Frotteurism Photo by: Yuri Arcurs

Definition Frotteurism is a disorder in which a person derives sexual pleasure or gratification from rubbing, especially the genitals, against another person, usually in a crowd. The person being rubbed is a victim. Frotteurism is a paraphilia, a disorder that is characterized by recurrent intense sexual urges and sexually arousing fantasies generally involving objects, the suffering or humiliation of oneself or one's partner (not merely simulated), or children or other nonconsenting persons.

Description The primary focus of frotteurism is touching or rubbing one's genitals against the clothing or body of a nonconsenting person. This behavior most often occurs in situations that allow rapid escape. Frottage (the act of rubbing against the other person) is most commonly practiced in crowded places such as malls, elevators, on busy sidewalks, and on public transportation vehicles. The most commonly practiced form of frotteurism is rubbing one's genitals against the victim's thighs or buttocks. A common alternative is to rub one's hands over the victim's genitals or breasts. Most people who engage in frottage (sometimes called frotteurs) usually fantasize that they have an exclusive and caring relationship with their victims during the moment of contact. However, once contact is made and broken, the frotteur realizes that escape is important to avoid prosecution.

Causes and symptoms

Causes There is no scientific consensus concerning the cause of frotteurism. Most experts attribute the behavior to an initially random or accidental touching of another's genitals that the person finds sexually exciting. Successive repetitions of the act tend to reinforce and perpetuate the behavior.

Symptoms In order for the disorder to be clinically diagnosed, the symptoms must meet the diagnostic criteria as listed in the professional's handbook, the Diagnostic and Statistical Manual of Mental Disorders . These symptoms include: Recurrent, intense, or sexually arousing fantasies, sexual urges, or behaviors that involve touching and rubbing against a nonconsenting person.

The person has acted on these sexual urges, or the fantasies or urges cause significant distress to the individual or are disruptive to his everyday functioning.

Demographics Males are much more likely to engage in frotteurism than are females. Females are the most common victims of frotteurism. Most acts of frottage are peformed by those between 15 to 25 years of age. After the age of 25, the acts decline.

Diagnosis Most people with frotteurism never seek professional help, but people with the disorder may come into the mental health system as a result of a court order. The diagnosis is established in an interview between the person accused of frotteurism and the mental health professional (a psychiatrist or a psychologist , for example). In the interview, the individual acknowledges that touching others is a preferred or exclusive means of sexual gratification. Because this acknowledgment can bring criminal charges, the disorder is underdiagnosed and its prevalence is largely unknown. In some cases, other people besides the accused may be interviewed, including observers or the victim.

Treatments For treatment to be successful, the frotteur must want to modify existing patterns of behavior. This initial step is difficult for most people with this disorder to take. Behavior therapy is commonly used to try to treat frotteurism. The frotteur must learn to control the impulse to touch nonconsenting victims. Medroxyprogesterone, a female hormone, is sometimes prescribed to decrease sexual desire. Frotteurism is a criminal act in many jurisdictions. It is usually classified as a misdemeanor. As a result, legal penalties are often minor. It is also not easy to prosecute frotteurs as intent to touch is difficult to prove. In their defense statements, the accused often claim that the contact was accidental.

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.

Prevention Most experts agree that providing guidance as to behavior that is culturally acceptable will prevent the development of a paraphilia such as frotteurism. The origin of some instances of frotteurism may be a truly accidental contact that becomes associated with sexual gratification. There is no way to predict when such an association will occur.

Resources

BOOKS American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition, text revised. Washington DC: American Psychiatric Association, 2000. Gelder, Michael, Richard Mayou, and Philip Cowen. Shorter Oxford Textbook of Psychiatry. 4th edition. New York: Oxford University Press, 2001. Kohut, John J., Roland Sweet. Real Sex: Titillating but True Tales of Bizarre Fetishes, Strange Compulsions, and Just Plain Weird Stuff. New York, Plume, 2000. Wilson, Josephine F. Biological Foundations of Human Behavior. New York: Harcourt, 2002.

PERIODICALS Eiguer, A. "Cynicism: its function in the perversions." International Journal of Psychoanalysis 80, no. 4 (1999): 671-684. Rosler, A., and E. Witztum. "Pharmacotherapy of paraphilias in the next millennium." Behavioral Science Law 18, no. 1 (2000): 43-56. Seelig, B. J., and L. S. Rosof. "Normal and pathological altruism." Journal of the American Psychoanalytic Association 49, no. 3 (2001): 933-959.

ORGANIZATIONS American Medical Association. 515 N. State Street, Chicago, IL 60610. Telephone: (312) 464-5000. Web site: <http://www.ama-assn.org/> . American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. FAX (202) 682-6850. Web site: <http://www.psych.org/> . American Psychological Association. 750 First Street NW, Washington, DC, 20002-4242, Telephone: (800) 374-2721 or (202) 336-5500. Web site: <http://www.apa.org/> .

L. Fleming Fallon, Jr., M.D., Dr.P.H.