Frotteuristic Disorder DSM-5 302.89 (F65.81)
This Article Is Part of A Series For Paraphilic Disorders
DSM-5 Category: Paraphilic Disorders
Introduction
The Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5, The American Psychiatric Association, 2013) defines paraphilic disorders as those involving the preference for sexual behaviors other than the forms of courtship and genital stimulation considered normal within a given society. A sexual preference is only definable as a disorder if there is a significant risk of physical harm to the individual or their target, or if the individual diagnosed with the disorder experiences significant distress as a direct result of their actions (The American Psychiatric Association, 2013).
These disorders are then further divided into sub-types, with frotteuristic disorder defined as a courtship disorder. This sub-category placement indicates that the behaviors demonstrated by frotteuristic disorder, specifically sexual arousal as a result of touching or rubbing a nonconsenting individual, are actually inappropriate distortions of normal human courtship behaviors (The American Psychiatric Association, 2013).
Symptoms of Frotteuristic Disorder
Frotteuristic disorder typically manifests as intense sexual arousal resulting from touching or rubbing against individuals who are nonconsenting, and may extend to fantasies of touching as well. This inappropriate touching often occurs in public settings, such as on crowded buses. The symptoms must have been present for at least 6 months and the patient must experience significant distress or negative impact on functioning. It should also be noted whether the individual is in a controlled environment, such as institutionalization with restricted access to others, or in full remission, where urges have not been acted upon and distress and impairment have not occurred for a minimum of 5 years (The American Psychiatric Association, 2013).
Diagnosis of Frotteuristic Disorder
Diagnosis of frotteuristic disorder is based on recurrent touching or rubbing of one or more nonconsenting individuals on at least three occasions, and clinically significant distress. Diagnosis of frotteuristic disorder can occur without having followed through with touching behaviors as long as sufficient distress regarding impulses is noted. Frotteuristic disorder may be diagnosed both in individuals who freely disclose their fantasies and frotteuristic behaviors, and in those who deny either their urges, the resulting behaviors, or both, despite compelling evidence to the contrary (The American Psychiatric Association, 2013).
Onset of Frotteuristic Disorder
Initial symptoms of surreptitious touching may begin as early as late adolescence. In the earliest phases, adolescents may rub or brush against family members, peers, or teachers without a result of sexual arousal, though these behaviors may elicit non-sexual pleasurable emotions. It should also be noted that frotteuristic behaviors may occur due to conduct disorders or other factors without meeting the criteria for frotteuristic disorder. There may be a causal relationship between frotteuristic disorders and nonsexual antisocial behaviors or hypersexuality, as well as other sexual impulse disorders (The American Psychiatric Association, 2013).
Co-morbidity of Frotteuristic Disorder
Frotteuristic disorder is known to be comorbidly diagnosed with other paraphilic disorders, including hypersexuality, exhibitionistic disorders and voyeurism, as well as conduct disorders, antisocial personality disorder, mood disorders (including depression, bipolar, and anxiety disorders) and substance abuse. It is also important to note that while conduct disorder, antisocial personality disorder, and substance abuse disorders may involve isolated instances of frotteuristic behaviors, these rarely qualify for diagnosis of frotteuristic disorder, particularly if the behavior only occurs during intoxication (The American Psychiatric Association, 2013).
Additionally, there have been individual case studies indicating that frotteuristic disorder or frotteuristic behaviors may occur along side diagnoses of obsessive-compulsive disorder (Patra et al., 2013) and severe unipolar depression (Bhatia, Jhanjee, Srivastava & Kumar, 2010, and Patra et al., 2013). The concurrent diagnoses of frotteuristic disorder and obsessive-compulsive disorder or depression is still considered rare (The American Psychiatric Association, 2013).
Prevalence of Frotteuristic Disorder
It has been estimated that as many as 30% of adult males may have engaged in frotteuristic acts, and 10-14% of men diagnosed with paraphilic disorders also meet the diagnostic criteria for frotteuristic disorder. While it is known that frotteuristic disorder is far more prevalent among men than women, with acts most commonly committed against women, specific statistics regarding female diagnoses are unavailable (The American Psychiatric Association, 2013).
Despite the relatively low rates of diagnosis for frotteuristic disorder, the nature of frotteuristic behaviors may make it difficult to accurately assess the frequency of this disorder. Because instances of unwanted touching are often conducted in crowded public places, such as subway cars, buses, elevators, victims may interpret frotteuristic touches as accidental bumping, particularly if the individual with frotteuristic disorder does not make any overt attempt at masturbation. As such, frotteuristic assaults may be grossly under-reported (Fileborn, 2013).
Treatment of Frotteuristic Disorder
Treatment of frotteuristic disorder focuses on the reduction of sexual urges and behaviors through behavioral therapy, used to identify triggers and redirect behavior, and psychopharmaceutical intervention (The American Psychiatric Association, 2013). There has been significant improvement in symptoms for patients with frotteuristic disorder when utilizing antiandrogens or synthetically derived female sex hormones, specifically medroxyprogestrone and cyproterone, along with antipsychotics and serotonin reuptake inhibitor antidepressants (Kafka, 1995).
In one case study of a male diagnosed with frotteuristic disorder following a report of over 1,000 instances of frotteuristic molestation, a successful treatment course was implemented to reduce instances of frotteuristic behaviors. In this case, the use of behavioral therapy to identify the stimuli leading to the behavior and redirect urges into socially appropriate channels, along with addressing the need for psychosocial stimulation through work and extracurricular hobbies proved successful, even in the absence of additional psychopharmaceutical intervention (Rose, 1995). However, it should be noted that since this is a case study of one individual, these results may not generalize to other patients diagnosed with frotteuristic disorder.
Outcomes for Frotteuristic Disorder
Due to the nonconsenting contact involved in frotteuristic disorder, it is safe to assume that there is a significant potential for legal consequences, including conviction of and incarceration for sex crimes, and as a result, long-term psychosocial consequences. Individuals diagnosed with frotteuristic disorder should remain in contact with a licensed mental health practitioner familiar with the treatment of paraphilic disorders, a psychiatrist capable of regulating the use of antipsychotics and antidepressants, and appropriate medical specialists to monitor the potential side effects of antiandrogen therapy (The American Psychiatric Association, 2013).
References
American Psychiatric Association, The (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bhatia, M.S., Jhanjee, A., Srivastava, S., & Kumar, P. (2010). An uncommon case of hypersexual behavior with frotteurism. Medicine Science and the Law, 50(4), 228-229.
Fileborn, B. (2013). ACSSA Resource Sheet. Australia: The Australian Institute of Family Studies.
Kafka, M.P. (1995). Current concepts in the drug-treatment of paraphilias and paraphilia-related disorders. CNS Drugs, 3(1), 9-21.
Patra, A.P., Bharadwaj, B., Shaha, K.K., Das, S., Rayamane, A.P., & Tripathi, C.S. (2013). Impulsive frotteurism: A case report. Medicine Science and the Law, 53(4), 235-238.
Rose, A. (1995). Behavior-therapy of frotteurism: A case report. Verhaltenstherapie, 5(3), 154-160.
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