Frotteurism (302.89)

DSM-IV-TR criteria:

• Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person.
• The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.
• Frotteurism is the paraphilic focus that involves touching and/or rubbing against a nonconsenting person. This particular behavior usually occurs in crowded places, such as public transportation facilitates and concerts, from which the individual can more easily escape arrest. The most common form of Frotteurism is when he or she rubs his or her genitals against the victim’s thighs and buttocks or with women, fondles her genitalia or breasts with his hands. Individuals with Frotteurism will often fantasize that they have an exclusive and caring relationship with their victim at the moment of contact. While doing this when he or she usually recognizes what has happened and to avoid possible prosecution, he or she must escape detection after touching his victim.

Associated features

• A person who is suffering from Frotteurism usually experiences symptoms such as intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person for over a period of at least six months. These fantasies, urges, and behaviors can cause distress and problems associated with work, social atmospheres, and other important daily activities. Frotteurism is a derivative of the French word “frotter” meaning “to rub.”
• Frotteurism is also known as “mashing”. Mashing has been reported exclusively among males (DSM, 2000). Mashing usually takes place in crowded places, such as buses, elevators, or subway cars. The man usually incorporates images of his mashing within his masturbation fantasies. Mashing is related to “toucherism”, which is the fondling of nonconsenting strangers. Mashing can be so furtive and fleeting that the victim may not realize what has happened.

Child vs. adult presentation

Typically, children under the age of 12 do not have Frotteurism due to lack of understanding and maturity. Most individuals who participate in frotteurism are between the ages of 15 and 25.Tendencies typically increase the age of 15 and decrease after the age of 25.

Gender and cultural differences in presentation

• Activities related to this disorder have been well-documented, particularly during historic periods in which they were considered more appropriate in certain less-established areas.
• Men are more likely to engage in frotteurism than women. Women are most likely to be the victims of the acts of frotteurism.

Epidemiology

Currently, there is no information on the epidemiology of Frotteurism available. Frotteurism is associated with paraphilic fantasies, but it occurs most commonly in adolescents. This disorder is not associated with traumatic experiences in either adolescent or adult life.

Etiology

Research has been unable to uncover a direct cause for Frotteurism; however, some possible causes have been suggested. One theory that experts agree on is that there are underlying issues related to one’s childhood that plays a major role. Other experts say that when a person accidentally and randomly touches or rubs on another person’s genitals or other body parts in public and finds sexual arousal from that contact, the person’s feelings act as a reinforcer that perpetuates the behavior. Sometimes the sexual arousal and excitement become too much for one to bear and the person succumbs to these urges.

Empirically supported treatments

• To treat paraphilias, one generally uses either medication and/or behavioral therapy. This behavioral therapy or psychotherapy is focused on uncovering and establishing the cause and reason for taking part in frotteurism. The most successful treatment is Cognitive-behavioral therapy (CBT). Other therapies include biofeedback therapy, and covert sensitization. In biofeedback therapy, an individual is connected to a machine that displays light and/or sound. The individual must attempt to keep the light or sound within a certain range while he or she is exposed to sexually-enticing objects or material. Covert sensitization is a therapy in which an individual is relaxed and then asked to picture things in her or his mind that excite them. The individual is then instructed to picture something negative. The goal behind this therapy is to link the sexually pleasing cognitions to negative cognitions in order to suppress them. In order for treatment to be successful, the individual must learn how to control the temptations and impulses to touch other non-consenting individuals for sexual gratification. An example of a medication that can be given to help females who suffer from Frotteurism is Medroxyprogesterone, which is a female hormone that is credited to decrease sexual desire. Antiandrogens are a type of medication given to males suffering from Frotteurism. The medicine fluoxetine, or Prozac, is commonly given to people who suffer from Frotteurism to increase the chemical serotonin in the brain, which would reduce obsessive thoughts and behaviors that are compulsive.

Prognosis

The prognosis for eliminating frotteurism is poor as most “frotteurs” have no desire to change their behavior. Since frotteurism involves nonconsenting partners and is against the law in many jurisdictions, the possibility of embarrassment may deter some individuals.