Understanding Childhood Sexual Trauma

CHAPTER 1

1.0 Introduction

1.1 The Concept of Childhood sexual traumas

Blom & Mangoenkarso (2018) defined childhood sexual trauma as the situation when children face sexual or physical abuse situations that have long-term physical or mental effects on them. Mostly, childhood sexual trauma occurs following a child’s experience of negatively overwhelming sexual abuse that may emerge from a range of circumstances such sexual violence or rape (Steel, 2013). Besides, according to Blom & Mangoenkarso (2018), childhood sexual trauma can be caused by an experience of sexual abuse on their parents or close relatives.

1.2 Sexual Hallucinations

Generally, hallucinations occur when people sense things that do not exist outside their minds. According to Bailey et al. (2018), this may occur through a sense of taste, smell, or visually. Most forms of hallucinations are frightening and occur as a result of various human activities such as addiction to drug abuse, as a result of illnesses such as schizophrenia, as a result of neurological diseases such as Parkinson’s disease, or as a result of blindness emanating from muscular degeneration (Lim et al, 2016). However, sexual hallucinations can be defined having sexual false perceptions. While most types of hallucinations are known and given attention by both practitioners and researchers, there is a paucity of knowledge and awareness given to sexual hallucination (Sheffield et al., 2013). Bailey et al. (2018) observe that even in mental healthcare settings, sexual hallucination is one of the most ignored forms of hallucinations. Ideally, scientists attribute this ignorance to the fact that it does not exist within some of the most common sensual modalities such as touch, auditory senses, vision, taste, or the olfactory senses (Read et al, 2005). They are therefore not given attention by healthcare professionals, especially those who are not familiar with all the categories of the existing sensual modalities (Lim et al., 2016). Steel (2013) also suggest that sexual hallucination is mostly ignored because most patients may feel embarrassed to talk about it, and also, it is for the same reason why health practitioners may not ask their patients about it. Besides, Bernstein et al. (2003) claim that whereas other forms of hallucination may have more prominent reasons to receive pharmacological interventions; clinicians may find it superfluous to seek pharmacological treatment for sexual hallucinations. It appears, therefore, that there are several reasons why sexual hallucinations may be ignored. Hence, this may also be a reason why it is mostly unreported or unexplored by researchers (Fisher et al., 2011).

1.3 Statement of the Problem

Existing research has established that childhood sexual abuse/trauma has an influence on the severity of delusions and hallucinations, especially among psychotic patients. For instance, in a meta-analysis of 29 research papers (a total of 4680 participants) focusing on psychotic symptoms and childhood sexual abuse to establish evidence, it was found that schizophrenic children who face physical, sexual, and emotional abuse were more likely to experience hallucinations (Bailey et al. 2018). Whereas the study did not find any correlation between childhood sexual trauma and negative psychotic symptoms, the findings of this study had specific implications for practice and future research. For instance, the study implied that childhood sexual trauma correlated with hallucinations. Existing research has also established that victims of sexual hallucinations are burdened mainly by this condition. In fact, based on the observations made by Blom & Mangoenkarso (2018) in nursing wards for schizophrenic patients, it is known that sometimes patients report a taste of sperm in their mouths, the feeling of being converted not the opposite sex, or a feeling of organismic sensations that affect their ability to thrive socially. According to Blom & Mangoenkarso (2018), other schizophrenic patients may experience hallucinated sex behaviour, become aggressive due to the hallucinated sensations of being sexually harassed, and even in the observations made by the same authors, a woman with no psychiatric disorder history committed suicide weeks after hospital admission. Whereas only a few of the sexual hallucinations have such fatal outcomes, the suicide highlights the critical need for health practitioners to pay attention to sexual hallucination, which is virtually a less explored health issue.

Literature by Read et al. (2005) reveal that physicians have for the last few decades established that childhood sexual trauma is one of the risk factors for auditory and verbal types of hallucinations, especially among schizophrenic patients. However, to the best of the researcher’s knowledge, there is little evidence highlighting whether this is true for the sexual hallucinations. Therefore, the main aim of this study is to explore the evidence that exists for identifying the relationship between sexual hallucination among patients with schizophrenic disorder spectrum and childhood sexual trauma.

1.4 Research Question

What evidence exists on the relationship between sexual hallucination in patients with schizophrenic disorder spectrum and childhood sexual trauma?

1.5 Justification of the Study

Health and social care workers encounter challenges of sexual hallucinations among patients with schizophrenic spectrum disorder. When hallucinating, these patients may be aggressive and can cause harm to the caregiver, or cause damages that have financial implications to the care facility. Therefore, conducting this study will help in solidifying evidence that exists on the relationship between childhood sexual trauma and sexual hallucination among schizophrenic patients, thereby enabling caregivers and care facilities to have adequate preparation for such events whenever they admit or handle patients with a history of child sexual abuse. Besides, by delivering more evidence the current topic of study, patients and health, and social workers will have better knowledge about this condition and therefore become more ready to talk about it. Last but not least, the findings of this study will seal the knowledge gap that exists with regards to sexual sensory modality – as opposed to other others, such as olfactory and auditory sensory modalities.

Chapter 2

2.0 Research Methodology

2.1 The Literature Review Research Methodology

In the spirit of evidence-based research, clinicians and other medical practitioners need to synthesize knowledge, mainly because there is a vast volume of knowledge that emanates from an increasing number of research and scientific publications (Bernard, 2011). Consequently, according to Baumeister (2013), the literature review research methodology may be required to compare and contrast the divergent research findings or to establish the underlying reasons for lack of consensus in different pieces of research evidence before the application of the research knowledge into practice. However, as opposed to original/primary research, literature reviews do not present new information but rather; they analyse and conduct an assessment of already existing data for purposes of revealing more evidence. Hence, the literature review research methodology refers to a form of secondary research that is based on primary research sources (Hoffmann et al, 2009).

2.2 Literature Search

The researcher conducted a scoping search on a few online databases such as EBSCO, CINAHL, and PUBMED to ensure that first, there was no similar research that had been carried out, and secondly, to retrieve the most relevant secondary sources of data. Some of the keywords used in the search process include schizophrenia, hallucination, delusions, and sexual trauma. Moreover, to ensure the quality and reliability of the selected sources, the researcher relied on predetermined inclusion/exclusion criteria.

2.3 Inclusion/Exclusion Criteria

Being secondary research, the researcher was determined to ensure that only the most relevant and quality sources of data were retrieved for data collection. This was done by ensuring that only the sources that were:

• Published in the English language

• Could be retrieved in full-text

• Were published from the year 2000 onwards

2.4 Search Outcome

When the researcher used the search terms in PUBMED, a total of 1756 sources were retrieved. However, upon subjecting these sources to the inclusion/exclusion criteria, only 234 sources fit the requirements. Ultimately, the researcher chose only one source from this database. Secondly, the researcher used the keywords in EBSCO and yielded 1673 references in the first instance. When these sources were subjected to the inclusion/exclusion criteria, only 124 sources fit these criteria. The researcher ended up choosing only one source from this database. Lastly, the researcher used the keywords in CINAHL and retrieved 447 sources. When these sources were subjected to the inclusion/exclusion criteria, only one reference was found to be relevant. This source was selected for review. The following table illustrates the selected studies with their specific details:

2.5 Ethical Considerations

Regardless of being secondary research, there were several ethical considerations made by the researcher to ensure the credibility and reliability of the study. For instance, the researcher only used de-identified data to maintain the anonymity of any participant in cases where the study participants were identified. Secondly, while the researcher was not able to get permission from each author before using their own data, there was a determination to acknowledge all the authors by maintaining an appropriate citation method and a reference list.

Chapter 3

3.0 Literature Review

3.1 Historical Conceptualization of Sexual Hallucination

Generally, there is a lack of research highlighting the concept of sexual hallucination, what causes it, its prevalence, and its relationship with childhood sexual trauma among patients with schizophrenia spectrum disorders. However, several authors have attempted to explore the concept of sexual hallucination through a historical perspective, even though the ancient descriptions of sexual hallucination have also proven to be rare. But, Blom & Eker (2015) acknowledge that a memorable historical description of sexual hallucination can be found within the incubus phenomenon, which described compound hallucination that could be encountered by individuals experiencing episodes of sleep paralysis involving animals or persons attempting to exert pressure on their thorax or sometimes subjecting them to various forms of sexual harassment. However, according to Roscher et al. (1972), this condition has been known since the era of antiquity and was until the 19th century associated with supernatural beings such as fallen angel or demons. Moreover, according to Goldmeier & Andrews (2017), other characteristics associated with sexual hallucination were the persistent desire for sex as well as orgasmic sensations. In the 19th century, Parish (1894) conceptualized sexual hallucination from the perspective of hysteria, especially in situations where nitrous oxide was administered, and in cases where an individual was intoxicated with Datura stramonium. However, remarks by Bluer (1911) indicates that tactile sexual hallucination among individuals with schizophrenia spectrum disorder often takes the character of genital sensations, while Von Hrafft-Ebing (1886) narrates of a man under the influence of cannabis complained that his body had transformed into a woman overnight and that he acquired complete female organs such as breasts and genitals. Later on in the 1940s, various cases of sexual hallucinations were reported in the context of mental retardation, schizophrenia, narcolepsy, hypoparathyroidism, and epilepsy, (Green & Swanson 1941; Connolly & Gittleson 1971, Stein et al. 1996, McGuire et al. 1994, & Szucs et al. 2003). Balasubramaniam & Park (2003) & Schneemilch et al. (2012) also reported a case series of sexual hallucination in the context of anesthetics, in which a bit of controversy has emerged regarding nitrous oxide because of its capabilities to induce sexual hallucination.

It is also worth to mention about the persistent genital arousal disorder (PGAD), explained by Goldmeier & Leiblum (2006) & Leiblum & Nathan (2001) as the modern way of conceptualizing nymphomania. Furthermore, whereas PGAD was earlier associated with clitoral priapism especially when the individual is under the influence of trazodone, latest studies reveal that pelvic conditions such as Tarloc cyst may be the leading cause of PGAD (Goldmeier & Andrews, 2017). Ideally, this suggests that orgasmic sensations that are unbidden and experienced in this context may not necessarily be hallucinations.

3.2 The Pathophysiology of Sexual Hallucination

Having evaluated the historical cnceptualization of sexual hallucinations, it is also useful to highlight existing literature on its pathophysiology. First, the historical overview of sexual hallucination indicates that they occur within the contexts of a wide variety of syndromes. Thus, its occurrence in the context of schizophrenic spectrum disorder may indicate the existence of various mesolimbic dopaminergic mediating their existence, or their occurrence in other settings may indicate different causal pathways. I, therefore, elucidate that sexual hallucination occurs after withdrawal of serotonin-norepinephrine reuptake inhibitors or selective serotonin reuptake inhibitors suggests that serotonergic mechanisms may be involved (Leiblum & Goldmeier, 2008). However, according to Jevtovic-Todorovic et al. (1998), scientists are not yet sure of the mechanism involved in the sexual hallucination that occurs after the administration of nitrous oxide, even though it suspected that it might be as a result of NMDA glutamate blockade. But, Cheyne (2003) argues that because the incubus phenomenon is often experienced in the context of narcolepsy, sexual hallucination may be occurring under the mechanism of dissociated sleep phases and a subsequent intrusion of dream contents. Furthermore, referring to an electroencephalographic study conducted by Remillard et al. (1983), orgasmic hallucinations within the context of epilepsy may be associated with the limbic part of the temporal lobe in the non-dominant hemisphere.

3.3 Sexual Trauma

Whereas trauma has received the attention of health practitioners and academics since the arrival of post-traumatic stress disorder, researchers have recently been more attentive to the relationship between trauma and non-psychotic disorders. Interestingly, some researchers had denied, ignored, or minimized a possibility of its ties with psychosis. According to Read (1997), a possible reason for this denial is that they were either adhering to rigid biological principles or an attempt by researchers or clinicians to avoid traumatization after the discovery of the abuse. However, later on, evidence linking the child sexual abuse as well as child physical abuse and various mental health issues among children emerged (Spataro et al., 2004). Furthermore, these two types of sexual abuse were found to have a causal role in a range of adult mental health issues such as sexual dysfunction, post-traumatic stress disorders, drug abuse, eating disorders, suicidality and dissociative disorders (Mullen et al. 1993, Christoffersen et al. 2003, Bushnell et al. 1992), and some of these problems are associated with people diagnosed with schizophrenia. Literature also indicates a relationship between child abuse and the severity of disturbance. For instance, according to (Mullen et al 1993, Lange et al 1995, Sansonnet-Heyden et al 1987), patients who had been either subjected to sexual abuse or physical abuse at their childhood received more hospitalization, were put under more medication, spent longer time in seclusion, and were more likely to perform suicide than their counterparts who were not subjected to these kinds of abuse at their childhood. In a study by Read et al. (2001) exploring the prevalence of suicidal habits among adults, the researcher found that participants who had either experienced physical abuse or sexual abuse at childhood were more likely commit suicide than those who had currently been diagnosed with depression. Similar results were found by Garno et al. (2005), Sautter et al (1999) and Nolen et al (2004) who remarked that adults who had experienced either sexual abuse or neglect at their childhood were more likely to experience an onset of mania, more episodes of mania, or higher episodes of suicide attempt.

There are similar pieces of literature agreeing that childhood sexual trauma has a causative association with sexual hallucination. For instance, Howes and Murray (2014) used the socio-developmental-cognitive model to prove that sexual hallucination in adults who had experienced sexual abuse in their childhood could be mediated by the Pathophysiological factors highlighted above. Furthermore, Thompson et al. (2010) found a significant (p < 0.01, odds ratio of 7.17) relationship between attenuated symptoms of psychosis with sexual content and sexual trauma. This hints the need for further scientific exploration of childhood sexual as possible risk factors for sexual hallucination, especially considering that therapeutic interventions focused on injury are no longer a contraindication for patients with schizophrenia spectrum disorder (Van den Berg et al., 2016). Ideally, this may have various therapeutic implications even among patients who claim that sexual hallucination has no distressful effects on them.

3.4 Classification of Sexual Hallucination

Previous studies indicate that sexual hallucination is often experienced in a multimodal form among patients with schizophrenia spectrum disorders than in an auditory way. For example, Lim et al. (2016) found that sexual hallucination was often experienced in somatic, visual, tactile, auditory, and gustatory forms rather than in an auditory way. However, it is also important to note that some studies (e.g., Blom 2010) adopt a broader definition of sexual hallucination (i.e., based on the seven sensory modalities), even though there is a need to select a definition that is more clear for purposes of more straightforward diagnosis, for example by adding appropriate adjectives to fit a particular type of hallucination. The following figure illustrates the seven modalities within which sexual hallucination is conceptualised by Blom (2010).

3.5 Childhood Trauma and Psychotic Symptoms

Whereas evidence shows a causative relationship between adult interpersonal trauma and an experience of psychosis, and that there is also a causative relationship between childhood trauma and various psychiatric sequelae. But, a prominent question is whether there is a relationship between childhood sexual trauma and other forms of psychosis such as sexual hallucination; a question that many researchers have shied away from answering. For instance, in an earlier study by Read (1997), a review of 15 studies were conducted among male and female participants and the results showed that among 64% of the participants, 50% had suffered from child sexual abuse while 44% had suffered from child physical abuse. Furthermore, in a review of literature by Read et al (2005), 39 studies comprising of female inpatients and seven studies containing female outpatient samples that had experienced childhood sexual abuse were reviewed and at least 50% of these samples were diagnosed with various forms of psychosis including sexual hallucination. Furthermore, excluding the Indian study (Chandra et al 2003), which indicated a lower rate of child sexual abuse among the patients with psychotic symptoms, the rest of the studies reviewed by Read et al (2005) tallied an average of 50% representing patients that had undergone child sexual hallucination. On the other hand, in five of the studies reviewed by Read et al (2005) with a total of 100 samples, an average of 51% of them had experienced child sexual hallucination. However, when Read et al (2005) contacted the primary researchers on why there was a particular low rate of child sexual abuse among the Indian samples, the researchers attributed this low rate to underreporting, explaining that sometimes when the studies are conducted within societies where sexual matters are rarely discussed, it is difficult to have the respondents give details information about their sexual experiences. A similar challenge of underreporting is reported in the study by Fergusson et al (2001), whereby the researcher also observed that psychiatric patients tend not to report their sexual experience. A review of literature on child abuse and scientific studies measuring schizophrenia and psychosis also indicates that survivors of child sexual abuse score higher than non-abused counterparts in schizophrenia scales. For instance, Read et al (2004) conducted a review to compare the score of samples with a history of childhood sexual abuse versus those without the history of child sexual abuse and found that the latter group scored more in the schizophrenia and paranoia scales and psychosis scale i.e. Symptom Checklist 90-Revised Scale (SCL-R). Among five of the nine studies reviewed by Read et al (2004), psychosis appeared be more associated with the abuse. However, the tenth study reviewed by Read et al (2004) comprised of child sexual abuse survivors with PTSD and when these samples were subjected to the MMPI schizophrenia scale, they were found to have the highest readings in the scale. Interestingly, the findings of studies using MMPI schizophrenia scales and SCL-R scales were similar to the findings in studies with clinical diagnoses. Whereas some (Cohen et al 1996, Friedman et al 2002, Ritsher et al 1997) find that psychosis and schizophrenia are related to child sexual abuse, other found a stronger relationship in samples with schizophrenia and psychosis. For example, Robins (1996) conducted a study including 500 child attendants in a child clinic, 35% of the of those diagnosed with schizophrenia in their adulthood were found to have been put under foster care due to a myriad of child abuses including sexual abuse. Similarly, in another study by (86), 50% of out-patient adult participants diagnosed with schizophrenia had suffered from various child abuse and neglect cases including child sexual abuse. On the other hand, among the adult female participants in the study by Friedman et al (2002), 78% of them had experienced child sexual abuse compared to 26% and 30% who had experienced anxiety and depression disorders respectively. Finally, Livingston (2003) conducted a study among inpatient children and found that 77% of those who had been sexually abused were diagnosed with psychosis.

3.6 Child abuse and schizophrenic symptoms

Due to the varied nature in which schizophrenia presents itself (Bental 2003, Ross 2005), researchers have now shifted their focus on understanding the various psychotic symptoms associated with schizophrenia. For example, Muenzenmaier et al (1993) conducted a study on female samples with chronic mental illness and found that those with a history of child sexual abuse had more psychotic symptoms of hallucination that their non-abused counterparts. Similar results have been found in other studies (e.g. Ross et al 1992, Janssen & Krabbendam 2004) of psychotic symptoms involving the populations with schizotypal elements such as magical ideation. For example, in a qualitative study involving people with schizophrenic symptoms, samples with more than one schizophrenic symptom were found to have experienced either child sexual abuse or physical abuse. Similarly, a study involving in-patient samples found that among the participants with more than one schizophrenic symptom as measured with the DSM five characteristic scales, 76% of them had suffered from child sexual abuse while 100% of them had suffered from incest (Read & Argyle 1999). In a similar study by Read et al (2003), 200 samples of adult patients were examined and it was found that 35% of them had undergone child sexual abuse and later displayed two or more symptoms of psychosis including hallucination. Ross et al (1994) conducted a study among in-patient schizophrenic and found that those who had either experienced child sexual abuse of physical abuse had more positive schizophrenic symptoms and fewer negative symptoms compared to who had not experienced such types of abuse at childhood. Notably, some of the symptoms related to abuse included paranoid ideation and visual hallucination.

Chapter 4

4.0 Findings and Discussions

I strategically used these selected studies based on the BEAM method coined in 2008 by Joseph Bizup. According to Bizup (2008), research sources can be used in four main ways, namely: as background sources, as exhibit sources, as of argument sources and as method sources. When a researcher uses a journal article as a background source, they use it to establish a common ground with the audience i.e., providing general information, background information and to give context to the current phenomenon under investigation. Next, the use of sources to exhibit entails an analysis of these sources to provide evidence. Fundamentally, the researcher uses the sources as an example to validate their points or presents and analyses these sources to make specific conclusions. Conversely, the use of a source for argument purposes entails engaging the claims and ideas presented in that source to refute or confirm a proposition. Lastly, using an article as a method source involves deriving perspectives and insights from the source and identifying how they apply to the current research context (Bizup, 2008). Therefore, in the present study, I use the selected sources based on the BEAM model because it enables a broader and more in-depth analysis of data to answer the current research question. The review focused on two primary studies (Mangoenkaeso & Blom 2018 & Read et al 1999) and one secondary study (Read et al 2005). One study (Mangoenkaeso & Blom 2018) was a survey; one (Read et al 1999) was a cross-sectional study while the other one was a review of existing evidence.

Mangoenkaeso & Blom (2018) attempted to identify the relationship between sexual hallucination and childhood sexual trauma, its prevalence, and symptoms. The study was based on the premises that whereas there is much information about other types of hallucinations such as auditory hallucination, there is a lack of research regarding sexual hallucination, how it presents itself and its relationship with childhood sexual trauma. The qualitative study potentially had 778 patients with a schizophrenia spectrum disorder, but only 42 of them were considered suitable for recruitment into the study. Among the 42, 30 of them were subjected to a Childhood Trauma Questionnaire to assess their levels of childhood sexual trauma. Out of the 30, 13 were reported to have sexual hallucination with a 0.017 one-year prevalence rate. Furthermore, 46.2% of the hallucinating patients were found to be undergoing multimodal hallucinations i.e.; their hallucinations involved all the five sensory modalities. More interestingly, 76.9% of the sexually hallucinating patients had a history of sexual trauma, while 61.5% of the participants were highly depressed. The interviews by Mangoenkaeso & Blom (2018) revealed some interesting insights into the definition, conceptualization and experience of hallucinations by the sample population. For instance, one participant explained that whenever she was alone in a room, she felt like her genitals were being touched, and that her genitals, anus and breasts were under an electric shock. On the other hand, one participant noted that a ghost’s figure was running over her body. Generally though, most respondents reported a sensation of being sexually penetrated a description that fits what Gittleson & Levine (1966) defined as ‘tactile sexual hallucination’, which includes a feeling of being raped or sexually assaulted. These conceptualizations of sexual hallucination are comparable to Gittleson & Levine’s (1996) and Dawson-Butterworth’s (1967) definition of sexual hallucination as genital hallucination characterised by unusual feelings.

Significant evidence emerges from Mangoenkaeso & Blom (2018) regarding the relationship between sexual hallucination among patients with schizophrenia spectrum disorder and childhood sexual trauma. For example, besides finding several participants to be experiencing sexual hallucination, the authors found a significant (0.017) level of one-year prevalence of sexual hallucination among this group of patients , a finding that corroborates with those of Waters et al (2018) that 70% to 80% of patients with schizophrenia spectrum disorder encounter various forms of hallucination. Nonetheless, there are very few studies available for comparison and validation of this prevalence, considering that no epidemiological survey studies conducted on hallucinations have singled out sexual hallucination as a form of hallucination, and a paucity of clinical surveys on sexual hallucinations (Blom 2013). That said, Mangoenkaeso & Blom (2018) found a prevalence of sexual hallucination among patients with a history of childhood trauma, with sexual trauma indicating more association with sexual hallucination at an odds ratio of 8.7. However, because the diagnosis of sexual hallucination within this study includes other conditions such as intoxications, epilepsy and narcolepsy, the results of this study should carefully be generalised. Furthermore, future studies should exclude these conditions even when diagnosing schizophrenia spectrum disorder. Therefore, I use this study both as an exhibit and as an argument source – to make an argument that there is a possible relationship between sexual hallucinations among patients diagnosed with schizophrenia spectrum disorder and childhood sexual abuse. This argument is defendable even in the context of fewer evidence considering that even among the retrievable surveys on sexual hallucination, most of them were performed in the 1990s and had smaller sample population. Consequently, they displayed a prevalence rate of 0.08 to 0.57, a phenomenon attributable to methodological differences such as a disparity in in the provision of case definitions and a difference in the explicit mentioning of the long-term or short-term presence of sexual hallucinations. A possible implication of these findings is that more research is needed to establish the prevalence of sexual hallucination among this group of patients as a means of theorizing the relationship between their experiences of sexual hallucination and their history of childhood abuse. This is especially important considering that the highest prevalence of sexual hallucination among patients with schizophrenia spectrum disorder was highlighted by Klaf (1961) whose study was based on both delusions and sexual hallucinations pooled on a single category, and therefore the prevalence level of sexual hallucination they reported could not be taken at face value.

In another study by Read et al. (2005), the researchers were determined to explore childhood trauma, various types of psychosis such as hallucinations and delusions, and schizophrenia. They also intended to evaluate the clinical and theoretical implications of this relationship. After reviewing a series of literature materials, the researcher found that various symptoms related to schizophrenia and psychosis (e.g. hallucinations) were strongly related to either child physical abuse of child sexual abuse. Consequently, Read et al (2005) concluded that childhood sexual or physical trauma cause psychosis among schizophrenic adults through various biological and psychological mechanisms. Studies reviewed by Read et al (2005) indicated a strong relationship between either child sexual abuse or child physical abuse and hallucinations. Whereas these findings were not specifically focused on sexual hallucination, the evidence produced herein can be used as background sources to validate the speculation of a relationship between childhood abuse and psychosis, and as an argument source that childhood sexual abuse has a causative effect on various symptoms of psychosis such as hallucination and delusion. Nonetheless, I draw from this study that while research evidence child abuse is a causal factor for hallucinations among patients with schizophrenic spectrum disorder, understanding this relationship requires integration between biological and psychosocial underpinnings that consider various events causing an alteration of brain functioning. The last study I reviewed was that of Read et al (1999). This study gives a wide scope of knowledge on childhood sexual abuse, schizophrenia spectrum disorder and psychotic symptoms such as delusion and hallucination. However, because the study does not specifically focus on sexual hallucination, the data and evidence it presents makes it a useful background as well as argument source for evaluating the relationship between sexual hallucination and childhood sexual trauma among patients with schizophrenia spectrum disorder. Read et al (1999) conducted their study based on the records of 100 patients admitted in a New Zealand hospital with a history of either child sexual or physical assault, or displaying symptoms of hallucination, thought disorder and delusions. The authors found half of the recorded symptoms were related to the child abuse, and that hallucinations were more common that delusions in samples with a history of incest. These results corroborate with the findings by Goodman et al (1995) who included a sample of female outpatients with schizophrenia spectrum disorder and found that 92% of them had experienced either childhood sexual or physical abuse.

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Read et al (1999) also found a significant correlation (p 01) between incest, and the likelihood of hallucination, although not with the likelihood of other schizophrenic symptoms. Moreover, the study found that patients who had a history of sexual and physical abuse were more likely to experience hallucination compared those who experienced only one of the abuses – even though this difference was not statistically significant.

Chapter 5

5.0 Conclusion

In conclusion, the main aim of this study was to explore the relationship between childhood sexual abuse and sexual hallucination among patients with schizophrenia spectrum disorder. A detailed review of literature was conducted on three previous studies: one being qualitative, the second one being cross-sectional, and the third one being a review of literature. While only one study (Mangoenkaeso & Blom, 2018) could be used as an exhibit source, others could only be used either as a background sources or as argument sources. Among the studies reviewed, one found a statistically significant one year prevalence of sexual hallucination among patients with a history of childhood sexual abuse who was also suffering from schizophrenia spectrum disorder. This study acted as an exhibit source, providing empirical evidence that there is a causative relationship between childhood sexual abuse and sexual hallucination among patients with schizophrenia disorder spectrum. The other studies, although not exhibit sources, were useful as a background sources, as they found a correlation between child physical and sexual abuse and hallucination as a symptom indicative of psychosis. The reviewed studies provided evidence that there is a causative relationship between sexual hallucination and childhood sexual abuse among patients with schizophrenia spectrum disorder, even though these pieces of evidence are not adequate enough to make a conclusion on the same. From this review though, I infer the importance of routinely asking about childhood trauma whenever they are handling people diagnosed with schizophrenia spectrum disorder. Another clinical implication of these findings is that there is a clinical importance in gathering data on childhood sexual and physical abuse both at community and inpatient level. Ideally, this information can help in the development of various abuse-focused therapies. These pieces of evidence also highlight the importance of paying close attention to sexual hallucination among patients with schizophrenia disorder spectrum and childhood sexual hallucination. Conversely, there are several theoretical and clinical implications of these findings. For example, these findings imply that the confusion and distress experienced by people while hallucinating can be better understood through psychosocial perspectives as well as through the application of various biological frameworks. However, a major impediment to the latter paradigm is that there is a dearth of information about the characteristics and content of various psychotic symptoms Read et al 1999). Future research should focus the biological frameworks through which this relationship can be understood. Lastly, the findings of this study imply several considerations that are worth recommending that research on the relationship between sexual hallucination and childhood sexual abuse among patients with schizophrenia disorder spectrum is still on its infancy stage, and therefore, more research efforts are needed, especially those that focus on other confounding factors that mediate this relationship.

References

Bailey T, Alvarez-Jimenez M, Garcia-Sanchez AM, Hulbert C, Barlow E, Bendall S. Childhood trauma is associated with severity of hallucinations and delusions in psychotic disorders: a systematic review and meta-analysis. Schizophrenia Bulletin. 2018 January 2;[Epub ahead of print].

Blom, J. D., & Mangoenkarso, E. (2018). Sexual Hallucinations in Schizophrenia Spectrum Disorders and Their Relation With Childhood Trauma. Frontiers in psychiatry, 9, 193. doi:10.3389/fpsyt.2018.00193.

Balasubramaniam B, Park GR. Sexual hallucinations during and after sedation and anaesthesia. Anaesthesia (2003) 58:549–53.

Blom JD. Hallucinations and other sensory deceptions in psychiatric disorders. In: Jardri R, Cachia A, Thomas P, Pins D, editors. , editors. The Neuroscience of Hallucinations. New York, NY: Springer; (2013). p. 43–58.

Blom JD. Hallucinations and other sensory deceptions in psychiatric disorders. In: Jardri R, Cachia A, Thomas P, Pins D, editors. , editors. The Neuroscience of Hallucinations. New York, NY: Springer; (2013). p. 43–58.

Cheyne JA. Sleep paralysis and the structure of waking-nightmare hallucinations. Dreaming (2003) 13:163–79.

Chandra P, Deepthivarma S, Carey M, Carey K, ShalinianantM. A cry from the wilderness: women with severe mental illness in India reveal their experiences with sexual

Christoffersen M, Poulsen H, Nielsen A. Attempted suicide among young people: risk factors in a prospective register based study of Danish people born in 1966. Acta Psychiatr

Connolly FH, Gittleson NL. The relationship between delusions of sexual change and olfactory and gustatory hallucinations in schizophrenia. Br J Psychiatry (1971) 119:443–4.

Christoffersen M, Poulsen H, Nielsen A. Attempted suicide among young people: risk factors in a prospective register based study of Danish people born in 1966. Acta Psychiatr

Friedman S, Smith L, Fogel D et al. The incidence and influence of early traumatic life events in patients with panic disorder: a comparison with other psychiatric outpatients.

Goldmeier D, Andrews S. Persistent genital arousal disorder. In: Sharpless BA, editor. , editor. Unusual and Rare Psychological Disorders. A Handbook for Clinical Practice and Research. Oxford: Oxford University Press; (2017). p. 109–123.

Goldmeier D, Leiblum SR. Persistent genital arousal in women—a new syndrome entity. Int J STD AIDS (2006) 17:215–6.

Gittleson NL, Levine S. Subjective ideas of sexual change in male schizophrenics. Br J Psychiatry (1966) 112:779–82.

Gittleson NL, Dawson-Butterworth K. Subjective ideas of sexual change in female schizophrenics. Br J Psychiatry (1967) 113:491–4.

Howes OD, Murray RM. Schizophrenia: an integrated sociodevelopmental-cognitive model. Lancet (2014) 383:1677–87.

Jevtović-Todorović V, Todorović SM, Mennerick S, Powell S, Dikranian K, Benshoff N, et al. . Nitrous oxide (laughing gas) is an NMDA antagonist, neuroprotectant and neurotoxin. Nat Med. (1998) 4:460–3.

Leiblum SR, Nathan SG. Persistent sexual arousal syndrome: a newly discovered pattern of female sexuality. J Sex Marital Ther. (2001) 27:365–80.

Leiblum SR, Goldmeier D. Persistent genital arousal disorder in women: case reports of association with anti-depressant usage and withdrawal. J Sex Marital Ther. (2008) 34:150–9.

Lim A, Hoek HW, Deen M, Blom JD, Group Investigators. Prevalence and classification of hallucinations in multiple sensory modalities in schizophrenia spectrum disorders. Schizophr Res. (2016) 176:493–9.

Lim A, Hoek HW, Deen M, Blom JD, Group Investigators. Prevalence and classification of hallucinations in multiple sensory modalities in schizophrenia spectrum disorders. Schizophr Res. (2016) 176:493–9. 10.1016/j.schres.2016.06.010

Mullen P, Martin J, Anderson J, Romans S, Herbison G. Childhood sexual abuse and mental health in adult life. Br J Psychiatry 1993;163:721–732.

Parish E. Ueber die Trugwahrnehmung (Hallucination und Illusion). Leipzig: Verlag von Ambrosius Abel; (1894).

Read J, van Os J, Morrison AP, Ross CA. Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatr Scand. (2005) 112:330–50.

Read J, Agar K, Argyle N, Aderhold V. Sexual and physical assault during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychol Psychother Theory Res Pract 2003;76:1–22.

Read J. Child abuse and psychosis: a literature review and implications for professional practice. Prof Psychol Res Pr 1997;28:448–456.

Read J, Goodman L, Morrison A, Ross C, Aderhold V. Childhood trauma, loss and stress. In: Read J, Mosher L, Bentall R, eds. Models of madness: psychological, social and biological approaches to schizophrenia. Hove, UK: Brunner-Routledge, 2004:223–252.

Steel C. Hallucinations as a trauma-based memory: implications for psychological interventions. Front Psychol. (2015) 6:1262.

Szucs A, Janszky J, Holló A, Migléczi G, Halász P. Misleading hallucinations in unrecognized narcolepsy. Acta Psychiatr Scand. (2003) 108:314–7.

Schneemilch C, Schiltz K, Meinshausen E, Hachenberg T. Sexualbezogene Halluzinationen und Träume unter Anästhesie und Sedierung. Anaesthesist (2012) 61:234–41.

Spataro J, Mullen P, Burgess P, Wells D, Moss A. Impact of child sexual abuse on mental health: prospective study in males and females. Br J Psychiatry

Sansonnet-Hayden H, Haley G, Marriage K, Fine S. Sexual abuse and psychopathology in hospitalized adolescents. J Am Acad Child Adolesc Psychiatry 1987;26:753–757.

Thompson A, Nelson B, McNab C, Simmons M, Leicester S, McGorry PD, et al. . Psychotic symptoms with sexual content in the “ultra high risk” for psychosis population: frequency and association with sexual trauma. Psychiatry Res. (2010) 177:84–91.

Waters F, Blom JD, Jardri R, Hugdahl K, Sommer IE. C. Auditory hallucinations, not necessarily a hallmark of psychotic disorder. Psychol Med. (2018) 48:529–36.

Klaf FS. Female homosexuality and paranoid schizophrenia. A survey of seventy-five cases and controls. Arch Gen Psychiatry (1961) 4:84–6.

Fergusson D, Horwood L, Woodward L. The stability of child abuse reports: a longitudinal study of the reporting behaviour of young adults. Psychol Med 2000;30:529–544.

Muenzenmaier K, Meyer I, Struening E, Ferber J. Childhood abuse and neglect among women outpatients with chronic mental illness. Hosp Community Psychiatry