A 49-year-old married woman presented on an urgent basis for psychiatric evalution because of delusions of being a wolf and "feeling like an animal with claws." She suffered from extreme apprehension and felt that she was no longer in control of her own fate: she said, "A voice was coming out of me." Throughout her 20-year marriage she experienced compulsive urges towards bestiality, lesbianism, and adultery.
The patient chronically ruminated and dreamed about wolves. One week before her admission, she acted on these ruminations for the first time. At a family gathering, she disrobed, assumed the female sexual posture of a wolf, and offered herself to her mother. This episode lasted for approximately 20 minutes. The following night, after coitus with her husband, the patient suffered a 2-hour episode, during which time she growled, scratched, and gnawed at the bed. She stated that the devil came into her body and she became an animal. Simultaneously, she experienced auditory hallucinations. There was no drug involvement or alcoholic intoxication.
The patient was treated in a structured inpatient program. She was seen daily for individual psychotherapy and was placed on neuroleptic medication. During the first 3 weeks, she suffered relapses when she said such things as "I am a wolf of the night; I am a wolf woman of the day...I have claws, teeth, fangs, hair... and anguish is my prey at night...the gnashing and snarling of teeth...powerless is my cause, I am what I am and will always roam the earth long after death...I will continue to search for perfection and salvation.
She would peer into a mirror and look frightened because her eyes looked different: "One is frightened and the other is like the wolf--it was dark, deep, and full of evil, and full of revenge of the other eye. This creature of the dark wanted to kill." During these periods, she felt sexually aroused and tormented. She experienced strong homosexual urges, almost irresistable zoophilic drives, and masturbatory compulsions--culminating in the delusion of a wolflike metamorphosis. She would gaze into the mirror and see "the head of a wolf in place of a face on my own body--just a long-nosed wolf with teeth, groaning, snarling, growling...with fangs and claws, calling out "I am the devil." Others around her noticed the unintelligible, animal-like noises she made.
By the fourth week she had stabilized considerably, reporting, "I went and looked into a mirror and the wolf eye was gone." There was only other short-lived relapse, which responded to reassurance by experienced personnel. With the termination of that episode, which occurred on the night of a full moon, she wrote what she experienced: "I don't intend to give up my search for (what) I lack...in my present marriage...my search for such a hairy creature. I will haunt the graveyards...for a tall, dark man that I intend to find." She was discharged during the ninth week of hospitalization on neuroleptic medication.
On the Wechsler Adult Intelligence Scale, the patients performance showed normal intellect; the subscale configuration was devoid of behavioral correlates associated with organicity, as was the Bender Motor Gestalt Test. On the Holtzman Ink Blot Technique, the performance was indicative of an acutely psychotic schizophrenic with distorted body image and gross sexual preoccupation. The Lovinger Sentence Completion Blank was corroborative. The Minnesota Multiphasic Personality Inventory was interpreted as showing an acute schizophrenic reaction with evidence of obsessional thinking, marked feelings of inferiority, and excessive needs for attention and affection.
We believed that the patient suffered from chronic pseudoneurotic schizophrenia. What is of particular interest is that the delusional material was organized about a lycanthropic matrix. Her symptom complex included the following classic symptoms:
These symptoms occurred significantly in the absence of exposure to toxic substances. Furthermore, the patient responded to the treatment protocol used for acute schizophrenia psychosis. After reviewing ancient and modern literature, it is felt that the differential diagnosis for lycanthropy should include consideration of all of the following possibilities: 1) schizophrenia, 2) organic brain syndrome with psychosis, 3) psychotic depressive reaction, 4) hysterical neurosis of the dissociative type, 5) manic-depressive psychosis, and 6) psychomotor epilepsy. The last item is mentioned because of the reports that individuals suffering from lycanthropy have been described as being "prone to epilepsy" and suffering from intercurrent amnestic episodes.
A search of modern literature produced three cases. In two cases, the patients were ultimately diagnosed as having paranoid schizophrenia, facilitated by involvement with hallucinogenic drugs, and chronic brain syndrome with periodic psychoses. In the third case, described by Morrell in 1852, it seems that the patient was suffering from a deteriorating psychotic depression.
We believed that the metamorphosis undergone by the patient we have described provided temporary relief from an otherwise consuming sexual conflict that might have taken the form of a completed suicide.
Lycanthropy is a rare phenomenon, but it does exist. It should be regarded as a symptom complex and not a diagnostic entity. Furthermore, although it may generally be an expression of an underlying schizophrenic condition, at least five other differential diagnostic entities must be considered.