The sexual transformation delusion

Medical journal Epilepsy and Behavior has a curious case study of a female patient who had the experience of changing sex when she had a seizure.

The patient in question had a small tumour near the right amygdala and showed abnormal right temporal lobe activity on an EEG. Interestingly, when she had the experience of changing sex, she also experienced other females in the vicinity as also transforming into males.

She experienced a sensation of dull nausea rising from the epigastrium [abdomen] with concomitant fear, sometimes also accompanied by déjà vu, in isolation, several times per week. Occasionally this developed into a complex alteration of perception, which she explained as follows: ”I’m no longer feeling to be a female. I have the impression to transform into a male. My voice, for example, sounds like a male voice that moment. One time, when I looked down to my arms during this episode, these looked like male arms including male hair growth.”

This particular kind of perceptual disturbance was not restricted to herself, but also characterized her perception of female persons nearby during the episode: “One time another woman, a friend of mine, was in the same room, I perceived also her as becoming a male person including changing sound of her voice.” After introduction of anticonvulsive treatment with carbamazepine, only the elementary simple-partial phenomena of epigastric aura and déjà vu persisted. Secondary generalized tonic–clonic seizures never occurred.

Sex change delusions have been reported in the medical literature before, but usually in longer-term psychoses in people with diagnoses like schizophrenia, rather than occurring as a short-term effect of a seizure.

In fact, sex change delusions were reported by one of the most famous psychiatric patients in history: Daniel Schreber, a 19th century German judge who wrote about his experience of insanity in his book Memoirs of My Nervous Illness.

Among other experiences he describes how he believed that his mind was attracting ‘rays’ from God causing him feminising sensations of ‘voluptuousness’ which he noticed as female body changes.

Temporary sex change ‘delusions’ have also been created using hypnosis in highly hypnotisable people in two remarkable studies that attempt to understand how the mind justifies a belief clearly contrary to reality.

Link to DOI entry and summary of case study.