Snoozing personality: The strange case of ‘Sleeping Beauty’ paraphilia

Just recently (and quite by accident while I was doing some research into fingernail fetishes – the topic of an upcoming blog) I came across a case study of an allegedly unique sexual paraphilia called ‘Sleeping Beauty’ paraphilia. The paper was by Dr. Francesco Bianchi-Demicheli and three colleagues, and published in a 2010 issue of the journal Medical Science Monitor. The case involved a 34-year old married man who was admitted to a psychiatric unit in February 2007 following a violent physical attack on his wife. The marriage had been failing for a number of years because of the man’s paraphilic actions in which his wife was an unwilling participant.

The man’s sexual focus was arousal from seeing women sleeping. This as I have written about in a previous blog on somnophilia is not unheard of. (Somnophilia is a sexual paraphilia in which sexual arousal is derived from intruding on, caressing, and/or fondling someone – typically a stranger – while they are asleep without force or violence.) However, where the paraphilia differed from ‘classic’ somnophilia was that the man liked to look after the woman’s hands and nails while they were asleep (this helps explain why I came across the case while researching into fingernail fetishism). The man also had an idealized routine and would always start with the women’s right hand before moving on to the left. Over the years of the marriage, the urge to control his paraphilic interest worsened. At the start of his marriage he used to give his wife sleeping pills that she consented to take. However, the wife eventually refused to take the medication given by her husband. Consequently, the man began to surreptitiously administer sleeping pills (the benzodiazepine Bromaezepam) to his wife without her knowledge. In 2006, the man’s wife discovered what her husband had been doing and the relationship deteriorated even further. The authors wrote that:

“Because of the extremely powerful obsession with sleeping women and painting their nails, the patient disguised himself with a latex mask and attacked his wife, as she returned from work, with an Olerosin Capsicum (OC) spray, to anaesthetize her. During this episode, his wife succeeded in taking off his mask, escaped and called the police who brought him to the psychiatric emergencies”.

Following a psychiatric assessment that was deemed “normal” the man revealed that when he was 10 years old he had an incident of head trauma that resulted in a four-day long coma. He subsequently received various neurological evaluations, including neuroimaging brain scans. The authors reported that:

“The cerebral MRI showed a moderate atrophy in the fronto-parietal region with a diffuse and severe white matter injury compatible with his previous head trauma. On a functional viewpoint, this brain network is known to sustain among others, the sense of self, body-image, and attention mechanisms. His neuropsychological exam was in line with this assumption. The patient was diagnosed with a moderate dysexecutive syndrome and a very specific body image disorder characterized by an incomplete mental image of his hands, mostly the right (i.e., personal representational hemineglect), as ascertained by his graphical representation of his body parts. The clinical hypothesis was that the paraphilia might be related to his post-traumatic disturbed body image and more specifically to the incomplete hands representation”.

The authors made reference to a number of studies that suggest paraphilic behaviour can appear following brain damage (see ‘Further reading’ below) and concluded that their case study highlighted “the potential link between paraphilia, deviant and aggressive sexual behaviour, neurological disturbance and self-representation…Presumably, the occurrence of head trauma leading to catatonia in adolescents might have played a critical role on the development of his sexual self and body image”.

A good critique of this particular case study was by The Neurocritic who wrote that:

“One puzzling aspect of this case is why the ‘Sleeping beauty paraphilia’ became uncontrollable only in adulthood, showing a progressive escalation during his marriage. This might be suggestive of a neurodegenerative disorder, but that was not part of his diagnosis. And I’m not sure why an old traumatic brain injury would have lead to ‘moderate’ atrophy in the fronto-parietal region. I might have expected more involvement of the orbitofrintal cortex, given the nature of the patient’s behavioral changes. However, many other examples of impulsive sexual offenses are even less obviously related to neurological status (e.g., after head injuries when the damage might not be visible on an MRI scan, and of course the population of offenders who have never sustained a TBI [traumatic brain injury]). Since the lesions were distributed and not focal, a final mystery is why the body image disturbance was confined to the right hand (implying a left hemisphere origin). This type of personal representational hemineglect (neglect for a mental representation of one side of the body) is most often associated with lesions in the right hemisphere”.

The Neurocritic also makes a point that I have raised in other blogs that I’ve written on various paraphilias concerning the issue of whether something is problematic if there is a willing participant to share the sexual urges. The Neurocritic concludes:

“What is considered acceptable can vary widely across cultures and subcultures (Bhugra et al, 2010) and across individuals. If the patient of Bianchi-Demicheli et al. found a partner willing to have her fingernails done while sedated with sleeping pills, perhaps the classification would change from paraphilic disorder to something that might be considered strange and paraphilic to most people, but causing no distress to the two willing participants”

Personally, I feel this paraphilic behaviour is just a sub-type of somnophilia or somnophilia overlapping with hand fetishism. However. Given the complete lack of case studies ion the clinical literature on somnophilia, who is to say that this case study is not representative of somnophiles more generally?

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Bianchi-Demicheli F, Rollini C, Lovblad K, & Ortigue S (2010). “Sleeping Beauty paraphilia”: Deviant desire in the context of bodily self-image disturbance in a patient with a fronto-parietal traumatic brain injury. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 16(2), C15-C17.

Bhugra D, Popelyuk D, McMullen I. (2010). Paraphilias across cultures: Contexts and controversies. Journal of Sex Research, 47, 242-56.

Briken, P., Habermann, N., Berner, W. & Hill, A. (2005). The influence of brain abnormalities on psychosocial development, criminal history and paraphilias in sexual murders. Journal of Forensic Science, 50, 1204-1208.

Lehne G.K. (1994). Brain damage and paraphilia treated with medroxyprogesterone acetate. Sex and Disability, 10, 145–158.

Miller, B.L., Cummings, J.L,. McIntyre H et al (1986). Hypersexuality or altered sexual preference following brain injury. Journal of Neurology, Neurosurgery and Psychiatry, 49, 867–873

The Neurocritic (2010). “Sleeping Beauty Paraphilia” and Body Image Disturbance After Brain Injury. April 11. Located at: http://neurocritic.blogspot.co.uk/2010/04/sleeping-beauty-paraphilia-and-body.html