Snake me up before you go-go: An unusual case of ophidianthropy

In a previous blog I examined clinical lycanthropy, a delusional psychiatric syndrome or neurological condition in which individuals believe they are transforming (or have already have transformed) into a non-human animal (often – but not necessarily – a wolf). As I noted in that blog, these identity disorders should be really be referred to as ‘therianthropy’ (as noted in Dr. Edward Podolsky’s 1953 Encyclopedia of Aberrations) or ‘zoanthropy’ but in the psychiatric literature it is ‘lycanthropy’ that tends to be used as the ‘catch-all’ name of the disorder.

A 2004 study by Dr. Petra Garlipp and her German colleagues in the journal Acta Psychiatrica Scandinavica noted the different types of animal transformation that have occurred in the psychological and psychiatric literature. Obviously human-to-wolf (or other canine) cases exist, but they appear to be in the minority. Other types include humans believing they have transformed into cats, dogs, tigers, hyenas, horses, birds, frogs and bees. Predictably, psychiatry authors claimed that the mythology surrounding human-animal transformation is controversial in Western popular culture.

Perhaps one of the most unusual cases of therianthropy was a case described by Drs. Shivanand Kattimani, Vikas Menon, Manohar Kant Srivastava and Aniruddha Mukharjee in a 2010 issue of the online journal Psychiatry Reports. They published a case report of about a 24-year old well educated woman who believed she had turned into a live snake. They published the case study because of its rarity and unique phenomenology. The case also provided difficult diagnostic problems and treatment was a challenging. The authors wrote that she:

“…presented to us with complaints that she had died 15 days before and that in her stead she had been turned into a live snake. At times she would try to bite others’ claiming that she was a snake. Her food intake and other behaviour remained as normal. We showed her photos of snakes and when she was made to face the large mirror she failed to identify herself as her real human self and described herself as snake. She described having snake skin covering her and that her entire body was that of snake except for her spirit inside. She repeatedly said that her saliva was that of snake’s and very poisonous. She would often complain of difficulty in swallowing telling that was due to snake skin being wrapped around her neck. She had protruding sharp upper incisor teeth which she could claim were snake fangs. She was distressed that others did not understand or share her conviction. She felt hopeless that nothing could make her turn into real self. She made suicidal gestures and attempted to hang herself twice on the ward and once when she was sent for short leave home. There were depressive symptoms accompanying this theme. There was no significant contributory medical history”.

The woman was subsequently treated with ten sessions of electro-convulsive therapy (ECT) along with a variety of drugs. The authors first tried fluoxetine (but there was no response), followed by risperidone, then olanzapine, trifluperazine, and carbamazepine. She remained on the psychiatric ward for nearly half a year “and during each drug trial there was some initial improvement in her symptoms but later she would return back to same conviction of her beliefs”. The ECT was administered to inhibit her severe depression and suicidal ideation. At the time the case study was written up for publication she was administered a drug combination of escitalopram and quetiapine but still had the same psychopathology as when she entered treatment (in fact the authors . In a discussion of the case, the authors noted:

“Our initial diagnosis – as she predominantly presented with depressive symptoms and suicidal attempt along with delusion of nihilism – was a severe depressive disorder with psychotic symptoms…As she additionally had a delusion of being transformed into a snake we consider the diagnosis of an acute transient psychosis. While she remained in the ward her behaviour with our other patients and personal hygiene was well preserved except for brief periods of exacerbation of her psychopathology lasting for few hours to two days wherein she would enact being a snake”

The authors also considered possible diagnoses of both dissociative disorder and schizophrenia. However, the authors decided that her “psychopathology pointed towards something more than that”. They also noted that the delusion that she had become a snake “was bizarre from the point of view of the patient’s cultural background”. Consequently (and after discussion with other psychiatric colleagues) the authors reached no consensus on the diagnosis for the disorder (except that it was clearly a psychotic illness). They did, however, propose that this “novel delusion” could be called ‘ophidanthropy’. The patient’s relatives weren’t interested in diagnosis, only that she be treated. However, this was something that the authors admitted they “were unable to provide”. In the paper’s conclusions, the authors said they planned next to try “supportive psychotherapy in combination with pharmacotherapy” but the results of these therapies have not yet (to my knowledge) been published.

Interestingly, the authors commented in passing that the woman believed she was dead but they made no other reference to this at all in their paper. To me, this looks like a possible case of Cotard’s Syndrome (where individuals hold the delusional belief that they are dead). I did note in my previous blog on clinical lycanthropy that there was an interesting case report in the psychiatric literature of a man who had both clinical lycanthropy and Cotard’s Syndrome. This case was reported by Dr. A.G. Nehad and Dr. K. Toofani in a 2005 issue of the journal Acta Psychiatrica Scandinavica. Their patient had a bipolar mood disorder, along with a psychotic delusion that he had transformed into a dog. He also suffered from the delusion that he was dead. There would certainly seem to be comparisons that can be made between these two cases.

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

Further reading

Garlipp, P., Gödecke-Koch, T., Dietrich, D.E. & Haltenhof, H (2004). Lycanthropy: Psychopathological and psychodynamic aspects. Acta Psychiatrica Scandinavica, 109, 19-22.

Kattimani, S, Menon, V., Srivastava, M.K. & Aniruddha Mukharjee, A. (2010). Ophidianthropy The case of a woman who ‘turned into a snake’. Psychiatry Reports. Located at: http://www.priory.com/psychiatry/ophidianthropy.htm

Keck, P.E., Pope, H.G., Hudson, J.I., McElroy, S.L. & Kulick, A.R. (1988). Lycanthropy: alive and well in the twentieth century. Psychological Medicine, 18, 113–20.

Larner, A.J (2010). Neurological signs: Lycanthropy. Advances in Clinical Neurocience and Rehabilitation, 10(4), 50.

Nejad, A.G. & Toofani, K. (2005). Invited comment (on ‘Co-existence of lycanthropy and Cotard’s syndrome in a single case’). Acta Psychiatrica Scandinavica, 111, 250-252.

Podolsky, E. (1953). Encyclopedia of Aberrations: A Psychiatric Handbook. New York: Philosophical Library.

Barking mad? A brief overview of clinical lycanthropy

With the recent success of the ‘Twilight’ series of films, lycanthropy has once again come to the fore in popular culture. Lycanthropy is usually defined as a supernatural behaviour in which a person believes they have changed into a wolf (i.e., a shape-shifting ‘werewolf’). However, as a psychiatric syndrome, ‘clinical lycanthropy’ is similar to a psychosis and involves individuals who have delusional behaviour and believe they are transforming (or have already have transformed) into a non-human animal (often – but not necessarily – a wolf). Technically, this should be referred to as ‘therianthropy’ or ‘zoanthropy’ but in the psychiatric literature it is ‘lycanthropy’ that tends to be used as the ‘catch-all’ name of the disorder. These changes (understandably) only happen in the mind of the affected individual. Although there is a clear similarity to various psychotic behaviours, there do not appear to be any specific diagnosis of mental or neurological illness associated with the resulting behaviour. Some authors have also described lycanthropy as an identity disorder.

The delusional belief in metamorphosis to animal form is not new and back in the 18^th century was termed ‘Insania Zooanthropica’. A reference as recent as 1992 by Dr. W.M. Davis and colleagues – in the Canadian Medical Association Journal – referred to it as ‘lycomania’. Those individuals affected with clinical lycanthropy typically have other conditions such as clinical depression, mood disorders (e.g., bipolar disorder), and schizophrenia. A 2004 study published describing clinical lycanthropy in over 30 cases by Dr. Petra Garlipp (Hannover Medical School Germany) and colleagues in the journal Acta Psychiatrica Scandinavica proposed some diagnostic criteria (based on past and/or current behaviour) by which the disorder can be diagnosed:

• Individuals report in “a moment of clarity” or retrospectively that they sometimes feel and/or have felt like an animal.
• Individuals behave in a way that resembles animal behaviour (creeping, barking, etc.).
• Individuals voice their beliefs that they are animals.

The review paper by Dr. Garlipp and her colleagues also noted the different types of animal transformation that have occurred in the psychological and psychiatric literature. Obviously human-to-wolf (or other canine) cases exist, but they appear to be in the minority. Other types include humans believing they have transformed into cats, tigers, hyenas, horses, birds, frogs and bees. There are also cases of “multiple serial lycanthropy” where a range of animal transformations is reported within one individual. For instance, one case reported in a 1989 issue of the journal Psychopathology described a man who believed he had transformed first into a dog, and then into a horse, and a cat. There is some evidence that people who report lycanthropic experiences really do perceive the feelings as real. Neuroimaging studies (again published in the journal Psychopathology) have shown that the areas of the brain (e.g., cerebellum) concerned with body shape and body image perception are activated in such individuals.

There also appear to be unusual variants of lycanthropy in the psychological literature. In rare cases, individuals may also believe that other people around them have changed into animals. This has been called ‘lycanthropic intermetamorphosis’ (by Dr. H.F. Moselhy, in a 1999 issue of Psychopathology) and ‘lycanthropy spectrum’ (by Dr. A.G. Nejad in a 2007 issue of Acta Psychiatrica Scandinavica). A study published in a 2009 issue of the journal Addiction and Health by Dr. Mansoureh Nasirian and colleagues (all at the Kerman University of medical Science, Iran) described the symptoms of lycanthropy in other individuals appearing after an unemployed 28-year old man had taken the drug ecstasy. The man believed that three of his close relatives had changed into donkey, boar, and horse. The authors argued that ecstasy drug can induce paranoid psychosis similar to schizophrenia, and that in their lycanthropy case, the ecstasy appeared to have had a role in the man’s underlying susceptibility to schizophrenia.

There is also an interesting case report in the psychiatric literature of a man who had both clinical lycanthropy and Cotard’s Syndrome (where individuals hold the delusional belief that they are dead – figuratively or literally – and do not exist) that I examined in a previous blog. He also had zoophilic tendencies. This particular case was reported by Dr. A.G. Nehad and Dr. K. Toofani in a 2005 issue of the journal Acta Psychiatrica Scandinavica. Their patient had a bipolar mood disorder, along with a psychotic delusion that he had transformed into a dog. Confusingly, he also suffered from the delusion that he was dead. The authors also reported that he was restless and had a serious sense of guilt about his previous sexual contact with sheep. As far as the authors are aware, this is the only case of its kind. In this case, they believed that the man’s zoophilic orientation producing a sense of guilt were the most important factors causing his delusions.

Despite the rareness of the disorder, Dr. Petra Garlipp – in an invited comment on the paper by Nehad and Toofani – thinks it is more common than is reported. She concludes:

“Lycanthropy is a delusional symptom rarely described in the literature but probably seen a lot more often in clinical psychiatry. Reasons for this discrepancy may be the often short duration of the symptomatology, the lack of interpretation as lycanthropy if the metamorphosis is not verbally uttered by the patient and just the behaviour is shown”.

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

Further reading

Davis, W.M. Wellwuff, H.G., Garew, L. & Kydd, O.U. (1992). Psychopharmocology of lycanthropy. Canadian Medical Association Journal, 146, 1191-1197.

Dening, T.R. & West, A. (1989). Multiple serial lycanthropy. A case report. Psychopathology, 22, 344–347.

Fahy, T.A. (1989). Lycanthropy: A review. Journal of Royal Society of Medicine, 82, 37-39.

Garlipp, P. (2005). Invited comment (on ‘Co-existence of lycanthropy and Cotard’s syndrome in a single case’). Acta Psychiatrica Scandinavica, 111, 252.

Garlipp, P., Gödecke-Koch, T., Dietrich, D.E. & Haltenhof, H (2004). Lycanthropy: Psychopathological and psychodynamic aspects. Acta Psychiatrica Scandinavica, 109, 19-22.

Keck, P.E., Pope, H.G., Hudson, J.I., McElroy, S.L. & Kulick, A.R. (1988). Lycanthropy: alive and well in the twentieth century. Psychological Medicine, 18, 113–120.

Larner, A.J (2010). Neurological signs: Lycanthropy. Advances in Clinical Neurocience and Rehabilitation, 10(4), 50.

Moselhy, H.F. (1999). Lycanthropy: New evidence of its origin. Psychopathology, 32, 173–176.

Nasirian M., Banazadeh, N. & Kheradmand, A. (2009). Rare variant of lycanthropy and ecstasy. Addiction and Health, 1(1), 53-56.

Nejad, A.G. (2007). Belief in transforming another person into a wolf: Could it be a variant of lycanthropy? Acta Psychiatrica Scandinavica, 115, 159-161.

Nejad, A.G. & Toofani, K. (2005). Invited comment (on ‘Co-existence of lycanthropy and Cotard’s syndrome in a single case’). Acta Psychiatrica Scandinavica, 111, 250-252.