Frotteuristic Disorder: Causes & Treatment Options

What Is Frotteuristic Disorder?

Frotteuristic disorder is a pattern of recurrent and intense sexual arousal resulting from fantasies, urges, or behaviors involving touching or rubbing against a non-consenting person, usually a stranger. Genital arousal and/or masturbation in conjunction with non-consenting touch may occur for some people with frotteuristic disorder. Generally, there is no further attempt at sexual activity with the non-consenting person.

Frotteuristic disorder is a subcategory of paraphilic disorders. A paraphilia is an intense and persistent sexual interest in atypical sexual targets or activities. A paraphilic disorder causes significant distress, functional impairment, and/or harm to self or others. Only when frotteuristic interests cause significant distress or are acted upon would frotteurism be considered a mental disorder.

Frotteuristic disorder is believed to occur primarily in males. More information is needed to determine whether frotteuristic disorder occurs at a clinically significant level within the female population. Perpetrators typically have a wide victim base, although older females are most likely to be victimized, and a majority of frotteuristic acts go unreported. Negative outcomes for victims include feelings of violation, changes in behavior, and psychological distress.³

Is Frotteurism Illegal?

Yes, forcing oneself on a non-consenting stranger is illegal. However, it is unusual for frotteurs to be arrested or face legal consequences as they typically leave the scene immediately after initiating non-consenting touch.² The more exclusively an individual’s arousal centers on the act of touching or rubbing against a non-consenting person, the more likely it is that these urges will cause illegal or inappropriate behavior to occur.

Occasional Thoughts of Frotteurism Vs. Diagnosable Frotteuristic Disorder

Note that sexually active adults may occasionally become aroused by accidental touch or the fantasy of touching or rubbing against a non-consenting person; however, the absence of fixation, mental distress, or perpetrating behavior means that this arousal would not be classified as a mental disorder.

Symptoms of Frotteuristic Disorder

The main criterion for frotteuristic disorder is a recurrent and intense sexual arousal from touching or rubbing against a non-consenting person, as manifested by fantasies, urges, or behaviors. A person with frotteurism is often only able to achieve arousal when inappropriate touch is imagined or acted upon and they may feel shame and distress at the atypical focus of their sexual desire.¹

In order to meet the diagnostic criteria for frotteuristic disorder, the individual must have these symptoms:¹

• Frotteuristic fantasies, urges, or behaviors for at least six months
• Has acted on these urges with a non-consenting person or their sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Causes & Triggers of Frotteuristic Disorder

Some professionals theorize that accidental touch that leads to sexual arousal in childhood or adolescence may cause frotteuristic fantasies later in life. While children and adolescents may touch or rub against unwilling participants, sexual motivation tends to be less clear, and frotteuristic disorder is not a typical diagnosis until late adolescence or adulthood.

Both antisocial behavior and hypersexuality have been linked to frotteuristic disorder, although causality has not been determined. Depression, anxiety, and low self-esteem have been linked to frotteuristic disorder.⁴ People with frotteuristic disorder tend to be isolated and have difficulty finding consenting sexual or romantic partners.

Substance use, particularly involving stimulants such as cocaine and amphetamines may lead to frotteuristic episodes; however, unless someone also experiences frotteuristic fantasies, urges, or behaviors when not intoxicated, frotteuristic disorder is not an appropriate diagnosis.

How Is Frotteuristic Disorder Diagnosed?

Frotteurism is typically diagnosed when someone is known to have intentionally touched or rubbed against a nonconsenting person. They may receive a citation for lewd or inappropriate behavior and be remanded to psychological treatment. It may also be diagnosed when an individual experiences recurrent urges or fantasies which cause anxiety, obsessive thinking, guilt, or shame, even when those urges have not been acted upon. However, these symptoms could also be a sign of OCD with sexually intrusive thoughts.

Treatment of Frotteuristic Disorder

Frotteuristic interests require treatment when inappropriate or illegal behavior is occurring and/or the sexual impulses are causing significant impairment or distress. For individuals who require treatment, psychotherapy is the most common approach. Some medications have been shown to be effective in reducing the compulsive behavior associated with frotteuristic disorder when utilized in conjunction with therapy.

Sex Therapy

Sex therapy with a certified sex therapist who specializes in paraphilias will ensure a knowledgeable and non-judgmental approach to psychotherapy. They will take a detailed sexual and psychosocial history to assess for factors that contribute to the frotteuristic interest and its expression through urges, fantasies, and behaviors. Then, they will explore the onset and context of the symptoms being experienced, especially any changes in the situations or cues that have escalated frotteuristic thoughts or urges. Additionally, they will likely offer coaching on mindfulness and behavioral techniques. Co-occurring psychological conditions, such as mood disorders or hypersexuality, will also be assessed and treated.

Cognitive Behavioral Therapy (CBT)

Sex therapists with cognitive behavioral therapy training will employ cognitive restructuring techniques to identify and change thoughts and behaviors. They may utilize aversion therapy or guided imagery to reduce interest in frotteuristic behavior. Studies have shown CBT to be an effective treatment for frotteuristic disorder when utilized in conjunction with drug therapy.

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) can help with co-occurring mood disorders, such as depression or anxiety, while simultaneously lowering sex drive. A lowered sex drive can help with the impulsivity associated with frotteuristic thoughts and behaviors, however it does not directly address the frotteuristic urge the way that therapy can.

Antiandrogens

Medroxyprogesterone acetate and cyproterone acetate are members of a class of drugs that can be used to lower testosterone levels temporarily in order to reduce sex drive and allow for more effective therapy. These drugs help reduce the levels of circulating testosterone and prime the recipient for cognitive restructuring therapy techniques.

Group Therapy

Group therapy conducted in conjunction with individual therapy has been shown to be effective in reducing inappropriate behaviors and enhancing social skills.⁵

How to Get Help for Frotteurism

Most people who suffer from frotteuristic disorder seek psychological treatment only when legally forced to do so. If you have a frotteuristic interest which has had or may have negative consequences, seeking psychological help from someone knowledgeable and nonjudgmental is an important step towards taking control of sexual impulses and channeling them into healthy, consensual behavior.

When consulting a therapist for the psychological treatment of sexual issues, make sure that your mental health practitioner is certified by the American Association of Sexuality Educators Counselors (AASECT). “Sex therapist” and “sex therapy” are not protected terms, meaning that anyone can call themselves a sex therapist in their marketing. Additionally, most mental health licensure requirements contain little or no instruction in human sexuality. AASECT certified providers receive an additional 18-24 months of training and a minimum of 300 additional hours of supervision in sex specific psychological issues.

Cost of Therapy

Typical rates for an AASECT certified sex therapist are on the upper end of private pay therapy rates in your area. Most sex therapists see individual clients for 45-60 minute sessions at rates between $120-$180 and couples for 75-90 minute sessions at rates between $190-$310. These rates may vary widely based on the availability of certified sex therapists in your area and on general mental health costs in your state.

Frotteuristic Disorder Statistics

Here are additional statistics on frotteuristic disorder:¹

• Frotteuristic behavior occurs in up to 30% of adult males
• Frotteuristic disorder occurs in approximately 10-14% of adult males seen in outpatient settings for paraphilic disorders
• Frotteuristic disorder occurs almost exclusively in men
• Frotteuristic fantasies and behavior may decrease with age
• In one study, approximately 24% of women reported being a victim of frotteuristic behavior in their lifetime³
• Frotteuristic disorder typically develops during late adolescence or early adulthood

Coping With Frotteuristic Disorder

If you are suffering from frotteuristic disorder, there are ways to cope with and manage symptoms; start by consulting with a certified sex therapist to explore your options. They can provide best practices for reducing compulsive behaviors and dealing with symptoms of co-occurring mental health conditions.

Here are a couple other ways to cope with and manage frotteuristic disorder:

• Minimize the use of stimulants and other inhibition-lowering substances which may increase the inappropriate acting out of frotteuristic urges
• Remember that, like most mental health conditions, frotteuristic disorder is more effectively treated the sooner it is addressed

Frotteuristic Disorder Vs. Conduct Disorder & Antisocial Personality Disorder

Conduct disorder in adolescents and antisocial personality disorder in adults are characterized by norm-breaking behavior which could include frotteuristic behavior. That said, the sexual arousal experienced by touching or rubbing against a nonconsenting person in the context of frotteuristic disorder would be lacking in conduct disorder or antisocial personality disorder and additional behaviors would be present. 

Frotteurism Vs. Substance Use Disorders

Alcohol and substance use disorders may involve single frotteuristic episodes. However, recurrent sexual fantasies, urges, and behaviors related to touching or rubbing against a nonconsenting person would be absent when the individual is not intoxicated.

Final Thoughts on Frotteurism

If you’re dealing with frotteuristic thoughts or exhibiting frotteuristic behaviors, consult with a certified sex therapist; you can find the right match through an online therapist directory. Remember, you are not alone in your struggle; other people experience these kinds of urges and fantasies and are able to find help.