Indian J. Psychiat. (1983), 25(2), 159—161 A CASE OF FROTTEURISM AND ITS SUCCESSFUL TREATMENT BY BEHAVIOUR THERAPY K. KURUVILLAS M.D., MRC Psych., FAPA. SUNNY JOSEPH', M.B.B.S.,D.P.M. Frotteurism or Frottage is defined by Allen (1969) also considers this as an Solomon and Patch (1971) as "sexual uncommon perversion which rarely comes pleasure obtained by rubbing or pressing to the attention of the psychiatrists because against the object, usually fully clothed the person who does it performs it stealthily woman. It commonly takes place in sub­ in crowded buses, trains etc., and usually ways and other crowded situations and does not get into trouble with the law, may pass unnoticed by the victim. Frot- and admits that he has never seen a case teurs are perverts only if this is the sole of pure frotteurism. The two cases he des­ mode of obtaining orgasm. Little is cribes are associated with exhibitionism. known of its psychopathology, but it is He considers, "Frotteurism as a perversion thought to be a partial instinct. Frotte- of the infantile reaction to cuddle and rub urs rarely seek help voluntarily". against the mother. Young men who do Reports on this condition is sparse it often have premature ejaculation or in psychiatric literature. Kraft-Ebbing impotence on attempting heterosexual (1925) in his book Psychopathia Sexualis intercourse." describes four case histories, three of which Here we are reporting the details of are borrowed from Magnan. The fourth a patient who presented with this rare patient, seen by Kraft-Ebbing himself is complaint of Frotteurism and its success­ described as one who was "apparently ful treatment by behavioural techniques disturbed in virility, yet libidinous and had which took only a short time, in compa­ come to practise frottage, by having sight rison with the analytical treatment which of posteriora feminae fall together acci­ took several months for Allen (1969). dentally with sexual excitement; thus An additional interesting feature of our associative combination of a perception case is that the Frotteurism in our patient with a feeling permitted the former to was homosexual in orientation, which to attain the significance of a fetich". This our knowledge has not yet been descri­ description by Kraft-Ebbing clearly brings bed in psychiatric literature. out a classical conditioning process invol­ Mr. A. M.a 50 year old married man ved in the development of this disorder. came to our clinic with the complaint of He also views it as a "masturbatorial act of getting seminal emissions at inappropriate a hyper-sexual individual who is uncertain times for the past 12 years. He reported about his virility in corpore feminae". that the symptom occurred when he came "This", he wrote, "would also explain the into contact with any part of the body of motive of the assault being made not ad another male. This caused him a lot of anteriora but ad posteriora". He believed social embarassment because it tended to that Frottage contains elements of both occur when he went for a haircut or a fetichism and exhibitionism. shave particularly when the barber would 1. Professor of Psychiatry and Head of unit I, Christian Medical College, Vellore. 2. Formerly Registrar in Psychiatry, Christian Medical College, Vellore. Present Address : Psychiatrist, Mandiram Mental Health Centre, Manga nam, Kerala. 160 K. KURUVILLA & SUNNY JOSEPH ^ sprinkle water over his hair and face and On psychiatric evaluation there were or massage, when he travelled in crowded no abnormalities except features of mild bus or underwent physical examination by reactive depression which were of recent a male physician etc. These physical onset and related to his son's acute illness. contacts always gave the patient a plea­ Patient denied any loss of libido or surable sensation and resulted in penile erectile or ejaculatory problems either in erection and then ejaculation. He admi­ his present hetero or past homosexual tted that often when the opportunity arose activities. The patient was earlier treated he would rub his genitals against other with Amitryptilene for his depression with­ males to derive this pleasure and later out any beneficial results. Under the would feel guilty and embarassed about it. assumption that his Frotteurism was a He had tried various methods of treatment variant of premature ejaculation he had to stop this pattern of ejaculation—allo­ a course of treatment with small doses of pathic, auyrvedic and unani, with little Thioridazine, with no improvement. improvement. During psychiatric interviews patient Patient was born to poor working reported that whenever he would rub class parents, eldest in a family of 16 child­ against another male he indulged in plea­ ren, was a good student but had to dis­ surable homosexual fantasies which cul­ continue studies after 6th grade to help his minated in ejaculation and that he often father in his small grocery shop. At the entered into situation which gave him age of 16 he went to work in a city far opportunities to rub against other men. away from his home. During his stay Yet the occurance of ejaculation in ina­ there for the next 2 years he had frequent ppropriate situations caused a lot of social homosexual experiences both as the active embarassment and so he wanted to get and as the passive partner. For the next rid of it. An even stronger factor which 20 years he worked in another country motivated him for treatment was his be­ where he was very successful in his work. lief that one drop of semen is formed from During this time also he continued his sixty drops of blood and so the frequent homosexual activities with younger boys loss of semen through Frotteurism will who were his employees. He did have lead to physical weakness. The social an opportunity for heterosexual relation­ embarassment and somatic misconcepts to­ ships, but enjoyed the homosexual activi­ gether made the patient feel anxious about ties much more. entering into situations which could give At the age of 38 he got married to a him an opportunity to rub against other young girl with whom he had normal men, but he admitted that once he happe­ and satisfactory sexual relationship. ned to be in such an environment he would Around this time he had an intense reli­ go ahead and indulge in the rubbing, gious experience following which he gave in spite of the above anxieties—and so he up his homosexual activities as something started avoiding such situations as trave­ sinful. His presenting symptoms appeared lling in a crowded bus, going to the market one year after this. place etc. Patient was examined by a neurolo­ Since the patient's anxiety about gist and a urologist before he was referred being in these social situations and the to the psychiatrist. They could not detect tendency to avoid them were causing him any physical abnormality. All laboratory great social and professional difficulties, investigations including EEG and Semen it was decided to try systematic desensiti- analysis yielded normal results. zation for that problem. He was taught FROTTEURISM & ITS SUCCESSFUL TREATMENT 161 Jacobson's progressive muscle relaxation treated only in imagery. In between technique. A heirarchy of the anxiety these sessions of aversion treatment he was provoking situations was constructed and encouraged to have imagery of pleasurable the patient was given systematic desensi- heterosexual experience with his young tization in imagination as well as encou­ and attractive wife and these were not raged to expose himself to such situations paired with shock. By the tenth session in vivo. By the end of seven sessions he patient ceased to develop homosexual reported freedom from anxiety while fantasies, erection or ejaculation even visualising those scenes during the therapy when his whole body (except genitalia) sessions as well as in real life situations and was massaged by a male. He was able to completely stopped avoiding such situa­ have both haircut and shave in a barber­ tions. But his tendency to rub against shop without indulging in homosexual men to the point of ejaculation continued fantasies or getting an ejaculation. Pa­ whenever he got such an opportunity. tient continued to travel by buses and visit At this stage it was decided to intro­ crowded places without experiencing any duce aversion therapy for his Frotteurism anxiety and without indulging in Frottage. per se. Patient had reported that it is not All this while the patient has been living only actual rubbing of his genitals against with his wife. Both patient and wife another male which resulted in homo­ independently reported that they are sexual fantasies and ejaculation, but also having satisfactory sexual relationship, contact of other parts of body like when the about 3 times a week. The patient had a barber touches him for haircut, shave etc. total of 18 one hour sessions, which were A heirarchy of such pleasure giving situa­ spread out over a period seventy days. tions were constructed with the maximum The patient continued the contact sexual excitement resulting from delibe­ with the clinic by letter once a month and rate contact between his genitals and a visits once in 3 months for a total of 1 man's posterior. In the treatment session year. During this period there was no a male would touch different parts of body indulgence in Frotteurism or ejaculation (excluding genitals) starting with the least during nonsexual contacts with males as exciting item in the heirarchy and moving in a barbershop, bus etc., and normal up gradually. When this contact stimu­ heterosexual being continued as before. lated patients pleasurable homosexual fantasy, he was asked to indicate it by REFERENCES raising a finger and this signal was imme­ diately followed by a low voltage but ALLEN, C.