PARAPHILIA

-FROTTEURISMBY MOHD ZAMIR GHOUSE 060100848

Normal Human Sexuality

Depends on 4 interrelated psychosexual factors: Sexual identity Gender identity Sexual orientation Sexual behaviour
These affect the personality, development and functioning.

KaplansTextbook of Psychiatry 7th Edition (2000)

Paraphilia
Abnormality in sexual intention, that result in

paraphiliac behaviours. Recurrent, intensely sexually arousing fantasies, sexual urges or sexual behaviours that involve either nonhuman objects, the suffering of the self or partner, children or non-consenting persons. To qualify as diagnosis, these patterns have to exist for at least 6months and cause significant distress or impairment in social, occupational and sexual function.
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

Paraphilia
There are nine paraphiliac diagnoses which are : Exhibitionism Voyeurism Sadism Masochism Pedophile Fetishism Frotteurism Transvestic Fetishism Paraphiliac NOS

Frotteurism
Definition
A disorder in which a person derives sexual pleasure by

rubbing, especially the genitals against another unconsenting person. These behavior often occur in crowded places such as elevators, malls, trains, buses, busy sidewalks etc. Common act of frottage is rubbing ones genitals against the victims thighs or buttocks, or alternatively to rub ones hand over the victims genitals or breasts.

KaplansTextbook of Psychiatry 7th Edition (2000)

Frotteurism
Etiology and Prevalence
No scientific consensus regarding the cause of

frotteurism Experts attribute the behaviour to an initially random and accidental touching of anothers genitals that the person find sexually exciting. Succesive repetitions of the act tend to reinforce and perpetuate the behaviour. Most act of frotteurs are often from the age of 15-25, after the age of 25 the act declines. Men are more likely to be the frotteurs, females are often the victims.

Frotteurism
Diagnostic criteria
To be diagnosed with frotteurism one must have : The patient experiences intense, recurrent, sexual urges and sexually arousing fantasies involving touching and rubbing against a nonconsensual person. Symptoms must be present for at least 6 months. The patient experiences significant distress or impairment in social, occupational, or other important areas of functioning because of the fantasies, urges, or behaviors, or the patient has acted on the sexual urges.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

Frotteurism
Treatment
For treatment to be succesful, frotteurs must be able to

modify existing patterns of behaviour. The frotteur must control the impulse to touch nonconsenting person. There are 2 most commonly used methods of therapy which are :1) Cognitive behavioural therapy 2) Reduction of sexual drives

Treatment
Cognitive behavioural therapy
Exclusive treatment that is tailored to the individual. Each paraphiliac lifestyle and behavior can be

modified. Techniques used include :1) Social skills training 2) Cognitive restructuring (sex education) 3) Learning about feelings and adverse consequences of behaviour (victim empathy) 4) Imaginal desensitization

Treatment
Reduction of sexual drives
Used when patients have lost self-control or autonomy. Drugs used that is safe, effective and reversible is antiandrogens. Medroxyprogesterone (Provera) administration 20-120mg orally

daily or 400-600mg IM a week. Within 96 hours of administration, reduction in sexual drive is noted with patient behaving well sexually. Medroxyprogesterone typically reduces serum concentration of testosterone to subnormal concentrations of 100-250g/dL. Sperm production will also decrease, which will require 10 months for total recovery.

Frotteurism
Prognosis and Prevention
Prognosis is poor because most frotteurs have no

desire to change their behaviours. Since frotteurism involves touching an unconsenting person and is against the law in some jurisdictions, some offenders may be afraid to continue these behaviours. Providing guidance and behaviour that is culturally acceptable is believed to prevent the development of paraphilia such as frotteurism.

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