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Compulsive Sexual Behaviors in a Young Male with Social Anxiety OPEN ACCESS Freely availableonline Journal of Psychiatry ISSN: 2378-5756 Research Article Compulsive Sexual Behaviors in a Young Male with Social Anxiety Disorder (Social Phobia) Kingsley Mayowa Okonoda1,2, Erefagha Leonardo Allagoa2* 1Department of Psychiatry, University of Jos, Nigeria; 2Department of Psychiatry, Jos University Teaching Hospital, Jos, Nigeria ABSTRACT Compulsive sexual behaviours are relatively rare and are not known to be associated with social phobias, with an intense scientific debate on going if it constitutes a behavioral addiction. Compulsive sexual behaviours otherwise known as Hypersexuality/problematic sexual behaviour and is identified by a persistent pattern of failure to control repetitive, intense urges, fantasies and behaviours of a sexual nature over an extended period of time that causes marked impairment in multiple areas of functioning, in this case, especially educational functioning. Phobic anxiety disorders also known as social phobias are a group of conditions in which anxiety is triggered typically in well- defined situations that are not currently dangerous with resulting avoidance of such situations. Nevertheless, CSB is not captured in DSM V and ICD10, although, diagnostic criteria were proposed during DSM V revision, it is not currently recognized in the DSMV. Although, CSB has been proposed for inclusion in ICD 11 as an impulse control disorder, rather than as a mental and behavioural disorder as previously debated, in addition, strict diagnostic guidelines were instituted due to concerns of over pathologizing sexual behaviours. This presents a diagnostic and treatment dilemma for the psychiatrist when a patient presents with symptoms of Compulsive sexual behaviours with or without anxiety, since there are presently no diagnostic and treatment guidelines. We present the case of a 23 year old 3rd year medical student with a 5 year history of compulsive masturbation, persistent pornography viewing, failure to resist impulses and fantasies with accompanying intense distress especially following periods of abstinence and a two year history of recurrent panic attacks in social settings in which women were triggers complicated by depressive symptoms, symptoms significantly impaired most areas of functioning particularly his academics. A diagnosis of Social Phobia/Social Anxiety disorder with episodic panic attacks and compulsive sexual behaviours and mild depressive episode was made because patient met criteria according to ICD 10 and proposed ICD 11. Mental state examination shows anxious mood, congruent with affect, depersonalization, derealization as well as anxious ruminations. Within a year, after commencement of an SSRI, Atenolol and Lisonopril and CBT all anxiety symptoms resolved with marked reduction in the frequency of pornography viewing as well as compulsive masturbation with associated fantasies. This case report lends voice to the on-going debate about the inclusion of compulsive sexual behaviours as a mental and behavioural disorder Dependence syndrome in diagnostic classification systems as well as the need for development of standardized appropriate treatment modalities. This case report will highlight Compulsive Sexual Behaviours, rationale for its inclusion as an addiction in classification systems and treatment approaches to the disorder. Key words: Social Anxiety Disorder; Compulsive Sexual Behaviors; Social Phobiaprofessions INTRODUCTION such as palpitations, fear of dying and fear of embarrassing oneself or fears of going crazy, these results in considerable distress and Phobic anxiety disorders also known as social phobias are a group disrupts the patient’s life with debilitating effects. Phobic disorders of conditions in which anxiety is triggered typically in well-defined may coexist with panic attacks and depression as seen in this case. situations that are not currently dangerous with resulting avoidance Compulsive sexual behaviours are relatively rare and are not known of such situations. The patient is usually distressed by symptoms to be associated with social phobias, with an intense scientific *Correspondence to: Erefagha Leonardo Allagoa, Department of Psychiatry, Jos University Teaching Hospital, Jos, Nigeria, Tel: +2348131216468; E-mail: [email protected] Received: July 15, 2020; Accepted: August 17, 2020; Published: September 07, 2020 Citation: Okonoda KM, Allagoa EL (2020) Compulsive Sexual Behaviors in a Young Male with Social Anxiety Disorder (Social Phobia). J Psychiatry 23:471. doi: 10.35248/2378-5756.20.23.471. Copyright: © 2020 Okonoda KM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. J Psychiatry, Vol.23 Iss.8 No:471 Allagoa Erefagha Leonardo, et al. OPEN debate on-going if it constitutes a behavioural addiction, it is Raymond N. C et al shows that 100% of CSB participants in one also known as problematic sexual behaviour. Compulsive sexual study had a lifetime prevalence of Axis I disorder with Depression behaviours otherwise known as Hyper sexuality/problematic being the most common as seen in this case report although Social sexual behaviours is identified by a persistent pattern of failure phobia was prominent in this case report [3]. Several studies as well to control repetitive , intense urges, fantasies and behaviours of a as a study on the applicability of substance use disorder criteria in sexual nature over an extended period of time that causes marked sexual addiction show that 34% and 71% of individuals with CSB impairment in multiple areas of functioning, in this case, personal, had comorbid substance use disorders, CSB can also be comorbid family, social, educational settings. Nevertheless, CSB is not with impulse control disorders such as pathological gambling and captured in DSM V and ICD10, although, diagnostic criteria were compulsive buying. Majority of persons who suffer from CSB come proposed during DSM V revision, it is not currently recognized in from dysfunctional homes with about 86.8% and 77% were from the DSMV. Historically, it was after Richard von Krafft-Ebing who disengaged and rigid families respectively. described sexual behaviour in men that we had a description of A theory regarding CSB and dysfunctional family interactions sexual behaviour that mimics our modern understanding of CSB:” suggests that as children the CSB patient's needs are unmet due sexual instinct which permeates all thoughts and feelings, allowing to rigidity and failure to follow through these results in the child of no other life...in a rut like fashion demanding gratification believing that they have to depend on themselves since parents are without granting the possibility of moral counter representations unreliable, in time, sexual activities become a source of wellbeing and resolving itself into an impulsive, insatiable succession of to CSB sufferers. Other research shows that physical and sexual sexual enjoyment” (translated from German). Recent studies in the abuse appears to be more prevalent in CSB patients with about US show a prevalence rate of 3.7% among university students with 22% having a childhood history of physical abuse and 13% having symptoms consistent with current non paraphilic CSB. Another a history of sexual abuse as compared to the general population. US study of 1,837 university students who were screened specifically The effects of CSB can be very distressing to the sufferer and can for CSB criteria found a prevalence of 2.0% (3.0% for men, 2.0% interfere with different areas of the person’s life, some sufferers for women). A recent Scandinavian study in Sweden involving the experience a variety of medical conditions such as STIs, [4] assessment of Internet sexual addiction shows a prevalence of 2% unwanted pregnancy and physical injuries due to repetitive sexual for women and 5% for men. The authors could not find any studies activities e.g anal, vaginal and pencil trauma. Sexual compulsivity on CSB in African literature. Due to the embarrassing nature as is linked to more unprotected sexual acts and a greater number well as shame that is frequently associated with CSB sufferers, it of sexual partners [5-7] implying an increased risk of risky sexual is difficult to evaluate. This is especially worse in the context of behaviours. Nigeria and Africa as a whole since sex related disorders are viewed as a taboo for discussion even in private settings. Nevertheless, A national survey on risk factors for lifetime suicide attempts most individuals who seek treatment for CSB are males with a showed that individuals with CSB appear to have a higher risk of primary onset of CSB during late adolescence as exemplified in suicide than the general population (19% versus 4.6%). However, a this case report. study by Harper C [8] among university students in Canada shows that addictive use of internet pornography is associated with poorer However, CSB has been reported to be far more common among psychosocial functioning ( depression, anxiety, life and relationship females than males (8.9% of females and 0% of males) shown in satisfaction) when people begin to use internet pornography daily, a study of 102 adolescents hospitalized for psychiatric reasons. with no strong significant association between internet pornography There appear to be fewer differences in men and women with use and general psychosocial functioning. The
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