Frotteurism

What is Frotteurism?

The Diagnostic and Statistical Manual of Mental Disorders V, or DSM-5, helps distinguish between what’s called a paraphilia and a paraphilic disorder.

“Paraphilia” refers to an intense and constant sexual interest that doesn’t involve sexual activities such as touch or contact with consenting adults, who are physically mature and typically have developed sexual characteristics.

The term “disorder” was added in DSM-5 to specify behaviors associated with paraphilia. A “paraphilic disorder” means a disorder that causes significant emotional distress or issues for the person or puts others in harm’s way while the individual obtains sexual satisfaction.

Frotteurism is a type of paraphilic disorder. It involves touching or rubbing one’s genitals against a non-consenting person in a sexual manner. It’s one of eight paraphilias listed in the DSM-V. The term “frotteurism” comes from the French word “frotter,” meaning “to rub.” This behavior was first detailed by Kraft-Ebbing in the book Psychopathia Sexualis in 1886. The term “frotteurism” was introduced by Clifford Allen in the 1960s.

What Causes Frotteurism?

The exact cause of frotteurism, a behavior in which an individual derives sexual pleasure from rubbing against a non-consenting person, isn’t fully understood. There are several theories available. Some psychologists suggest that people with this behavior have an unfulfilled desire to rub against and cuddle with others, similar to the way a baby interacts with its mother. These individuals might daydream about having a special bond with the person they’re touching. Other experts like Freund and Seto suggest that these individuals may struggle with normal physical interactions that happen during romantic or sexual situations.

There are also thoughts that biological factors might play a role, specifically with the monoamine pathway. This is an area in our bodies that plays a vital role in our moods and could potentially lead to abnormal sexual behaviors.

While none of these factors are exclusive to frotteurism, a range of additional mental health conditions have been identified in people with various paraphilias (unusual sexual interests). These include:

* Social anxiety, a fear of social situations that involve interaction with other people.
* Traumatic brain injury, damage to the brain caused by an external force.
* A history of sexual abuse, which has been linked to a wide range of paraphilic disorders.
* Intellectual disabilities, conditions that cause significant limitations in intellectual functioning and adaptive behavior.
* Substance abuse, which involves the misuse of substances like alcohol, prescription drugs, or illegal drugs.
* The presence of other or more than one paraphilia, particularly exhibitionism (deriving sexual pleasure from exposing one’s genitals) or frotteurism.

Risk Factors and Frequency for Frotteurism

Frotteurism is a condition that is not well-known because not many people report it. Some studies suggest that it usually shows up in young men who are between 15 and 25 years old. However, it can start as early as 12 years old, as shown in one reported case. It is unclear how common this condition is, but estimates suggest that it could affect anywhere from 9% to 35% of the population. It’s rare to see it in women. The people who are usually targeted by those with this condition are mostly women, often younger, but some could be older.

• Frotteurism is a condition that is not well-understood because it’s rarely reported.
• It mostly affects young men between the ages of 15 and 25.
• There was a reported case of a 12-year-old boy having this condition.
• We aren’t sure how common it is, but estimates range from 9% to 35%.
• Female sufferers of frotteurism are rare.
• The usual targets of this behavior are mostly women, often younger but can be of older age.

Signs and Symptoms of Frotteurism

When someone is suspected of having a psychiatric disorder, they will usually undergo a thorough psychiatric evaluation after their physical assessment is completed. This is especially true in cases where the individual is legally required to seek medical evaluation and treatment. When carrying out the assessment, the evaluator should avoid making judgments and should focus on asking open-ended questions to gather a lot of information. It’s crucial to remember that it’s common for a person to have more than one disorder present simultaneously. It’s also common to note a history of premature ejaculation.

Testing for Frotteurism

Frotteurism is a behavior where someone touches or rubs their genitals against another person without their consent for sexual pleasure. This behavior is often repeated.

The Diagnostic and Statistical Manual-5 (DSM-5), a guide for mental health professionals, sets out specific criteria needed for a diagnosis of Frotteuristic disorder:

1. For at least six months, there’s been repeated sexual excitement from touching or rubbing against someone who hasn’t consented. This is shown by fantasies, desires, or actions.
2. The individual has acted on these sexual desires with someone who hasn’t consented, or these desires or fantasies cause significant distress or negatively impact their work, social life, or other areas of their life.

The DSM-5 also classifies cases if:

* The person is living in a controlled environment, such as a facility, where there are limited opportunities to touch or rub against someone who hasn’t consented.
* The person hasn’t acted on these desires with someone who hasn’t consented and hasn’t experienced any distress or negative impact on their work, social life, or other areas of their life for at least five years while in an uncontrolled environment.

The DSM-5 also notes that if someone hasn’t acted on these desires and isn’t distressed or impaired, they’re seen as having an interest in frotteurism but not a disorder.

To confirm the diagnosis and rule out other causes doctors may require routine lab tests and imaging.

These lab tests might include:

* A metabolic panel which is a group of tests that measure different chemicals in your blood.
* Hormone tests that might include tests for thyroid function, prolactin, luteinizing and follicle-stimulating hormone, and testosterone levels.
* If other sexually inappropriate behaviors are suspected, a test for nocturnal penile tumescence (erections during sleep) might be considered, along with brain scans if needed.

Some additional key points that can assist in forming a diagnosis include:

* The most common behavior is rubbing genitals against a person’s thighs or buttocks.
* The act typically occurs in crowded public settings such as public transit, elevators, malls, or other crowded locations.
* The actions are usually repeated.
* Most cases are not reported. It’s suggested that people exhibiting frotteuristic behaviors often do not face legal consequences, have many victims, and are unlikely to receive long sentences. However, these findings haven’t been officially studied.
* People engaging in these behaviors typically do not seek to converse with the victims and are usually surprised if caught.

Treatment Options for Frotteurism

Frotteurism, or engaging in touching or rubbing against a non-consenting person for sexual gratification, is generally not sought treatment for, because it doesn’t interfere much with a person’s daily life. People with frotteurism may feel uncomfortable, ashamed, or guilty which makes it difficult for them to seek help themselves. Often, they only start to get help if they’ve been caught for sexual assault, ordered by the law to seek treatment, or if their friends or family members ask them to get help. Since there’s very little research based on this issue, treatments usually apply to all kinds of similar disorders.

When it comes to treatment, a combined approach is often the best way to go. This means individual work with a healthcare professional along with the support of family or community. This approach can include therapy and medication.

There are many different types of therapy that may be helpful, including psychotherapy (a type of therapy focused on mental health), cognitive behavioral therapy (a type of therapy focused on changing patterns of thinking or behavior), solution-focused therapy (helping to find solutions to problems), psychoanalysis (a type of therapy that aims to help people understand their unconscious thoughts), relaxation therapy (techniques to help to relax), and biofeedback (a technique you can use to learn to control your body’s functions). During this process, the healthcare professional needs to monitor their own emotional reactions to ensure they don’t affect treatment.

Frotteurism can be associated with other mental health problems like depression, anxiety, and low self-esteem, so treatment often involves helping with these problems as well. For the treatment involving medications, two approaches are used. One is medications that “suppress” the sexual drive by lowering levels of testosterone, a hormone that influences sex drive. The other is medications that “reduce” the sexual drive such as serotonergic antidepressants – these are medications related to serotonin, a chemical in the brain that can affect mood.

There are specific medications, called anti-androgens (hormones that regulate the development of male characteristics), that have been found to be useful in reducing impulsivity and overly sexual behavior in severe cases.

However, before administering these medications, it’s important that the patient understands what they are for and gives consent. In cases where impulsivity and obsessive sexual behavior play a big role, certain antidepressants such as Fluoxetine, Sertraline, and Paroxetine have been helpful. These can also help deal with other accompanying problems like depression or Obsessive-Compulsive Disorders (OCD), which is a disorder where a person has recurring thoughts or behaviors.

What else can Frotteurism be?

Frotteurism, a condition characterized by deriving sexual pleasure from touching or rubbing against a non-consenting person, can sometimes be mistaken for other conditions due to similar symptoms. Here are a few of those conditions:

• Substance Abuse Disorder: Someone who is intoxicated from drugs like methamphetamine or cocaine might show behavior similar to frotteurism. If they continue with this behavior when they are sober, doctors might consider a diagnosis of frotteurism.
• Traumatic Brain Injury: Injuries to the frontal and frontotemporal regions of the brain can lead to similar symptoms as frotteurism, such as lack of inhibition and increased sexual behaviors. However, people with a brain injury usually also show cognitive difficulties.
• Conduct Disorder and Anti-social Personality Disorder: These conditions involve a lack of moral compass and disregard for laws and societal norms, which might resemble frotteurism. However, people with these disorders don’t usually gain sexual satisfaction from touching or rubbing against non-consenting individuals.

Additionally, here are other conditions that may be confused with frotteurism:

• Obsessive-compulsive disorder
• Mood disorders
• Other sexual dysfunction disorders
• Other paraphilic disorders

Doctors will consider these possible conditions while making a diagnosis.

What to expect with Frotteurism

This disorder is not extensively studied, so no solid conclusions have been reached about what to expect in the long run. Very few cases come to light through the individuals themselves; it’s usually due to legal encounters. There aren’t many large-scale or long-term studies about this disorder available.

A significant piece of the treatment depends on the person’s willingness to report their issues and seek help. Therefore, it’s reasonable to assume that those who are motivated, have strong support from their community, and actively participate in their treatment might have a better chance for recovery compared to those who don’t do these things.

Possible Complications When Diagnosed with Frotteurism

People don’t know much about the long-lasting effects of frotteurism, a sexual disorder involving touching or rubbing against a non-consenting person, for both the person doing it or the person affected by it.

If this disorder occurs together with other mental health issues, this could lead to clinically significant problems or dysfunction for the person with the disorder. They may struggle with low self-esteem, extreme social nervousness, and feelings of guilt. If their mental health issues aren’t treated, their mental wellbeing could further deteriorate. If they’re caught in the act, they might face social shaming and legal consequences. In severe cases of sexual misconduct, they might need to register as a sex offender, report frequently to the legal system, and they could face restrictions on where they can live, creating further complications in their life.

For the victim, this experience can be traumatic – they may experience heightened anxiety, an excessively watchful and alert state, avoidance of public transportation , feelings of insecurity, and a general mistrust of others.

• Low self-esteem
• Severe social anxiety
• Feelings of guilt
• Social stigma
• Legal consequences
• Sex offender registration
• Housing restrictions
• Increased anxiety for the victim
• Hypervigilance for the victim
• Avoidance of public transportation by the victim
• Insecurity for the victim
• Mistrust in others by the victim

Preventing Frotteurism

Currently, there are no treatments for frotteuristic behaviors approved by the Food and Drug Administration (FDA). Frotteuristic behaviors refer to a condition where someone derives sexual satisfaction from rubbing against a non-consenting person. Despite the lack of an official treatment, it’s important that individuals understand the need to seek professional help like therapy and, if needed, medication.

It’s also crucial for patients to understand that controlling any related or concurrent mental health conditions can also lead to an improvement in their behaviors. However, one of the significant issues patients face is the societal stigma attached to this condition. This is why it’s crucial for their healthcare provider to acknowledge this issue and address it appropriately during their treatment.