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Annals of Psychophysiology                                                                                                              Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                   www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Case Study 

Cenesthopathy-The Paradigm in Schizophrenia 
Anum Haider 

AQ Khan Center, Institute of Behavioral Sciences Karachi 

Corresponding Author: dranum.haider@gmail.com 

 

Abstract 

In this article, the frequently presented but underestimated or neglected area has been unveiled. 

The Abnormal body sensations, Cenesthesias has been discussed in the context of schizophrenia. 

The identified underlying Psychophysiological mechanisms and treatment options will also be 

discussed along with future recommendations. Two cases will be presented to contemplate this 

condition. 

 

Keywords 

Cenesthopathic, Schizophrenia, abnormal body sensations, prognosis 

 

Introduction 

The term cenesthopathy coined by Dupre and 

Camus in 1907 and described it as a 

phenomenology in mental illness (Takahash 

et al., 2013).This term has been derived from 

“cenethesia” which means abnormal body 

sensations. The abnormal body sensations 

come as frequent complaint in Schizophrenia 

(Jenkins et al., 2007).Huber in 1957 proposed 

cenesthopathic schizophrenia as “a subtype 

of Schizophrenia in which bizarre peculiar 

abnormal bodily sensations dominate, these 

are difficult to describe, chronic insidious in 

course and with limited psychotic symptoms” 

(Takahash, et al., 2013). It not only presents 

a separate entity of Schizophrenia but can 

also be present as onset and prodromal of 

Schizophrenia (Stanghellini, et al., 2014).Its 

prevalence as a separate entity is 6.25-23.3 % 

(Chang, 2014). It may appear as an onset of 

illness in 40% of cases while the rate of 

change in form of illness in later course is 

75.7% (Rajendar, et al., 2010). In this 

category of Schizophrenia, tactile 

hallucinations and somatosensory delusional 

beliefs are common (Blom,   2012). The most 

common presentations are dysmorphic or 

pain like experiences, morbid objectification 

or devitalization, dynamization of bodily 

boundaries and construction (Stanghellini, et 

al., 2014). 

The suggested underpinning neurobiological 

and psychophysiological mechanisms are 

central brain atrophy, thalamic disruption, 

cortical disorganization, alteration in pain 

perception and modulation (i.e. noxious 

inhibitory control and excitatory endogenous 

pain mechanisms). These changes if matches 

with schizophrenic pathophysiological 

factors like genetic vulnerability 

neurochemical changes-decreased inhibitory 

GABAergic and Increased excitatory 

Glutamatergic activities, NMDA receptor 

hypo function, changes in dopaminergic and 

cholinergic transmission can result in 

cenesthopathic entity of Schizophrenia 

spectrum disorder (Takahash, et al., 2013, 

Chang, et al., 2014). Cenesthopathy can 

present with both psychiatric and organic 

disorders (Dementia). As a Psychiatric 

disorder it can be a sole presentation or a 

symptom of paranoid psychosis (Takahash, 

et al., 2013 & Chang, 2014). Despite of such 

frequent and even dominant presentation, it 

could not get adequate importance 

(Stanghellini, et al., 2014). Moreover the 

term cenesthopathic schizophrenia has not 

been introduced in any classification system. 

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Anum Haider 68 

  

Annals of Psychophysiology                                                                                                              Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                   www.aeirc-edu.com 

ISSN 2412 - 3188 
 

However in ICD-10 it can be classified in the 

category of other Schizophrenic disorders 

(Jenkins, et al., 2007).It is a very important 

diagnosis to be aware of because it poses 

great burden of disability as a result of 

negative symptoms and personality 

deterioration (Chang, 2014). Early 

recognition and start of treatment is crucial 

for good prognosis and limiting the disability 

(Stanghellini, et al., 2014 & Rohircht, et al., 

2010). 

The aim of presentation of following two 

cases is to increase the awareness of the 

problem and to promote early recognition 

and better prognosis. 

 

CASE-1 

Mr. Y 60years old married male, father of 

three children, retired, educated up to 

intermediate, follows Muslim religion and 

belongs to Asian ethnicity. He has no known 

comorbid, presented by daughter in 

psychiatric clinic with complaints of; 

Excessive hand washing and feeling of sticky 

secretions from body for more than one year. 

The illness started with somatic complaints 

such as difficulty in urination and other gut 

related symptoms. Those had been 

investigated with unremarkable findings and 

ultimately handled by different physicians as 

medically unexplained symptoms. Then 

gradually the illness presented differently by 

patient with excessive hand washing and 

preoccupation with body because of the 

release of sticky secretions from skin 

including the mouth cavity and ears. The 

patient was convinced and claimed that he 

could see those secretions releasing from the 

skin in almost entire body but most at the 

conspicuous parts. He used to wash 

excessively the alleged affected areas and 

kept Vaseline all time with him to apply at the 

dry skin after washing. He reduced to take 

food due to those secretions and 

consequently his body weight was reduced. 

His sleep was disturbed and socio-

occupational functioning was ceased 

completely. On Mental State Examination; 

there was emotional bluntness, physical 

agitation, scanty speech, refusal of auditory 

hallucinations. Somatic delusion/ 

hallucination   (Fully convicted with the 

secretions and able to see it) Preoccupation 

with the secretions and interested to get rid of 

it. Absence of insight and grossly sound 

cognitive functions. Physical examination 

and laboratory investigation unremarkable. 

Treatment started with second generation 

antipsychotics (tab olanzapine 10mg) and 

called for follow up. 

 

CASE-2 

Mrs. X, 55years old divorced household lady 

educated up to graduation, follows Muslim 

religion, belongs to Asian ethnicity. She has 

no known comorbid, presented by brother in 

psychiatric clinic with complains of; feeling 

of discharge and malodor from body 

(including genitalia), avoidance of religious 

activities. These were insidious in onset and 

aggravated for past few months. The illness 

started gradually with social isolation and 

altered behavior (self-neglect and reduced 

oral intake). It then became obvious when she 

clearly started complaining about body 

secretions and behaving accordingly 

(excessive hand washing and securing from 

paravaginal discharge) and as well as asking 

family members if they could smell the bad 

odor from her body. She abandoned offering 

prayers contemplating herself contaminated. 

She also stopped socialization and started 

talking limitedly. She argued with baseless 

justifications on confrontation of family 

members. On Mental state examination; she 

had found with blunt affect, irritable on 

skepticism, preoccupied with body odor and 

discharge, poor rapport, convicted with her 

beliefs (somatic delusion and hallucination), 

refusing auditory hallucinations, lack of 

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Anum Haider 69 

  

Annals of Psychophysiology                                                                                                              Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                   www.aeirc-edu.com 

ISSN 2412 - 3188 
 

insight and intact gross cognitive 

functioning. Gynecologist cleared her from 

any pathology. Physical examination and 

labs were also unremarkable. Treatment 

started with Tablet Olanzapine10mg and 

sertraline 50mg and referred for 

psychological evaluation and therapy. Family 

Psychoeducational and counseling also 

offered. 

 

Discussion 

The above presented cases showing common 

pertinent pattern of presentation such as 

insidious onset of illness, predominance of 

somatic complains that were misdiagnosed 

and mismanaged, involvement of both 

genders, the change in presentation from the 

initial illness phase, Preoccupation with 

abnormal physical sensations i.e. secretions 

from the body, the strong conviction with 

their beliefs, lack of insight to correct that 

abnormal belief. Nevertheless their lives 

were revolving around those false 

perceptions with intense distress and socio-

occupational impairment, Absence of other 

physical comorbid and clinical signs of other 

psychiatric disorders (Depression, Obsessive 

Compulsive Disorder-OCD and mania) as 

per diagnostic criteria. 

 

The insidious course, lack of insight, strong 

conviction to the belief, behavioral alteration 

and socio-occupational impairment 

supported to consider for psychotic disorder 

i.e., Schizophrenia. The other studies in 

comparison to presented cases also mirrored 

most of the findings such as chronic insidious 

course (Chang, 2014), the predominant oral 

symptoms presentation in males, the late 

onset of presentation in females (>40yrs) 

(Takahash, et al., 2013).There is also a 

frequent presentation of chronic medically 

unexplained physical symptoms and 

misdiagnosis as somatoform disorder 

(Rohircht, et al., 2010).. Due to misdiagnosis 

and neglected care these are usually lately 

diagnosed as in presented cases (Rohircht, et 

al., 2010). The commonly identified hurdles 

in the early diagnosis are lack of knowledge 

and awareness due to non-inclusion of this 

diagnosis of cenesthopathic schizophrenia as 

a separate entity as well as appropriate 

assessment tools are not easily available to 

facilitate or confirm the diagnosis (Jenkins, et 

al., 2007 & Stanghellini, et al., 2014).The 

delayed diagnosis is usually associated with 

poor prognosis. Early identification and 

treatment with second generation 

antipsychotics, electroconvulsive therapy 

and antidepressants in indicated cases 

predicts good prognosis (Takahash, et al., 

2013). Almost half of the cases found to 

respond well on antipsychotics (Rohircht, et 

al., 2010). 

 

Recommendations 

- First of all it is essential to include this 

diagnosis as separate entity of 

schizophrenia in the standard 

classification systems 

- Need to educate the health professional to 

early recognize these cases for better 

prognosis 

- Improvement in making the health care 

services more accessible 

- Appropriate assessment tools must be 

easily available both for clinics and 

research. 

- Future research is needed to understand 

the psychophysiological mechanisms and 

to establish better evidence of treatment. 

 References

 

 
 Blom, J. D., & Sommer, I. E. (2012). 

Hallucinations of bodily sensation. 

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Anum Haider 70 

  

Annals of Psychophysiology                                                                                                              Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                   www.aeirc-edu.com 

ISSN 2412 - 3188 
 

In Hallucinations (pp. 157-169). 

Springer New York. 

 Chang W. (2014) Cenesthopathic 

schizophrenia (case conference TYPC 

Taiwan 20141227) 

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(2014). Could schizophrenia be a 

refractory condition to central pain 

sensitization? In Mental Health and Pain 

(pp. 157-171). Springer Paris. 

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