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Yesterday, the American Psychological Association released a set of proposed revisions to its Diagnostic and Statistical Manual of Mental Disorder, the document that sets guidelines for psychiatric diagnoses. One diagnosis going under the APA’s microscope this year: “frotteurism,” a condition marked by the “recurrent and intense sexual fantasies, sexual urges, or sexual behaviors involving touching or rubbing against a nonconsenting person.”
“Frotteurism” is one of the APA’s recognized “paraphilias,” a group of non-normative sexual behaviors that includes exhibitionism, fetishism, pedophilia, and transvestic fetishism. The APA’s revised DSM contains one significant proposed change to all paraphilias—-it differentiates between paraphilia and a “paraphilic disorder,” or “a paraphilia that causes distress or impairment to the individual or harm to others.” The change allows the APA to continue its research of non-normative sexual behavior in humans “without automatically labeling non-normative sexual behavior as psychopathological.” Under the new proposed guidelines, a pedophile’s interest in having sex with children doesn’t reach the level of disorder unless he acts on that sexual interest, or the sexual interest causes him or her personal distress.
Where does that leave us for diagnosing serial rubbers? Previously, a frotteurism diagnosis was reached when a patient had experienced “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person” over a period of six months. Simply becoming aroused at the idea of nonconsensual rubbing wasn’t enough to prompt a diagnosis: The patient must have either “acted on these sexual urges” in the past, or experienced “marked distress or interpersonal difficulty” as a result of the paraphilia.
The new guidelines would still allow patients to be diagnosed as frotteurs if they have experienced distress from the attraction. But for frotteurs who aren’t personally phased by their paraphilia, the APA has bolstered the requirements for the patient’s history of nonconsensual rubs. Under the new guidelines, the patient must have “sought sexual stimulation from touching and rubbing against three or more nonconsenting persons on separate occasions” in order to be diagnosed as a frotteur.
The APA explains the three-rub requirement:
The suggested minimum number of separate victims varies for different paraphilias. This represents an attempt to obtain similar rates of false positive and false negative diagnoses for all the paraphilias. The logic runs as follows: Paraphilias differ in the extent to which they resemble behaviors in the typical adult’s sexual repertoire. For example, sexual arousal from seeing unsuspecting people in the nude seems more probable, in a typical adult, than sexual arousal from hurting or maiming struggling, terrified strangers. It follows that the more closely a potentially paraphilic behavior resembles a potentially normophilic behavior, the more evidence should be required to conclude that the behavior is paraphilically motivated. We have therefore suggested, for example, three different victims for Voyeuristic Disorder but only two different victims for Sexual Sadism Disorder. We felt that fewer than three victims for Voyeuristic Disorder would result in too many false positives and more than two victims for Sexual Sadism Disorder would result in too many false negatives
The frotteur’s victim threshold is higher than that of sadists and pedophiles because the paraphilia is “relatively less intrusive” to the frotteur’s victims:
The suggestion of this threshold level of frotteuristic behavior in subjects not distressed or impaired by their attractions, or unwilling to report them, was based on frotteurism being relatively less intrusive than Sexual Sadism Disorder and Pedohebephilic Disorder–Pedophilic Type (which have thresholds of two or more persons on separate occasions). Albeit not supported by absolute levels in the empirical literature, the number of victims on separate occasions was chosen in an attempt to balance false negatives (i.e., inaccurately diagnosing someone as not having Frotteuristic Disorder from behavior only because of a too high threshold) and false positives (i.e., inaccurately diagnosing someone as having Frotteuristic Disorder from behavior only because of a too low threshold).
Over the course of our groping series, we heard from three victims of frotteurs—-one in a dance club, and two on the Metro. None of these victims reported the behavior to the police. If frotteurs don’t identify themselves to doctors, it’s highly unlikely that an undercover frotteur will accumulate the three reports necessary to be diagnosed. Even without a clinical diagnosis, however, the APA reminds us that the frotteur only needs to commit one nonconsensual rub for his or her conduct to be deemed “immoral or unlawful” by the American legal system:
The decision to suggest these thresholds for DSM-V diagnostic purposes does not imply that this Subworkgroup wants to comment upon or value the varying ways used to define immoral or unlawful conduct in different judicial traditions. Nor does it imply that we want to minimize victim experiences of such, immoral or unlawful, acts.
Illustration Brooke Hatfield