This is a lifelong disorder that has a high rate of recidivism, despite treatment. It is difficult to treat the patient well enough to modify and/or control their behavior. Family members need to be involved in managing the behavior by limiting internet access and restricting all substances. Regular therapy is necessary to contain the behavior and to recognize triggers for the behavior. Some individuals may spontaneously remit. Comorbidities include substance abuse and the various mood disorders. The patient may exhibit suicidal behavior upon being arrested or incarcerated. Various drugs have been tried with some success, particularly SSRIs. Antiandrogens may also be prescribed to decrease testosterone production.
FROTTEURISTIC DISORDER (302.89) Frotteuristic disorder is defined as a “courtship disorder” in which the patient demonstrates sexual arousal by touching or rubbing against a nonconsenting individual. There are fantasies around touching people. They tend to touch people in public places, such as in crowds or on mass transportation vehicles. The symptoms must last at least six months to qualify as having the disorder. Distress and/or impairment of function must be present to make the diagnosis. Full remission is the non-action of urges for a minimum of five years. To make the diagnosis, the touching of a nonconsenting person must have had to occur on at least three occasions and must be distressful to the patient. If distress and impulses have occurred and the patient hasn’t yet acted on it, they could be diagnosed with frotteurism; individuals who deny their behaviors despite evidence can also be diagnosed with the disorder. The symptoms start in late adolescence and may not initially involve sexual arousal. Other sexual impulse disorders (hypersexuality, exhibitionism, and voyeurism) can be comorbid, as can antisocial personality disorder, conduct disorder, substance abuse disorders, and mood disorders. This is a very common behavior, affecting up to 30 percent of adult males, who do not meet the criteria for the actual frotteuristic disorder. Patients with paraphilias have a 10-15 percent chance of also having frotteuristic disorder. It is almost exclusively seen in males and perpetrated upon women. The prevalence of frotteuristic behavior is unknown because many 285
