Frotteuristic disorder, often known as frotteurism, is a form of paraphilia that is uncommon and understudied. To get sexual enjoyment, it entails contacting or rubbing one’s genitals against another non-consenting individual in a sexual manner. This exercise examines the diagnosis and treatment of this ailment, focusing on the role of the interprofessional team in diagnosing and treating individuals with this condition.

Frotteuristic disorder definition

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) separates paraphilia from paraphilic disorder. According to the definition of paraphilia, “a strong and persistent sexual attraction that is not a sexual interest in genital stimulation or anticipatory fondling with phenotypically normal, physiologically mature, consenting human partners,” according to the definition of paraphilia. The word “disorder” was added to the DSM-5 expressly to describe paraphilic behavior. According to the definition of paraphilic disorder, “a disorder that causes clinically substantial suffering or impairment to the individual or involves damage or risk to others while enjoying sexual enjoyment.” Frotteurism is one of eight paraphilias included in the DSM-V and is classified as a subtype of paraphilic disorder. Frotteurism is defined as the act of sexually caressing or rubbing one’s genitals against a non-consenting person. The name “frottage” comes from the French word “frotter,” which literally means “to rub.”

Origin of the problem

Although the specific cause of frotteurism is unknown, there are several ideas. Psychoanalysts believe that people suffering from frotteurism may have unsatisfied desires to rub themselves on the victim and snuggle, similar to a newborn with his mother.During the act, those who engage in these activities may dream about having an exclusive and loving connection with their non-consenting victims. These individuals may also have issues with tactile exchanges that occur during typical human romantic or sexual encounters. Some studies have been conducted to hypothesize a biological explanation, mainly involving the monoamine system and aberrant sexual behaviors.

Epidemiology

Due to a paucity of reporting, frotturism is poorly understood. According to very limited studies, this conduct has been recorded more frequently among young males between the ages of 15 and 25. The condition is depicted in one example in the context of a twelve-year-old kid. Although the actual incidence is unclear, a broad range of prevalence has been observed, ranging from 9% to 35%. Female frottuers are quite uncommon. Other studies have pointed to the elderly.Following the completion of a history and physical examination, a full mental evaluation is recommended. Because this disease is seldom self-reported, the courts frequently require these people to seek examination and therapy. The evaluator must be objective and seek to obtain as much information as possible by asking open-ended questions. It’s crucial to understand that having more than one paraphilia isn’t uncommon. A history of premature ejaculation is frequently reported.

Treatment of the disorder

Because there is usually no clinical or functional damage, treatment for frotteurism is rarely sought. Furthermore, people with frotteuristic disorder rarely seek help on their own. While seeking therapy, it may make people feel uncomfortable, ashamed, or guilty about their actions. This paraphilic condition is frequently discovered after a person is “caught” for sexual assault and ordered by the legal system to seek therapy, or when asked to do so by friends or family members. Because there is a paucity of research on this subject, therapy approaches are frequently applied to all paraphilic diseases. Individual, family, and community participation, as well as psychotherapy and pharmaceutical therapies, are all recommended as part of a multi-modal strategy.

Several treatment paradigms have been tested with some effectiveness, including psychotherapy, cognitive behavioral therapy, solution-focused therapy, psychoanalysis, relaxation therapy, and biofeedback. During this process, the physician must also be conscious of his or her own counter-transference. As previously stated, frotteuristic behavior has been linked to a variety of mental health issues, including sadness, anxiety, and low self-esteem. As a result, addressing the underlying or comorbid disorder is frequently required. In terms of pharmaceutical therapies, there are medications that “suppress” sexual drive, such as testosterone suppression, and medications that “decrease” sexual drive, such as serotonergic antidepressants. In severe situations, anti-androgens, specifically GnRH analogs, have been used as an evidence-based therapeutic approach to lower impulsivity and hypersexuality. Before giving GnRH analogs, ethical issues demanding informed consent must be addressed. Furthermore, because impulsive hypersexuality is suspected to be a factor in this disorder, certain serotonergic antidepressants like Fluoxetine, Sertraline, and Paroxetine have shown some promise in reducing heightened sexual urges in people with comorbid conditions like depression or OCD.

Conclusion

Frotteurism and frotteuristic disorder are frequently misdiagnosed and under-reported, resulting in a paucity of evidence. As previously mentioned, these can manifest in a variety of ways, including anxiety, depression, obsessive-compulsive disorders, and so on. When it comes to recognizing these infrequently reported symptoms, the physician must be cautious. Because primary care physicians, therapists, nurses, and social workers may be the initial points of contact for many people with mental health issues, keeping these professionals aware of the triggering problems is critical. Any symptomatology that is unclear or perplexing should be reported to a specialist physician, such as a psychiatrist. To improve outcomes and reduce recidivism, the psychiatrist should be well-versed in and knowledgeable about relevant medical therapies. A forensic psychiatrist (a psychiatrist who specializes in the medico-legal aspects of mental health) may visit these people more frequently than a conventional psychiatrist. As a result, a forensic psychiatrist is in a unique position to assess, diagnose, and manage the treatment of people with frotteuristic illness, perhaps improving their outcomes by reducing future sexual offenses.

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