Frotteuristic disorder

Essential (Required) Features:

• A sustained, focused and intense pattern of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviours—that involves touching or rubbing against a non-consenting person.
• The individual must have acted on these thoughts, fantasies or urges or be markedly distressed by them.

Additional Clinical Features:

• Frotteuristic Disorder should not be diagnosed among children and should be diagnosed only with utmost caution among adolescents. Sexual experimentation is typical during adolescence and sexual acts may occur impulsively or opportunistically rather than representing a recurrent pattern of sexual arousal.
• The diagnosis of Frotteuristic Disorder is generally not adequately supported when the evidence indicating a sustained, focused and intense pattern of sexual arousal consists solely of a single or very limited number of instances of frotteuristic behaviour, as there may be other explanations for specific occurrences (e.g., intoxication, opportunity). In the absence of a report of the individual’s sexual thoughts, fantasies, or urges, examples of other forms of evidence supporting the presence of an frotteuristic arousal pattern include a preference for specific types of pornography; preference over other forms of sexual behaviour; or planning and repeatedly seeking out opportunities to engage in frotteuristic behaviour.

Boundary with Normality (Threshold):

• By definition, Frotteuristic Disorder specifically excludes consensual touching or rubbing that occurs with the consent of the individual involved.

Course Features:

• Individuals with Frotteuristic Disorder often report the onset of frotteuristic sexual interest during adolescence.
• Frotteuristic Disorder is relatively stable after young adulthood, but sexual thoughts, fantasies, urges, and behaviours may change over time such that an individual who was assigned a diagnosis of Frotteuristic Disorder no longer meets the diagnostic requirements.

Developmental Presentations:

• Advancing age may be associated with decreasing paraphilic sexual arousal and decreasing behavioural manifestations of Frotteuristic Disorder due to increased impulse control and decreased sexual drive.

Sex- and/or Gender-Related Features:

• Frotteuristic Disorder is much more common in men.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Compulsive Sexual Behaviour Disorder: Both Frotteuristic Disorder and Compulsive Sexual Behaviour Disorder may involve repetitive sexual impulses, urges or behaviours that result in marked distress or impairment. Frotteuristic Disorder is characterized by sexual impulses, urges, or behaviours that are manifestations of a sustained, focused and intense pattern of sexual arousal that involves touching or rubbing against a non-consenting person. In contrast, Compulsive Sexual Behaviour Disorder is characterized by a persistent pattern of failure to control sexual impulses, urges, or behaviours, regardless of the focus of sexual arousal. If an individual with Frotteuristic Disorder is able to exercise some degree of control over the behavioural expressions of the arousal pattern, an additional diagnosis of Compulsive Sexual Behavioural Disorder is generally not warranted.
• Boundary with Disorders Due to Substance Use: Episodes of impulsive or disinhibited sexual behaviour, including frotteuristic behaviour, may occur during substance intoxication. Such episodes may not be a manifestation of a sustained, focused, and intense sexual arousal pattern. At the same time, some individuals with Frotteuristic Disorder may use substances with the intention of engaging in frotteuristic behaviour that does reflect an underlying paraphilic arousal pattern. A diagnosis of Frotteuristic Disorder may be assigned together with a Disorder Due to Substance Use if the diagnostic requirements for both disorders are met.
• Boundary with other mental disorders: The occurrence or a history of behaviours involving sexual touching or rubbing against non-consenting individuals is not sufficient to establish a diagnosis of Frotteuristic Disorder. Rather, these behaviours must reflect a sustained, focused, and intense pattern of sexual arousal. When this is not the case, other causes of the behaviour need to be considered. For example, inappropriate touching or rubbing against others that does not reflect an underlying, persistent pattern of sexual arousal may occur in the context of some mental disorders, such as Bipolar Type I Disorder during Manic or Mixed Episodes or Dementia.
• Boundary with sexual crimes that do not involve a Paraphilic Disorder: Sexual crimes involving frotteuristic behaviour may consist of actions or behaviours that are not associated with a sustained underlying paraphilic arousal pattern. Rather, these behaviours may be transient and occur impulsively or opportunistically. The diagnosis of Frotteuristic Disorder requires that sexual touching or rubbing behaviours be a manifestation of a sustained, focused, and intense pattern of sexual arousal.