International Journal of Advanced Studies in https://www.sexology.ro/jurnal © Sexology Institute of Romania ISSN 2668-7194 (print), ISSN 2668-9987 (online) Vol. 2(1), 2020, pp. 15-19 DOI: 10.46388/ijass.2020.13.13

FROTTEURISTIC DISORDER

IRINA CRISTIANA STAN

Sexology Institute of Romania, Cluj-Napoca, Romania

Corresponding author email: [email protected]

Abstract or frotteuristic disorder describes a behavior through which one obtains intense sexual arousal from touching or rubbing, usually their genitals or pelvic area against a non-consenting person. Prevalence is more common in male population. This article addresses the characteristics, diagnosis criteria, prevalence, etiology, methods of evaluation and intervention and explains the onset and evolution as well as the psychological factors present in this particular paraphilic disorder.

Key words: frotteurism, paraphilc disorder, touching, rubbing, pelvic area, diagnosis, intervention.

INTRODUCTION Thus the recent view includes both rubbing and touching as part of a frotteuristic act. Oth- The term “frotteurism” was introduced in the literature for the first time in 1890 by the ers also argued that toucherism - sexual arous- French psychiatrist Valentin Magnan. It origi- al derived from touching, grabbing, or rubbing nally referred to the act in which a man touch- one’s hand against an unsuspecting person’s es (rubs) with his exposed penis the buttocks areas such as crotch and breasts - should be or thighs of women who do not consent to included.” [Balon R., p.94]. The DSM-III-R and this act. “The word “frottage” comes from the DSM-5 includes toucherism in the category of French “frotter”, which means to rub or to put frotteurism. pressure on someone, and has no sexual con- During the act, the frotteur usually fan- notation” [Balon R., p. 93-94]. Nowadays this tasizes that he is in an exclusive, affectionate, term is associated with obtaining intense sex- sensual relationship with the victim. Part of ual arousal as a result of touching or rubbing the excitement from frotteurism comes from one’s pelvic area against a person who does the risk of being caught, which heightens the not give consent, usually an unknown wom- sexual response. Most of these cases occur with an or a person in a crowded area. “Over the males inappropriately touching females, al- years, there has been some disagreement about though there have been cases of females touch- whether frotteurism has to really include rub- ing males, females touching females, males bing genitals against an unsuspecting person. touching males, and adults touching children. Some have argued that frotteurism does not Aside from being considered a criminal need to include the perpetrator’s genitals and activity because it is a form of nonconsensual that the act of frotteurism should also include sex, frotteurism is diagnosed as a mental sexual urges to touch and acts of touching. health disorder when the behavior continues

*Corresponding author: 160 Plevnei Street, Cluj-Napoca, 400000, Romania, Phone/Fax: 0264 550247

15 IRINA CRISTIANA STAN repeatedly for more than six months, or when genital area against a person who does not the fantasies and urges cause significant distress consent. The perpetrator manifests fantasies, or dysfunction in personal relationships and impulses and behaviors related to this typical daily activities of the perpetrator or those act, in order to obtain sexual arousal. Two di- around him. agnostic criteria must be met in order to make an accurate identification of frotteuristic dis- Clinical considerations order: the behavior has to manifest repeatedly This kind of disorder is one of the least un- and last for aproximatively 6 months (Criteri- derstood and studied types of paraphilic disor- on A), the person upon whom these particular ders. As characteristic features of this disorder sexual urges are enactd is nonconsenting, or a it has been noted that the deviant act usually serious distress these sexual impulses and fan- takes place in crowded places like subways, tasies generate in different areas of life for the trains, pedestrian alleys, stairs, elevators, theat- individual or those around him (Criterion B). ers, shopping areas, etc. This way, the aggres- According to the DSM-5, those who do not sor has the opportunity to disappear easily or report any suffering, meaning lack of anxiety, explain the behavior as accidental or, as well, obsessions, guilt or shame related to these hide in the crowd in case one should call the paraphilic impulses and do not have deficits police, but it is generally a type of aggression in other important areas of functioning due that is rarely or not at all reported to the police, to this sexual interest, and their psychiatric mainly because the victims simply do not feel or criminal history shows that they do not that they are being touched or do not find or act under the impulse of this preference, they recognize the aggressor. Still, there are nega- could be considered to have frotteuristic sexual tive consequences felt by the victims, namely interest, but should not be diagnosed with feelings of rape and changes in behavior. frotteurism disorder. Frotteurism occurs in many cultures. In The prevalence and incidence of paraphilic Japan and India especially, the problem has disorders is unknown. Studies are very become so widespread that special train cars difficult to perform because there is a tendency and buses have been converted to women only for these types of sexual interests not to be spaces since 2005, after studies revealed that reported to researchers. The only available over 66% of female passengers in their twenties data are those obtained from persons detained and thirties admitted that they had undergone for sexual offense. Most authors estimate that acts of frotteurism (rubbing, touching, ) generically, occur in 1% of the total on public trains in Tokyo. In Japan this kind of adult population, especially men, with one behavior is called “chikan”. Women rarely file exception - masochism. Further studies are reports of incidents of sexual harassment or as- necesarry for clarifyng these asepcts. sault on public transport, often because of em- The estimates of frotteuristic disorder barrassment, uncertainty as to whether it actu- prevalence vary widely. Based on the currently ally counts as a crime, or they simply accept existing data, the DSM-5 suggests that the issue as a fact of life. As a result, definitive behaviors of frotteurism can occur in 30% of the frotteurism statistics can be hard to find. Still, adult male population. The inclination towards this type of harassment is an issue recognized this type of actions is usually manifested all over the world. In response, female-only towards the end of adolescence and in young public transport and taxi services had been adults, meaning at a relatively later stage of the introduced in at least 15 countries - including development of sexual deviance over time. Brazil, Egypt, India, and Indonesia - to protect Not much is known about the etiology women. [FIA Foundation Research Series, Pa- of frotteurism, the characteristics of persons per 6, 2016] with this type of disorder, and the course of The distinctive feature, as mentioned be- this disorder. Some theories about the root fore, is the act of touching or rubbing one’s cause of this disorder focus on social issues

16 Frotteuristic disorder that result in a lack of consenting partners, intellectual disabilities of neurological nature and others on an inability to control one’s sex like Autism Spectrum Disorders, disorders drive, but eventually, what causes the disorder related to brain function, Parkinson’s disease, remains currently unknown. Persons suffering etc., and medications being used to treat these from frotteurism are frequently involved in diseases. Also, a history of sexual abuse may antisocial activities. The course is likely to vary play a role in the development of frotteuristic with time, and similar to some other paraphilic disorder, especially when signs of the disorder disorders, the sexual preferences and behaviors appear at an early age. may decline with older age. The main evaluation method consists in Several theoretical models of etiology of a detailed clinical interview focusing on the frotteurism have been proposed. It can be sexual experience and history of the individual attributed to behavioral interactions associated - experiences or sexual behavior in childhood, with the searching phases for a sexual partner, sexual experiences or lack of sexual activities namely the finding, the affiliative, the tactile in adulthood, as well as obtaining collateral and the copulatory phases. Kurt Freund - a information from medical, psychiatric or Czech-Canadian physician and sexologist judiciary documents. During the interview argued that some paraphilic behaviors, the clinican should be nonjudgmental, specifically , , empathic in order to develop a therapeutic frotteurism, obscene telephony, consensual relationship and an atmosphere of trust. The rape can be forms of altering a system of social therapist shoud focus on urges, fantasies, norms. They can be considered distortions behaviors, comorbidities as well as other of the normal courtship behavior, meaning paraphilic disorders, personality disorders, the interactions that precede or initiate mental illnesses, administered treatments coital behaviors, used by men. The reference or medication. There are no specific tests or system includes 4 phases: (1) identification of scales for diagnosing frotteuristic disorder. a potential partner, (2) an affiliation phase - Various scales and tests can be used to reveal materialized in verbal or nonverbal behaviors comorbidities, for example the Minnesota - looks, smiles, discussions, (3) a tactile phase Multiphasic Personality Inventory (MMPI). - in which physical contact occurs and (4) a Generally, in paraphilic disorders different copulatory phase - in which sexual contact approaches are used for therapeutic interven- occurs. Therefore: voyeurism is a distortion of tions and treatment – these include: psychody- the identification phase, the exhibitionism of namic interventions that help identify causes the affiliation phase, frotterurism of the tactile and neurotic conflicts that have led to these phase, in which physical contact occurs, and kind of deviant conducts, behavioral therapy, the consensual rape of the copulatory one. The aversive conditioning, confrontation, victim limit of this theory is that it does not explain all empathy, assertiveness training, desensitiza- paraphilic behaviors. tion, social skills training, orgasmic recondi- Another explanation would be the tioning, group therapy, relapse prevention, hypothesis of social incompetence, manifested and/or medications. Antiandrogens are used in shyness, inhibition, male insecurity in to lower the sex drive. Selective serotonin re- the presence of a woman, or the hypothesis uptake inhibitors (SSRIs), such as Zoloft may of sexual impulses and the inability to be prescribed to treat associated compulsive manage and control them. It can also occur in sexual disorders and/or to gain benefit from individuals with co-existing conditions which libido-lowering sexual side effects. Chemical may include hypersexuality or other paraphilic castration may be achieved by shots of Leupro- disorders, most commonly, voyeurism and lide which dramatically decreases testosterone exhibitionism - as well as nonsexual antisocial levels. This may completely abolish deviant personality disorder, conduct disorder, sexual tendencies. Numerous studies Delcea depression, anxiety, substance use disorders, C, Enache A, Stanciu C; Delcea C, Enache A,

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Siserman C.; Gherman C, Enache A., Delcea C.; Should there be no improvement, medica- Delcea C, Fabian A. M, Radu C. C., Dumbravă tion can be tried alongside therapy: seroton- D. P.; Rus M, Delcea C., Siserman C.; Siserman ergic antidepressants, medication for comor- C, Delcea C., Matei H. V., Vică M. L.; Gherman bidities, hormonal therapy, antiandrogenic C., Enache A., Delcea C., Siserman C.; Delcea medication can be given to decrease sexual de- C., Siserman C., confirm our results. sire. Treatments should be prescribed only in In any case, before any therapeutic ap- collaboration with a medical team of special- proach it is necessary to properly inform and ists, like endocrinologists, psychiatrists in case educate the client, his family and partners. of depression, etc. Once the behaviors are understood and the re- sistance to these initiations is eliminated, the CONCLUSION subject’s family and partners can provide the necessary support and support the therapeutic In many cases the clinician may come process. across some dificulties while trying to make a In the particular case of frotteurism, the diagnosis as one individual may suffer from prognosis for eliminating it is poor as most frot- several types of paraphilias and diagnostics teurs have no desire to change their behavior. might overlap. For example, in the case of child They most probably will not change. It is very victims the diagnosis might be both difficult, if not impossible, to change a person’s and frotterurism or if the behavior involves ex- sexual activity preferences. Without treatment, posure of genitals the diagnosis might be frot- individuals with paraphilias, including frot- teurism, exhibitionism or even fetishism. teurism, can have a recidivism rate of 100%. Furthermore, one should consider that the In order for treatment to be successful, a frot- paraphilic character in these cases of frotteur- teur must admit that they have a problem and istic acts is related to the context in which they want to change. Individuals with frotteuristic occur – whether the involved partner is con- disorder generally do not undergo treatment senting the act or not. on their own and only receive help after they The diagnostic of frotteuristic disorder are arrested for sexual assault and treatment is clearly needs to develop more rigorous re- imposed by the courts. And since those with search and data in order to clarify whether it frotteuristic tendencies tend to act quickly in should be separated from other paraphilic dis- crowded, public places, and often are able to orders or not. If frotteuristic disorder is contin- successfully disappear or blend into a crowd ued to be conceptualized independently, fur- without getting caught, there is little reliable ther clarification and more specific criteria are information on either prevalence or treatment needed, including some specifications about success rates. the victims, like age. Standard treatments for frotteuristic dis- order include psychotherapy and medication. BIBLIOGRAPHY Supportive and/or cognitive behavioral thera- 1. Balon, R. – Practical Guide to and py and relaxation training should probably be Paraphilic Disorders, Springer, 2016, p. 93-105; the first line of treatment that can help manage 2. Diagnostic and statistical manual of mental sexual urges and redirect thoughts to more ap- disorders. 5th ed. Arlington: American propriate ways of managing inappropriate sex- Psychiatric Association, 2013, p. 691–694; ual impulses and behaviors. Also, systematic 3. Johnson, S. R., Ostermeyer B., Sikes, K. A., desensitization has a key role in reducing anx- Nelsen, A.J., and Coverdale, J.H. - Prevalence iety, aversive conditioning, group therapy is and Treatment of Frotteurism in the Community: also used and sometimes gives results. Besides A Systematic Review, Journal of the American these aproaches, self help texts, programs such Academy of Psychiatry and the Law Online, as Anonymous Sex Addicts are recommended 2014, 42 (4) 478-483; as well.

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4. Safe and Sound, International Research on 10. Rus, M., Delcea C., Siserman C. The relationship Women’s Personal Safety on Public Transport, FIA between emotional distress and neuroticism at the Foundation Research Series, Paper 6, 2016. operational personnel of ambulance services. Rom 5. Delcea C, Enache A. Individual Differences J Leg Med27(3)279-284(2019). DOI:10.4323/ in Personality and Reasoning Traits between rjlm.2019.279 Individuals Accused of Murder and those who have not 11. Siserman, C., Delcea C., Matei, H. V., Vică M. L. Committed Murder. Int J MentHealthPsychiatry Major affective distress in testing forensic paternity. 3:1. 2017. doi: 10.4172/2471-4372.1000140. Rom J Leg Med27(3)292-296(2019). DOI:10.4323/ 6. Delcea C, Enache A, Stanciu C, Assessing rjlm.2019.292. Maladaptive Cognitive Schemas as Predictors of 12. Gherman, C., Enache, A., Delcea C., Siserman Murder. Int J MentHealthPsychiatry 3:1. 2017. C., An observational study on the parameters doi: 10.4172/2471-4372.1000142. influencing the duration of forensic medicine 7. Delcea C, Enache A, Siserman C. The Reasoning expert reports in assessment of inmates’ health Involved in the Decision Making Process of status in view of sentence interruption on medical Individuals Who have Committed Murder. grounds - conducted at the Cluj-Napoca Legal Int J MentHealthPsychiatry 4:1. 2018. doi: Medicine Institute between 2014 and 2018. Rom 10.4172/2471-4372.1000160. J Leg Med27(2)156-162(2019). DOI:10.4323/ 8. Gherman C, Enache A, Delcea C. The multi- rjlm.2019.156. factorial determinism of forensic expertise regarding 13. Delcea C., Siserman C. Validation and Standar­ sentince interruption on medical grounds and dization of the Questionnaire for Evaluation of decision. Journal of Forensicand Legal Medicine. Paraphilic Disorders. Rom J Leg Med 28 (1)14- Elsevier. 2019. Vol. 61, pp 45-55.DOI 10.1016/j. 20(2020). DOI: 10.4323/rjlm.2020.14. jflm.2018.10.005. 9. Delcea C., Fabian, A. M., Radu, C. C, Dumbravă D. P. Juvenile delinquency within the forensic context. Rom J Leg Med27(4)366-372(2019). DOI:10.4323/rjlm.2019.366.

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