Frotteuristic Disorder

What is Frotteuristic Disorder?

Prior to the release of the DSM-5, this disorder was known as Frotteurism. It is classified as a Paraphilic Disorder, which requires the presence of a paraphilia that is causing significant distress or impairment, or involve personal harm or risk of harm to others.

A paraphilia involves intense and persistent sexual interest (recurrent fantasies, urges or behaviors of a sexual nature) that center around children, non-humans (animals, objects, materials), or harming others or one's self during sexual activity. Sometimes this sexual interest focuses on the person's own erotic/sexual activities while in other cases, it focuses on the target of the person's sexual interest.

In order to be diagnosed with a Paraphilic Disorder, the paraphilia needs to be causing significant distress or impairment, or involve personal harm or risk of harm to others. You can have a paraphilia, but not have a paraphilic disorder. It is only when it causes impairment, harm or the risk of harm that it become a clinical diagnosis.

Symptoms of Frotteuristic Disorder include:

• over a period of at least 6 months, a person has had recurrent and intense sexually arousing fantasies, urges or behaviors from touching or rubbing against a nonconsenting person.
• the person has either acted on these impulses with a nonconsenting person or the fantasies and sexual urges are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Clinicians can also specify if the disorder is

• In a controlled environment - usually applicable to people who are living in institutions or other settings where opportunities to touch or rub against a nonconsenting person are restricted.
• In full remission - the person has not acted on their urges and there has not been distress or impairment for at least 5 years while in an uncontrolled (non-institutional) environment.

How common is Frotteuristic Disorder?

The prevalence for Frotteuristic Disorder in the general population is unknown. Frotteuristic acts, including uninvited sexual touching or rubbing against another individual are thought to occur in up to 30% of adult males in the general population. Roughly 10-14% of adult males seen in outpatient settings for paraphilic disorders and hypersexuality (having extremely frequent or suddenly increased sexual urges or sexual activity) meet the criteria for this disorder.

What are the risk factors for Frotteuristic Disorder?

Cause and effect risk factors have not yet been identified for this disorder, but it is believed that nonsexual antisocial behavior, a preoccupation with sex, and hypersexuality (having extremely frequent or suddenly increased sexual urges or sexual activity) might be risk factors.

What other disorders or conditions often occur with Frotteuristic Disorder?

Research in this area has focused on males who have been suspected of or convicted of criminal acts involving sexual touching or rubbing against a nonconsenting person. This means that the co-occurring conditions found in this population might not be the same as in the general population that has exhibitionistic disorder. They include hypersexuality (having extremely frequent or suddenly increased sexual urges or sexual activity) and other paraphilic disorders (particularly exhibitionistic disorder and voyeuristic disorder), conduct disorder, antisocial personality disorder, depression and bipolar disorder, anxiety disorders, and substance use disorders.

How is Frotteuristic Disorder treated?

People with this condition do not often seek treatment on their own and do not generally recognize that they have a problem until they have ended up in court and are then required to enter treatment.

Common treatments include psychotherapy and medication.

Behavior therapy is often used to help the person control their urges and use more acceptable means of coping with them than rubbing or touching others.

Cognitive-behavioral therapy can also be used where the therapist helps the person identify triggers that cause their urges and then works with the person to teach skills to manage the sexual urges in more health ways. This typically includes cognitive restructuring (identifying and changing the thoughts that drive the behavior), relaxation training (to reduce touching or rubbing impulses), and coping skills training (different ways to behave when feeling aroused).

Various medications can be used to inhibit sexual hormones (testosterone or estrogen) in order to reduce sexual desire. Selective serotonin reuptake inhibitors (SSRIs), which are commonly used for depression and other mood disorders, can also be used as lower levels of serotonin in the brain has been found to cause an increased sex drive. Therefore, using a SSRI can reduce the sexual desire being felt.