¶ Understanding Fratristic Disorder and Treatment
Welcome to our Licensure Exams podcast . I'm Stacey Frost and with me , as always , is Dr Linton Hutchinson .
Great to be here , Stacey Guess you've started to button things up for another freezing winter in the frozen tundra of Michigan . It is June , you know , after all .
No kidding . Well , we started planning for this winter as soon as last year's winter ended in May . But as brutal as the winters are , I do not miss those Florida summers . I just bet you are roasting like a potato down there right now .
It's true , but I love it . I prefer to enjoy my morning celery juice sitting on the beach while watching palm trees sway , instead of , like you , scraping ice off of my windshield , and without a Publix up north , which means no incredible sushi for you . Stacey , I don't know how you do it .
Okay , okay , I can see you already . Now for today's topic . This episode is part of our demystifying disorders series , where we'll be examining fratristic disorder , a paraphilic disorder involving recurrent , intense sexual arousal from touching or rubbing against a non-consenting person .
This is definitely one of the more rare and lesser known disorders of the DSM-5-TR , but one that you might find and encounter on your exam or in your daily practice , so it's important to understand the diagnostic criteria , associated features and evidence-based treatments .
Now you know me , Linton . I find the history of these disorders fascinating . So before we jump directly into how fraudulistic disorders diagnose today , let's take a little quick trip back in time to the late 1800s .
Okay , and before we do that , what is your favorite diagnosis after all ?
Oh gosh , well , I still stand by . You asked me this over 10 years ago and I still think the most interesting one is factitious disorder .
Okay , we'll have to do a podcast on that . What ?
do you say That'd be a lot of fun ? Oh , and conversion disorder is a second .
Let's take a quick trip back to the late 1880s , like you're suggesting in Germany . What do you say ?
Ah , jawohl . So this disorder was first documented by Richard von Croftebing , a German psychiatrist who is considered one of the founders of medical sexology . He was one of the first to categorize and study sexual behaviors that deviated from the norm , and he wrote about these in what became a famous book called Psychopathia Sexualis .
Like our buddy good old Sigmund Freud , croft-egbing's work was groundbreaking for its time and really laid the foundation for our modern understanding of paraphilic disorders . So with that little tidbit in the background , we'll move on into the criteria .
Okay . So with that little tidbit in the background , we'll move on into the criteria . Okay .
To receive a diagnosis of fratiristic disorder according to the DSM-5-TR , an individual must meet the following criteria First , over a period of at least six months , they must experience reoccurring intense sexual arousal from touching or rubbing against a non-consenting person , as manifest by fantasies , urges or behaviors .
And second , they must have acted on these sexual urges with a non-consenting person or the sexual urges or fantasies must cause clinically significant distress or functional impairment .
All right . Well , what if they have these urges but they've neither acted on them , nor do the urges cause significant problems in their life ? Can you still make the diagnosis ?
No , dear . No , you can say that they have fraudulistic sexual interest , but unless they acted on the sexual urges or the urges or fantasies cause significant distress or impairment functionally in relational , occupational , social or educational , they don't have the disorder .
Okay , so simply having unconventional sexual fantasies or urges is not enough to warrant a clinical diagnosis ? Is there a minimum age for the diagnosis ?
No minimum age , but it's common for adult men with fratricidal disorder to report first becoming aware of their sexual interest and touching unsuspecting people during their late adolescence or emerging adulthood .
Okay , got it . And what are some key differentials to consider for fratulistic disorder ?
The obvious ones are conduct disorder in adolescents and antisocial personality disorder in adults , which are characterized by norm-breaking and antisocial behaviors . A fratulistic disorder diagnosis should only be made if those urges and behaviors are persistent and cause distress or impairment beyond that already accounted for by substance intoxication .
Personality disorder , manic episodes and neurological conditions like dementia or brain injury can sometimes lead to disinhibited sexual behavior that resemble frauderism . So it's important to roll out those potential causes before making a fraudulistic disorder diagnosis .
Now , the onset of fraudulistic behaviors , as Lyndon mentioned , is usually late adolescence or early adulthood , and there are very few self-reported cases of the disorder . Adolescents or early adulthood , and there are very few self-reported cases of the disorder .
Usually , this issue is discovered when a client has been court-mandated to attend therapy after being charged with sexual assault .
Substance abuse is a common associated feature , potentially as a means of coping with negative emotions or disinhibiting oneself to act on fertilistic urges . Individuals with this disorder tend to have an impaired capacity for establishing meaningful reciprocal romantic and sexual relationships .
Their sexual fulfillment revolves around non-consenting touching of strangers rather than consensual sexual acts with a partner .
Touching or rubbing against a non-consenting person can also , as you can imagine , have serious legal ramifications .
So the specific consequences can vary depending on the jurisdiction and the circumstances of the incident , but generally , if the non-consensual touching involves sexual intent or contact with private parts , it can be classified as a sexual assault and this is a serious criminal offense that can lead to significant penalties , including imprisonment , fines and registration as a
sex offender . All right , so we've talked about the diagnostic criteria , some differential diagnoses to consider and some of the features that are associated with fratristic disorder . How about comorbid conditions , so other disorders that can be present alongside of this disorder ?
Well , we mentioned conduct disorder and antisocial personality as differentials , but they're also the most common comorbid conditions , meaning that they can exist alongside . For atroistic disorder , Substance use disorders are also common , as substances like alcohol can be used to disinhibit oneself from acting on the urges .
In other cases , the substance use may develop as a means of coping with the shame , anxiety and other negative emotions that are associated with the paraphilia . Depressive and bipolar disorders often co-occur with fraturistic disorder . Again , this likely represents difficulty coping with the consequences of the client's paraphilic behavior .
And other paraphilias can also co-occur with fraudulism , specifically exhibitionistic disorder and voyeuristic disorder .
Okay , now let's talk about treatment . Stacey , what's your best guess ?
Well , I'm going to say cognitive behavioral therapy .
You got it . Cognitive behavioral therapy , or CBT , is considered the first-line treatment for fractionalistic disorder . Through CBT , clients learn to challenge their maladaptive thought processes . Like you know , it's not really harmful if I rub up against someone without their knowledge or I just can't control my urges .
They learn to recognize the irrationality of these beliefs and replace them with healthier thought patterns . Behavioral techniques are used to help clients resist the fraudulistic urges and avoid high-risk situations .
This can include strategies such as leaving crowded areas when the urge to rise , avoiding alcohol or other distributing substances and engaging in alternative activities to manage stress and negative emotion .
Also a few that you might not think of intuitively but that can be helpful are solution-focused therapy and psychoanalysis . These can be helpful therapeutic models when treating clients with fraught tristate disorder .
With solution focus therapy , you'd collaborate with the client to establish clear , specific and achievable goals that focus on behavior changes , such as reducing the frequency of urges or increasing control over impulses . You want to frame goals positively , control over impulses .
You want to frame goals positively what the client will do rather than negatively what they won't do . A variety of techniques can be used in solution-focused therapy for this , including asking the miracle question , which helps identify the client's vision of a problem-free future and potential solutions .
For example , you might ask if you woke up tomorrow and your fratristic urges were completely manageable , what would be different in your life ? Scaling questions , which can help to track progress and identify small improvements .
For example , you might ask the client on a scale of 0 to 10 , where 0 is the worst that your urges have ever been and 10 is complete control where are you today ? Then you have exception-seeking questions , which allow you to identify existing coping strategies and resources For example , can you tell me about a time when you successfully resisted an urge ?
And coping questions which help clients recognize their strengths and resilience . For example , how have you managed to keep the problem from getting worse ? Now , with solution-focused therapy , it's important to offer genuine praise for the client's efforts and successes , no matter how small they seem . This reinforces positive behaviors and builds self-efficacy .
And lastly , I think we have psychoanalytic techniques that are typically applied over a very , very long-term therapeutic relationship , often involving multiple sessions per week over a series of years . The goal is to achieve deep structural changes in the client's psyche , addressing the root causes of the fratricidal disorder rather than just managing symptoms .
So the psychoanalytic techniques are free association this is when the client speaks freely about whatever comes to mind without censoring their thoughts . This uncovers unconscious thoughts and feelings related to the disorder , while the therapist listens for patterns , reoccurring themes or significant memories .
My favorite dream analysis and this is the process where the client shares and discusses their dreams in detail . The therapist helps interpret symbolic meanings related to this disorder to help reveal repressed desires or unresolved conflicts contributing to their urges . Analysis of transference why do we let the client project feelings about significant others onto us ?
We do this to analyze their projections , to understand the client's relational patterns and reveal how early relationships influence their current sexual behaviors . Use of interpretation interpretation is the process of offering insights into the unconscious motivations behind fatalistic behaviors , to help the client become aware of hidden thoughts and feelings .
The objective is to connect past experience with current symptoms .
Analysis of resistance this is when you identify and explore the client's reluctance to discuss certain topics this may reveal deeply buried shame or trauma related to the disorder and exploring childhood experiences by conducting a detailed examination of early life events and family dynamics detailed examination of early life events and family dynamics you may uncover the root
causes of fratulistic tendencies and resolve the conflicts driving the behavior .
That's great , and a few other approaches that you might employ with a client with fratulistic disorder are aversion therapy , which involves using aversive stimuli that means unpleasant images or smells , for example to create a negative association with the fraudulistic behavior .
Another approach , using covert sensitization , which is where you pair the fraudulistic behavior with vividly imagined negative consequences to reduce the behavior and sexual addiction treatment approaches like referring the client to programs like Sex Addicts Anonymous for additional support and accountability , and facilitating group therapy sessions where clients can share experiences and
learn from others with similar issues .
Okay , let's consider a case study to illustrate how the treatment principles can be applied in practice .
So let's consider a client named Marcus can be applied in practice . So let's consider a client named Marcus . He's 32 years old and he's court mandated to therapy with you after being arrested for rubbing his genitals against a woman on a crowded subway .
He reports a 10-year history of this kind of behavior , which has escalated in frequency and intrusiveness over time . In therapy , you teach Marcus to identify the distorted beliefs underlying his behavior . Like you know , women secretly enjoy being touched by strangers , or what's the problem ? I'm not really hurting anyone .
As his therapist , you help him challenge these beliefs by considering the negative impact of his behavior on his victims and himself . Now , these are examples of cognitive restructuring , in which you , as the therapist , identify and challenge the distorted beliefs that justify or minimize the behavior .
Marcus also learns in therapy to recognize his rhetorical urges as they arise , and you help him develop a plan for coping with these urges without acting on them , perhaps involving exiting crowded public spaces when he experiences the urges and practicing relaxation techniques like daybreak .
¶ Understanding Sexual Compulsion and Treatment
And as we close out today's episode , let's review some of the main points about frontalistic disorder that you'll need for your exam . First , this disorder is characterized by intense , recurrent sexual arousal from touching or rubbing against a non-consenting person Plus acting on these urges or experiencing significant distress or impairment from them .
Lack of consent is the key to the diagnostic feature . Associated features include substance abuse and difficulty with reciprocal romantic relationships reciprocal romantic relationships . Common comorbidities include antisocial personality disorder , substance use disorder and depressive and bipolar disorders . Other paraphilic disorders may also co-occur .
Finally , the main evidence-based treatment is cognitive behavioral therapy , which targets distorted beliefs and behavioral urges . Solution-focused therapy and psychoanalysis also show merit in treating this disorder . Behavioral methods such as aversion therapy and covert sensitization may also be effective .
All right . Well , thank you so much for joining us everyone . As you study for your exam , always remember it's in there .
It's in there .