Délire de fellation et hallucinations cénesthésiques multimodales dans la schizophrénie : au-delà de l’incubus

Background: Hallucinations with sexual content, particularly cenesthetic and oral hallucinations, are rarely reported in the psychiatric literature despite their significant potential for distress and impact on therapeutic engagement. Case presentation We describe a 51-year-old woman presenting with a complex psychotic picture, including cenesthetic hallucinations experienced as "forced oral sexual acts," associated with multimodal hallucinations (gustatory, visual, auditory, and olfactory) and marked mistrust toward healthcare providers. Differential diagnosis A review of the literature using MEDLINE and Google Scholar found no recognized autonomous nosographic entity corresponding to a "fellatio delusion," and neither the DSM-5-TR nor the ICD-11 describes a syndrome specifically centered on this content. Sexual-themed delusions in psychotic disorders are categorized by their general content rather than by specific sexual acts such as fellation. These manifestations are better conceptualized as a rare and severe subtype of sexual or somatic hallucinations within established psychotic disorders, most commonly schizophrenia spectrum disorders, and must be differentiated from the incubus phenomenon, a parasomnia occurring during sleep paralysis. Treatment Management required an integrated and adaptive therapeutic approach addressing psychotic symptoms, patient distress, and relational challenges within the clinical team. Outcome and follow-up Clinical follow-up highlighted the importance of tailoring care to ethical, relational, and gender-sensitive considerations in the therapeutic setting.

Discussion: This case underscores the need for careful phenomenological assessment, accurate differential diagnosis, and ethically informed clinical adaptation when managing rare and distressing sexual hallucinations in psychotic disorders.