Although vampirism as a sexual paraphilia has been noted in the academic literature for many years (in fact there are references to it in Richard van Krafft-Ebing's 1886 text Psychopathia Sexualis), there has been very little empirical research and most of what is known comes from clinical case studies. To complicate things further, vampirism (i) is rarely a single clinical condition, (ii) may or may not be associated with other psychiatric and/or psychological disorders (e.g., severe psychopathy, schizophrenia, hysteria, mental retardation), and (iii) may or may not necessarily include sexual arousal. Other related conditions have been documented such as odaxelagnia (deriving sexual pleasure from biting), haematolagnia (deriving sexual satisfaction from the drinking of blood), haematophilia (deriving sexual satisfaction from blood in general), and auto-haemofetishism (i.e., deriving sexual pleasure from sight of blood drawn into a syringe during intravenous drug practice).

In a 1964 issue of the Archives of General Psychiatry, Dr. R.L. Vandenbergh and Dr. J.F. Kelly defined vampirism as “the act of drawing blood from an object, (usually a love object) and receiving resultant sexual excitement and pleasure”. In 1983, Dr. A. Bourguignon described vampirism as a clinical phenomenon in which myth, fantasy, and reality converge and that other paraphilic behavior may be involved including necrophagia, necrophilia, and sadism. he also noted that “vampirism is a rare compulsive disorder with an irresistible urge for blood ingestion, a ritual necessary to bring mental relief; like other compulsions, its meaning is not understood by the participant”.

In 1985, Herschel Prins published what is arguably the most cited paper in the field (in the British Journal of Psychiatry), and proposed that there were four types of vampirism (although confusingly, one of these sub-types is not actually vampiric as no blood ingestion takes place and some of the satisfaction gained may not necessarily be sexual). These four types were:

• Necrosadistic vampirism (i.e., deriving satisfaction from the ingestion of blood from a dead person);

• Necrophilia (i.e., deriving satisfaction from sexual activity with a dead person without the ingestion of blood)

• Vampirism (i.e., deriving satisfaction from the ingestion of blood from a living person)

• Autovampirism (deriving satisfaction from the ingestion of one’s own blood).

In Prins’ typology above, vampirism evidently overlaps with that of necrophilia. However, earlier papers (such as Vandenbergh and Kelly’s in 1964) clearly differentiated between necrophilia and vampirism, arguing that vampirism shouldn’t be mixed with necrophilia given that vampirism is often focused on the living. Vandenbergh and Kelly also differentiate vampirism from sexual sadism (due to the fact that vampirism doesn’t always include pain and suffering). In fact, in a literature review of sexual sadism in the book Sexual Deviance: Theory, Assessment and Treatment, Dr. P.M. Yates and colleagues (2008) included the “rare phenomenon” of vampirism in their review. Drawing on the work of Jaffe and DiCataldo (Bulletin of the American Academy of Psychiatry and the Law, 1994), they described those people who get sexual arousal from bloodletting (either through cutting or biting), and for which a small minority enjoy sucking and/or drinking the blood too. Vanden Bergh and Kelly (1964) noted that the sucking or drinking of the blood from the wound is often an important part of the act but not necessarily essential.

Any discussion of vampirism wouldn’t be complete without at least a mention of Renfield's Syndrome (RS). Renfield was a fictional mental patient in Bram Stoker’s novel Dracula (1887) who ate living things (flies, spiders, birds) believing that this would bring him greater ‘life force’ powers. The RS disorder, named in a 1992 book (Vampires, Werewolves and Demons: Twentieth Century Reports in the Psychiatric Literature) by clinical psychologist Dr Richard Noll is a rare psychiatric compulsion (not necessarily sexual and often linked with schizophrenia) – in which sufferers feel compelled to drink blood. As with some of the papers written on vampirism as a sexual paraphilia, this has also been called ‘clinical vampirism’. Like the character Renfield, RS sufferers believe that they can obtain increased power or strength (i.e., the ‘life force’) through the imbibing of blood.

RS sufferers are predominantly male (although there are known female vampirists), and like many paraphilias, the disorder often originates from a childhood event in which the affected individual associates the sight or taste of blood with psychological and/or physical excitement. It is during adolescence that the attraction to blood can become sexual in nature. Clinical evidence suggests female RS sufferers are unlikely to assault others for blood, but male RS sufferers are potentially more dangerous. It has been noted that RS usually comprises three stages:

• Stage 1 – Autovampirism (autohemophagia): In the first stage, RS sufferers drink their own blood and often bite or cut themselves to do so (although some pay just pick at their own scabs).

• Stage 2 – Zoophagia: In the second stage, RS sufferers eat live animals and/or drink their blood. The sources animal blood may come from butchers and abbatoirs if they have no direct access.

• Stage 3 – True vampirism: In the final stage, RS sufferers drink blood from other human beings. The sources of blood may be stolen from blood banks or hospitals or may be direct from other people. In the most extreme cases, RS sufferers may commit violent crimes including murder to feed their craving.

Tom Cruise as Lestat in 'Interview With The Vampire'

In a 1981 issue of the Journal of Clinical Psychiatry, Dr M. Benezech and colleagues reported a case study of cannibalism and vampirism in a French paranoid and psychotic schizophrenic. After trying to kill a number of people (mainly neighbors) between 1969 (when he was aged 29 years) and 1978, he attempted a vampiric rape on a child in 1979. Although he was stopped he went on later that day to murder an elderly man and successfully ate large pieces of the victim's thigh, and attempted to suck his blood. Here, the vampirism was seen as secondary to the schizophrenia. A similar case of a 21-year old eastern European schizophrenic vampirist was published in 1999 by Dr Brendan Kelly and colleagues in the Irish Journal of Psychological Medicine. However, the patient didn’t attempt to suck blood from himself or others but instead frequented a hospital accident and emergency department in search of their supply of blood for transfusion.

In a 1989 issue of the Journal of the Royal Society of Medicine, Dr A. Halevy and his colleagues reported the case of a 21-year old man (who had been in prison since he was 16 years old) who had anemia and gastrointestinal bleeding as a result of self-inflicted injuries and blood ingestion on multiple occasions (for instance, one incident involved him cutting his arm with a razor blade, draining the blood into a glass, and then drinking it). He was classed by the authors as an ‘autovampirist’ in Prins’ typology although the authors were unable to determine if there was any sexual motivation involved.

In one of the few papers to examine more than one case study, Dr R.E. Hemphill and Dr. T. Zabow (in a 1983 issue of the South African Medical Journal) examined four vampirists in depth, including John Haigh (the English 'acid-bath murderer' who killed six people during the 1940s and drunk the blood of his victims), along with reference to other criminal vampirists. Hemphill and Zabow noted that since childhood all four cases had cut themselves, and that to relieve a craving they had drank their own, and others’ (human and/or animal) blood. All four cases were said to be intelligent with no mental instability or psychopathology in any of their family histories.

In 2006, Dr. K Gubb and his colleagues published a case study of a 25-year old African man suffering from ‘psychic vampirism’ in the South African Psychiatry Review. In this paper, they argued that this particular type of clinical vampirism had never been reported in the literature before. The man was brought in for psychiatric treatment by his mother after he had become withdrawn, stopped socializing, was undressing in public, and started talking to himself. He claimed to hear the voice of ‘Sasha’, a “flame vampire from the scriptures of Geeta”. The man himself believed he was “Vasever – lord of the vampires”. He claimed to have survived by hunting as a vampire by hurting more than 1000 humans “zooming in and out of them” (rather than biting them). Schizophrenia was diagnosed. The authors claimed that the vampirism was only of academic interest “because of its relative scarcity” but did not influence the diagnosis or treatment in any particular way.

They concluded that vampirism may be representative of some pathology other than schizophrenia (or simply represent an alternative belief system). Unlike other vampirism cases in the clinical literature, there was an absence of a fully developed psychopathic personality, along with a complete absence of sexual and gender identity disorders. This, they speculated, “may have protected the man from developing the homicidal, cannibalistic, libidinal and sexual features of vampirism seen in the other cases”.

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