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LETTERS TO EDITOR  
Year : 2019  |  Volume : 61  |  Issue : 5  |  Page : 541-543
Compulsive sexual behavior in depressed women


Department of Psychiatry, Safdarjung Hospital, New Delhi, India

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Date of Web Publication3-Sep-2019
 

How to cite this article:
Mina S. Compulsive sexual behavior in depressed women. Indian J Psychiatry 2019;61:541-3

How to cite this URL:
Mina S. Compulsive sexual behavior in depressed women. Indian J Psychiatry [serial online] 2019 [cited 2019 Nov 15];61:541-3. Available from: http://www.indianjpsychiatry.org/text.asp?2019/61/5/541/265870




Sir,

Compulsive sexual behaviour (CSB) disorder though at an increasing trend is still unexplored due to the lots of stigma attached to it. It is associated with numerous comorbidities- such as organic conditions (frontal lobe syndrome), medications (dopamine), substance use disorder, mania, psychosis, and personality disorders.[1] It disorder is characterized by persistent and repetitive sexual impulses or urges that are experienced as irresistible or uncontrollable, leading to repetitive sexual behaviors (International Classification of Diseases [ICD] 11 Draft).[2] These symptoms are covered under F 52.7, i.e., excessive sexual drive in the ICD-10 and in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, it can be diagnosed through code 302.70, i.e., as unspecified sexual dysfunction. In the present case, the author would like to highlight the presence of hypersexuality in females primarily suffering from depression.

A 42 year-old widow, resident of Delhi, presented to our department with chief complaints of sadness of mood, loneliness, crying spells, excessive guilt, disturbed sleep, and death wishes from the past 6 months. On probing why she was having this guilt, she disclosed to be very embarrassed for her deeds she can't control of, but never explained in details even after repeated psychiatric consultation. She finally decided to disclose this time due to extreme distress caused to her every day. She presented with a strong desire to involve in sexual act with any men with associated guilt with failed distraction techniques such as watching pornography, self-stimulation, consulting her close friend, and locking herself, but nothing helped. She also reported traveling in crowded places to touch men inappropriately and to experience what it felt like, leading to involvement with approximately ten strangers in the past 2-month period. She even tried contacting paid sex workers but backed out at the end, thinking that she might get AIDS. She also reported that, whenever any male would come near to her, she would have a strong impulse to touch him, and she would do it even if her daughter/friend is sitting near to her.

When she revealed all these behaviors to her friend, she advised to consult a psychiatrist, after which the patient came to our department.

There was no history suggestive of decreased self-care, any attempt to harm her, repetitive thought of checking/cleaning/doubt, strong urge for fire setting/hair pulling/gambling/stealing, and any unusual sexual preferences. There was no significant medical/surgical or family history.

Her general and systemic examination was normal and on mental status examination, she reported her mood as sad. There were ideas of hopelessness, helplessness, and worthlessness, but there were no suicidal ideations with delusions or hallucinations.

Her routine blood investigations, thyroid function tests, electroencephalogram, and magnetic resonance imaging brain were normal. Her HIV status and viral markers were seronegative.

On detailed assessment, she was diagnosed with major depressive disorder with excessive sexual drive according to the ICD-10. She was started on oral treatment with selective serotonergic reuptake inhibitor (SSRI) fluoxetine 20 mg and its dosage was increased to 60 mg in 2 months' period along with the behavior therapy. After about 8 months of treatment, she is almost 80% improved and regularly following up in the outpatient department.

In the current case, the patient was primarily suffering from depressive symptoms with increased sexual urges.

CSB is associated with constant association with sexual activity despite the awareness of its negative consequences. This behavior acts as a defense to cope up with the life stressors.[3]

The present case is an attempt to emphasize the increasing trend of CSB. In a study on 36 patients with CSB by Black et al., depression was the second most common comorbidity after anxiety.[4] In a study by Raymond et al., 100% of the cases of CSB had Axis I diagnosis, with the most common being major depression (58%) and sexual dysfunction (46%).[5]

Regarding the treatment of such cases, no drug is Food and Drug Administration approved till now. Studies have seen improvement with SSRIs, naltrexone, mood stabilizers (lithium, valproic acid), anti-androgens, and psychotherapy.

The purpose of this case report is to sensitize clinicians of this condition as despite the increasing trend, CSB is still underreported and goes unrecognized. It will also aid in developing the operational definition for diagnosing CSB.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Weintraub D, Potenza MN. Impulse control disorders in Parkinson's disease. Curr Neurol Neurosci Rep 2006;6:302-6.  Back to cited text no. 1
    
2.
World Health Organization. ICD-11 Beta Draft (Joint Linearization for Mortality and Morbidity Statistics). World Health Organization; 2015. Available from: http://apps.who.int/classifications/icd11/browse/l-m/en. [Last accessed on 2016 Mar 22].  Back to cited text no. 2
    
3.
Kafka MP, Prentky RA. Compulsive sexual behavior characteristics. Am J Psychiatry 1997;154:1632.  Back to cited text no. 3
    
4.
Black DW, Kehrberg LL, Flumerfelt DL, Schlosser SS. Characteristics of 36 subjects reporting compulsive sexual behavior. Am J Psychiatry 1997;154:243-9.  Back to cited text no. 4
    
5.
Raymond NC, Coleman E, Miner MH. Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior. Compr Psychiatry 2003;44:370-80.  Back to cited text no. 5
    

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Correspondence Address:
Shaily Mina
Department of Psychiatry, Safdarjung Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_137_18

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