[The cenesthesiopathies]

Abstract

Background: Up till a century ago the classic concepts of cenesthesis and cenesthesiopathy played a major role in the conceptualisation of aberrant somatosensory sensations and disturbances in the sensation of physical existence. Although these concepts are considered obsolete by a number of authors, the conceptual work of the German psychiatrist Gert Huber and the results of modern neuroimaging studies point to the need for a re-evaluation of the concepts cenesthesis and cenesthesiopathy.

Method: Background information was obtained from PubMed, Embase and the medical historical literature. By way of illustration, two cases are presented: the first is a female patient with a strongly diminished sense of physical existence (hypocenesthesiopathy) and the second is a male patient with such pronounced somatosensory sensations that he believed he was being transformed into a werewolf (hypercenesthesiopathy, clinical lycanthropy).

Results: On the basis of the literature and the two case studies, it is shown that the concepts of cenesthesis and cenesthesiopathy may be helpful in the conceptualisation of disorders of the sensation of bodily existence brought about by aberrant somatosensory sensations.

Conclusion: In the cases of peculiar and unexplained physical symptoms, the cenesthesiopathies should be part of the differential diagnosis. Particularly if patients have longlasting, medication-resistant forms of cenesthesiopathy, it is strongly recommended that such patients undergo neuroimaging and are given an EEG so that treatable somatic conditions can either be demonstrated or ruled out.