Overview
Frotteuristic Disorder is one of the eight sexual paraphilias noted in DSM-5. It involves sexual fantasies, urges and behaviours to rubbing oneself or one’s genitals against a non consenting person.
This behaviour or fantasies cause imminent distress to the person. They may report feeling guilty and ashamed. They may report these urges being irresistible and not being able to manage them properly.
It rarely happens that a person will seek help themselves. Often, evaluation is recommended by law and order authorities. They may or may not show remorse or guilt over this behaviour.
Frotteuristic sexual interest is different from frotteuristic disorder. People with frotteuristic sexual interest engage in these behaviours and fantasies with consenting adults and are capable of managing their urges.
There are no known causes for this disorder. But several theories indicate that the behaviour may stem from unmet needs of physical touch as well as sexual touch.
They would want to cuddle with their victims or may want to engage in sexual behaviour with them. They fantasise about caring and healthy relationships with the victim while committing such acts.
Brain biology studies note issues with monoamine pathways resulting in various paraphilias. In another study, it was found that serotonin and norepinephrine levels were significantly higher among individuals with paraphilias.
Common Signs and Symptoms
Common signs and symptoms include:
- Urges, fantasies or behaviours involving rubbing of oneself or genitals against a non consenting person.
- They have acted on these urges causing distress to multiple victims.
- They are distressed, unable to control the urges. It makes them feel guilty and quite ashamed of their behaviour. Some patients may not feel remorse or guilt over it.
Risk Factors
Frotteuristic Disorder is more common among males than females. Frotteuristic Disorder and frotteurism in general is considered a sexual offence. Hypersexuality, Sexual preoccupation, impulsive sexual behaviours are all common risk factors.
Antisocial personality disorder may also include this risky behaviour that can land the person in trouble with the authorities.
Paraphilias in general may be associated with other mental health comorbidities such as brain injury, history of sexual abuse, Intellectual disabilities, substance abuse and other paraphilias.
Diagnosis
Frotteurism with a nonconsenting person or with children below the age of 18 years is considered a sexual offence. Hence, most of the patients diagnosed with exhibitionistic disorder are criminally charged sex offenders or in clinical settings and institutions.
Frotteurism is considered a taboo. It is mostly practiced in private and not all people seek treatment for it readily. More often than not, the need to be diagnosed with this disorder arises in the clinical settings. A psychologist often provides the diagnosis for Frotteuristic Disorder.
To be diagnosed with Frotteuristic disorder, following criteria must be met:
In the past 6 months, there have been:
- Urges, fantasies or behaviours involving touching or rubbing oneself or one’s genitals against a non consenting person.
- The individual acted on these urges with a non consenting person.
- It causes distress, feelings of shame, guilt, sexual frustration and loneliness to the person.
At least three incidences are to be accounted for in the diagnosis. However, it is not a mandatory criteria for the diagnosis. It can be three incidents with the same individual or three separate individuals. This behaviour should not occur under the influence of a substance, medication or other mental disorder.
Treatment
People with frotteuristic disorder are often reluctant to seek treatment themselves making it harder to treat. Most of them are mandated by court for an evaluation and treatment. In some cases, friends and family of the person encourage them to seek therapy.
Pharmacotherapy includes medication that suppresses the urges or reduces them. Suppressing agents such as testosterone is administered in a controlled manner. To reduce the urges serotonergic antidepressants such as Fluoxetine, Sertraline, and Paroxetine may be administered.
However, they often cause some side effects such as erectile dysfunction, decreased sex drive, etc. Anti-androgens, typically Gonadotropin Releasing Hormone analogues, are suggested in severe cases.
Psychotherapeutic approaches include cognitive behavioral therapy, solution-focused therapy, psychoanalysis, relaxation therapy, biofeedback.
Their success rate is considerable but further research is still warranted. Other comorbid disorders which have low self esteem, depression or anxiety like symptoms should also be treated.
Differential Diagnosis
1. Conduct disorder and antisocial personality disorder: Conduct disorder in adolescents and antisocial personality disorder would be characterized by additional norm-breaking and antisocial behaviors, and the specific sexual interest in touching or rubbing against a nonconsenting individuals should be lacking.
2. Substance use disorders: Substance use disorders, particularly those involving stimulants such as cocaine and amphetamines, might involve single frotteuristic episodes by intoxicated individuals but should not involve the typical sustained sexual interest in touching or rubbing against unsuspecting persons.
Comorbidity
Conditions that occur comorbidly with frotteuristic disorder include hypersexuality and other paraphilic disorders, particularly exhibitionistic disorder and voyeuristic disorder, conduct disorder, antisocial personality disorder, depressive disorders, bipolar disorders, anxiety disorders, and substance use disorders.
Potential differential diagnoses for frotteuristic disorder sometimes occur also as comorbid disorders.
Specialist
Generally, clinical psychologists, psychiatrists and forensic psychologists are equipped to deal with this disorder. A sex therapist may also be approached.
