Introduction
Shared psychotic disorder (SPD), or folie à deux, refers to the induction of psychopathology from a primary patient (inducer) to a secondary individual in close emotional proximity. While delusional transmission is well recognized, shared hallucinations are rare.
Cenesthopathy – defined as abnormal bodily sensations without organic basis – has been described in schizophrenia (Huber’s “cenesthetic schizophrenia”) but is infrequently reported as shared between individuals. Existing literature describes familial or dyadic cases 1-3, medical precipitants 4, and genetically close dyads 5,6. Yet reports of shared cenesthetic hallucinations remain exceptionally rare.
We present a case of folie à deux hallucinatoire in which cenesthetic hallucinations were transmitted from a man with schizophrenia to his wife.
Case report
Index patient
Mr. X, a 45-year-old married male from Punjab, presented with a 20-year history of psychotic symptoms characterized by paranoid delusions, auditory hallucinations, abnormal bodily experience characterized by abnormal bodily perceptions, including subjective sensations of kidney rotation and genital retraction hallucinations, which the patient attributed to the influence of a supernatural agent. Inter-episodic periods would be completely symptom free. Comprehensive laboratory investigations, including routine hematological and biochemical panels, thyroid function tests, and a detailed neurological examination, revealed no abnormalities that could explain the reported cenesthetic phenomena. Over the preceeding 4 months patient had been feeling strange sensations in his body, following which he started experiencing the sensation of genital retraction. He interpreted these phenomena within a culturally sanctioned explanatory framework, attributing them to the influence of a powerful Jinn – a supernatural entity commonly described in South Asian and Middle Eastern traditions – which he believed intermittently entered his body and caused these disturbances. The patient believed the jinn wanted to establish sexual relations with his wife and was doing these because of the same. Patient also reported elementary hallucinations of hearing footsteps in his house. He began experiencing auditory hallucinations of anklet sounds (payal) and sensations of being sexually manipulated by the Jinn.
Secondary case
His wife, with no prior psychiatric history and not meeting criteria for any independent psychotic disorder, gradually began to share his experiences over the course of 3 months. Collateral information from relatives and several serial mental status examinations confirmed an absence of independent psychopathology in the wife. Initially fearful of an unseen presence, she subsequently developed auditory hallucinations (hearing anklets) and cenesthetic hallucinations of being touched and assaulted by the Jinn. During attempts at sexual intimacy, she reported feeling vaginal penetration despite her husband experiencing genital retraction – both attributing this to the supernatural agent.
Phenomenological framing
The patient’s genital retraction was classified as a cenesthetic hallucination due to its vivid perceptual quality, though the boundary with somatic delusion was acknowledged. The wife’s symptoms were conceptualized as shared cenesthetic hallucinations consistent with folie à deux hallucinatoire. The genital retraction phenomenon, though resembling Koro, was distinguished by its vivid perceptual quality, fluctuating course, and absence of enduring belief, aligning it more closely with cenesthetic hallucinations than fixed somatic delusions
Treatment and outcome
Mr. X was treated with risperidone (titrated to 4 mg/day). His wife received psychoeducation focusing on emotional differentiation and reality testing. Separation of patient and his wife was advised but not followed through by the family because of financial limitations. As his symptoms remitted following pharmacotherapy, her hallucinations also resolved without pharmacotherapy. At a two-year follow-up, both remained symptom-free.
Discussion
This case demonstrates the rare phenomenon of shared cenesthetic hallucinations in the context of schizophrenia. While folie à deux typically involves delusional transmission, hallucinatory contagion, of bodily sensations is scarcely described.
Several factors likely contributed:
Close emotional bond and dependency within the marital relationship.
Cultural explanatory models framing symptoms as caused by a Jinn, legitimizing shared experiences.
Negative symptoms and impaired functioning in the primary case 7, increasing dependency within the dyad.
Source-monitoring deficits 8, predisposing both patients to externalize internal sensations.
Comparable cases underscore the relevance of emotional closeness 1,2 organic precipitants 4, and genetic vulnerability 5,6. Distinguishing folie à deux from co-occurring psychosis in both partners remains a nosological challenge 9.
Similar cases of induced hallucinations have also been reported in the literature. A case described by Tenyi documented a married couple in which the husband, suffering from paranoid hallucinatory psychosis, induced auditory hallucinations in his wife, who had no independent psychiatric illness. Another case reported by Dantendorfer described a wife who developed hallucinatory psychosis due to her husband’s alcoholic hallucinosis. This latter report explored the nosological position of folie à deux hallucinatoire within broader psychopathological frameworks, emphasizing that induced hallucinations may constitute a distinct though underrecognized phenomenon 10,11.
The wife’s remission with psychoeducation and separation (via symptom resolution in the husband) illustrates that treatment of the primary inducer is pivotal in achieving remission of symptoms in the secondary case. Addressing cultural frameworks and offering reality testing were key to engagement.
Conclusion
This report adds to the very limited literature on folie à deux hallucinatoire by documenting the transmission of cenesthetic hallucinations within a marital dyad. It highlights the interplay of phenomenology, cognitive vulnerability, and cultural context. Clinicians should remain vigilant for shared hallucinations, clarify their distinction from somatic delusions, and apply culturally sensitive psychoeducation alongside antipsychotic treatment of the primary case.
Conflict of interest statement
The authors declare no conflict of interest.
Funding
None.
Authors’ contribution
K.S.N. and P.N. prepared the manuscript.
A.A. helped in management of the index case, final editing and approval of the manuscript.
Ethical consideration
Consent for research purposes was taken from the index case as per department protocol and anonymity was ensured.
History
Published online: December 30, 2025
