal cortex, and supplementary motor cortex areas of the brain in people with alien hand, which would affect intentional planning systems and could cause spontaneous movements.

Alien hand can be like a bad B movie… sufferers have reported their alien hand attempting to choke either themselves or others, ripping clothing, and scratching to the point of drawing blood. Yikes. Unfortunately, no cure exists for alien hand syndrome, and it’s best that those affected by it keep their hands constantly occupied, and use their other hand to control the alien hand. It’s used in some terrifying plot twists, but alien hand syndrome is hardly limited to the fictional world. 

Boanthropy

Boanthropy is a rare and serious psychological disorder in which a human being experiences a mental metamorphosis, believing they are a cow, and go so far as to behave as such. Sometimes people with boanthropy are found in fields with “other” cows, walking on all fours and chewing grass as if they were a member of the herd. This is actually how they’re identified, as a result of their behavior. But people with boanthropy not only walk like a cow, they often “talk” like a cow… they stop talking like human beings, using language, and instead prefer mooing. They often stop eating people food and develop a taste and craving for grass… they graze like a cow, eating whatever plants they see “the other” cows eating. 

Boanthropy isn’t new. It’s even referred to in the Bible, with King Nebuchadnezzar. He was king of the Neo-Babylonian Empire from 605 BC to 562 BC, the dude who conquered Judah and Jerusalem, and sent the Jews into exile. He was also credited with building the Hanging Gardens of Babylon. But he was constantly babbling about his great achievements, so he was humbled by God for being boastful. In the Book of Daniel, he basically lost his sanity, and lived like an animal for seven years. It says that he “was driven from men and did eat grass as oxen.” Lucky for him, God took pity on him and later restored his sanity, so he then praised and honored God. 

The cause of boanthropy is still unknown. Many link it with religious perceptions, while others think it’s related to witchcraft and black magic. Most likely, it’s an additional aspect of another psychological disease, such as schizophrenia. The person is probably experiencing severe delusions, and that affects their sense of self, their belief that they exist as a human being. But since the causes of boanthropy aren’t well understood, treatment isn’t exactly defined. That said, if a human is seen grazing and mooing, they clearly need help. Now, I’ve never had a patient with boanthropy, but I can tell you that some serious psychotherapy and pharmacotherapy would be in order, and the primary goal would be to treat the underlying condition, to help the individual give up the state of delusion and realize they’re human. 

I read an account online of a person suffering from boanthropy. Apparently he had stopped eating people food, despite his family’s increasingly frantic attempts to get him to do so, and he was dying. I mean, hello, malnutrition, he was only eating grass. Anyway, he was so sickly and weak, he begged to be butchered, so the villagers called the butcher, who was clearly really smart. When he came, he appraised the man’s body condition as he would any animal, and said that the man was too thin, that he must be fattened up with milk and meat for at least one year before he could be butchered. The man heard this and began to take the milk and meat, and started gaining weight. Eventually, this apparently helped him realize his delusion, and he stopped behaving like a cow and started acting like a human again. This wasn’t in a journal, just a random account on the interwebs, so I can’t vouch for the veracity of the story, but thought it was interesting. 

Ultimately, they don’t seem to realize what they’re doing at the time, but everything they do, from their behavior, to their diet, to the sounds they make, people with boanthropy moooove through life like a cow. Ha!

Clinical Lycanthropy

Like people with boanthropy, people with clinical lycanthropy also believe they can become animals, but in this case, it’s wolves and werewolves, or lycanthropes. Isn’t that a great word? Fun fact, the word lycanthrope comes from the Greek words lykos, meaning “wolf,” and anthropos, meaning “human being.” So everyone knows the legend of the werewolf, right? It’s the fearsome creature who only takes the form of a human until the night of the full moon, at which point they become a bloodthirsty beast… blood curdling scream!!!!

Clinical lycanthropy is actually another very rare and scary psychiatric syndrome involving a delusion that the affected person can transform into, or has transformed into, a wolf. Basically, these people claim that they can physically shapeshift into wolves and werewolves, and often, the symptoms include them relaying their “transformation experience” during a moment of clarity. I guess other symptoms would include howling at the moon? I joke, but this is a real thing, although exceedingly rare. Since 1850, there have been 56 original case descriptions of people who believed they were metamorphosing into an animal, 13 of which met the criteria for clinical lycanthropy. Once again, the cause is unknown, but several theories exist. Aside from being a garden variety delusion, another potential cause involves lesions or other physiological issues within the cerebral cortex, which is responsible for a person’s perception of their own body. Interestingly, studies have actually shown that when sufferers of clinical lycanthropy undergo a “transformation,” they display unusual levels of brain activity in these regions, suggesting that they may genuinely perceive themselves as other than human. It’s interesting that we’ve actually done imaging studies on people as they “transformed.” I guess it’s become a real phenomenon. 

If you search it, there are all sorts of forums and discussions on the interwebs about being a werewolf, the differences between werewolves and vampires, and how to get volunteers to “donate” their blood to lycanthropes. I remember seeing a guy on some tv show saying he had like five people that allowed him to drink their blood- he kept them in circulation- so he didn’t take too much from any one. Get it? Drank blood in circulation. Ha! He really did say that, but not as a joke. Anyway, he seemed perfectly rational as he talked about it. Again, it’s most likely a delusional state, secondary to another psych disorder, like schizophrenia or even bipolar disorder, though I’m sure he- and all those other werewolves out there- would disagree. 

Koro Syndrome

Also known as Shrinking Penis or Genital Retraction Syndrome- yikes- Koro syndrome is a delusional disorder in which a person feels that his genitals are retracting into his abdomen, and that they may totally disappear one day, and even possibly kill him… all of this without any physical proof of the retraction. It primarily strikes males, but females occasionally suffer from a variation of koro in which they believe that their nipples are retracting. Interestingly, koro often appears as an epidemic in which multiple cases are reported simultaneously within a specific geographic area. That should give you an idea of an underlying issue associated with koro… mass hysteria.

First identified in ancient China, koro almost always follows an identical pattern: the sufferer first experiences a tingling sensation in the genitals, followed by a rapid onset panic attack, which quickly leads to a sudden and pervasive fear that the genitals are disappearing. In Asia, this fear is almost always accompanied by an imminent fear of death, although interestingly, this element is often missing from reports in other parts of the world. 

Koro is clearly heavily influenced by cultural beliefs, which also helps explain why epidemics are common. Outbreaks may be blamed on any number of things, including an invading force, an individual rival, or extramarital affairs. I read that in some West African outbreaks, sufferers believed that their genitals were being stolen for occult reasons, rather than retracting into their bodies. In most cases, indigenous treatment is recommended, and that might include an exorcism, rest, herbal treatments, or other healing practices. “Defeating the foe” is sometimes the recommended treatment in some koro outbreaks. That sounds cool. Doctor, what should I do? Defeat the foe! Apparently, koro sufferers often ask friends or relatives to physically manipulate their genitals to stop them from retracting, which sometimes leads to injury. Ouch! Thankfully, the anxiety and hysteria from koro generally subsides very quickly when a culturally acceptable treatment is used. 

Koro happens around the world, including the Western world. Here, koro is treated as a specific phobia, with psychotherapy and antidepressant medications commonly prescribed. Clearly, it’s important to rule out physical causes for the koro symptoms, as pain, tingling, and similar physical symptoms that are common in koro could also indicate an underlying physiological condition. Captain Obvious says that here in the west, we would perform a full workup to determine exactly which factors are in play. Captain Obvious also says that it’s a good idea to first visit the urologist if you’re experiencing these symptoms. That’s my PSA for the day: see a urologist if your genitals are tingling.

That’s a good place to stop for today. I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in officeand on Amazon. 

Thank you and be well people!

MGA