Frotteuristic Disorder

Signs and symptoms² of frotteurism can include the following: 

• Intense, persistent sexual arousal, urges, fantasies, or interests in non-consensual touching or rubbing of genitals involving another person
• Touching or rubbing against a person with the pelvic region, often their thighs or buttocks, without consent, typically in crowded public spaces
• Fantasizing about a relationship with someone you’ve sexually harmed 
• Leaving the area after reaching sexual gratification from non-consensual touch or fantasies about rubbing against a nonconsenting person
• Experiencing shame or distress about frotteuristic fantasies or behaviors
• Obsession that interferes with daily functioning 

Some adults may experience occasional arousal from accidental touch or frotteuristic fantasy, which may not constitute a paraphilic disorder. When thoughts are not acted upon and do not cause distress to an individual or others, they may qualify as frotteuristic sexual interest rather than frotteuristic disorder. Frotteuristic sexual interest is considered paraphilia (i.e., an intense interest in non-consenting sexual acts). In contrast, frotteuristic disorder is a paraphilic disorder (i.e., a disorder causing significant distress or harm to yourself or others in the act of achieving sexual gratification). 

Frotteuristic disorder diagnosis

To be diagnosed with frotteuristic disorder, an in-person provider can assess if you meet both of the following DSM-5 criteria: 

• Recurrent sexual arousal from frotteuristic fantasies, fixation, urges, or behaviors, which persist for at least six months 
• Fantasies or desires causing significant personal distress or interference with daily life, or the action of carrying out frotteuristic behaviors against a non-consenting person

Experiencing frotteuristic thoughts is not your fault. If frotteurism meets DSM-5 criteria, it may be diagnosed as a mental disorder, which is a medical condition, not a choice. However, acting on your desires with someone who has not consented is a criminal offense that can cause significant distress or harm to yourself and others. For this reason, seeking treatment can be crucial.  

The causes of frotteurism are not fully understood. Some psychologists theorize that childhood sexual abuse or trauma³ might interrupt psychosexual development and what is considered “normal,” potentially leading to frotteurism. Some studies have found a positive correlation between childhood trauma and paraphilic disorders (including frotteurism), which supports this theory. Others theorize that a precipitating event in which accidental touching resulted in sexual arousal could initiate the sexualization of non-consensual touch and desire for repetition. 

Other factors associated with paraphiliac disorders may include the following: 

• Gender (frotteurism is most common in males) 
• Substance use 
• Anxiety or depressive disorders
• Hypersexuality or intense sexual urges 
• Antisocial behaviors
• Traumatic brain injury
• Intellectual disabilities
• Low self-esteem
• Difficulty finding consenting sexual partners
• Challenges with self-control and managing emotions
• High parental conflict or lack of parental supervision
• The presence of other paraphilic disorders, such as exhibitionism, pedophilia, voyeurism, or sexual masochism

Frotteuristic disorder is most common amongst males between the ages of 15 and 25, though it can occur at any sexually mature age. Frotteurism is uncommon in women, but women are most often the target of frotteuristic behaviors perpetrated in public spaces, such as at concert venues or on public transportation. Historically, the effect of frotteuristic behavior on survivors has been downplayed as a “nuisance.” However, survivors of frotteuristic perpetration often experience shame, feelings of violation, behavioral changes, and long-term distress, and this act is considered a form of sexual abuse, even if the survivor is not aware it is happening. 

There are several treatment options available for people with frotteuristic disorder, including medications and talk therapy, which may address underlying mental health challenges and reduce the occurrence of obsessive frotteuristic thoughts. 

Medication

Physicians may prescribe medications to treat comorbid mental health disorders, like depression and anxiety, or to reduce hypersexuality and impulsivity associated with paraphilias. Medications used to manage paraphilic disorders may include off-label medications developed and approved by the Food and Drug Administration (FDA) to treat a condition other than a paraphilic disorder. The following are classes of drugs that might be prescribed for frotteuristic disorder: 

• Serotonergic antidepressants like selective serotonin reuptake inhibitors (SSRIs), which may reduce obsessive thoughts and impulsivity.
• Anxiolytics, which may improve impulse control.
• Naltrexone, which may interfere with the reward center of the brain that drives addictive behaviors like compulsive sexual behaviors. 
• Gonadotropin-releasing hormone (GnRH) agonists, which can temporarily interrupt hormones that increase sex drive.
• Mood stabilizers, which might reduce aggressive tendencies and impulsivity. 

SSRIs may reduce libido (sex drive) in 60% to 70% of those taking them, and they may be prescribed for this purpose or to address underlying depression, anxiety, obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD). 

Self-care

Self-care can be a helpful way to work through challenging thoughts, feelings, and behaviors alongside proven forms of treatment for people with frotteuristic disorders. 

Mindfulness is a self-care strategy that involves awareness of the present moment. During mindfulness sessions, you can practice centering your breath and acknowledging thoughts and feelings without judgment. 

In people with hypersexual behavior, low impulse control, and difficulty with emotional regulation, mindfulness may reduce sexual urges, improve impulse control and emotional regulation, and help them develop healthier coping mechanisms. If you have underlying anxiety or depression, you may find mindfulness particularly useful, as over 200 studies have found it effective at reducing these symptoms. 

Other forms of self-care might include: 

• Support groups: Support groups can provide an opportunity to learn more about paraphilic disorders, receive peer support from people who understand frotteuristic disorder, and gain insight into coping mechanisms. 
• Arousal suppression strategies: Exercises that reduce sexual arousal, such as counting backward from 100, may help you manage sexual urges and obsessive thoughts. 

While research on effective treatment options for frotteuristic disorder is limited, a combination of talk therapy, medication, and self-care may have the potential to reduce unwanted or obsessive sexual thoughts and behaviors. 

Cognitive-behavioral therapy (CBT) is a type of evidence-based talk therapy that can reduce the severity of problematic pornography use, anxiety, depression, and compulsive sexual behavior, and it’s the most commonly used type of therapy for paraphilic disorders. During CBT sessions, therapists help clients reframe unhelpful thought patterns and behaviors, develop healthier coping mechanisms, and improve self-esteem. 

If you are uncomfortable discussing your sexual fantasies and urges in person, you may be more comfortable attending online therapy sessions. Platforms like BetterHelp offer online CBT from licensed therapists (some of whom specialize in sexual health), and most people are matched with a therapist, often within 48 hours. However, note that online platforms cannot provide documentation or approval for court-ordered therapy. 

Frotteuristic disorder resources

If you experience compulsive sexual behaviors, you may find resources for self-screening and support groups, which are provided by the National Alliance on Mental Illness (NAMI), helpful. Learn more about frotteurism, including evaluation and treatment outcomes, from the National Institutes of Health. 

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Frotteuristic disorder is not a highly researched type of paraphilic disorder, in part because non-consensual touching in public places is not often reported or investigated and because people with frotteurism rarely self-report the disorder. However, some recent studies have explored the causes and treatments for this disorder. 

For example, a 2019 study published in Frontiers in Psychology found an association between traumatic brain injuries to the right hemisphere and acquired sociopathy, of which frotteuristic behaviors can be a symptom. In individuals with symptoms of frotteurism and other indications of sociopathy, the authors indicate that this information can inform decisions in neurosurgery and therapeutic neuromodulation. However, note that “sociopathy” is not a clinical term. 

Frotteurism

In another 2019 study, researchers found that neurotransmitters (chemicals that transmit messages in the body) may appear at different concentrations in people with paraphilic disorders compared with the general population. In particular, the researchers found higher levels of serotonin and norepinephrine—at levels correlated with obsessive thoughts and behaviors—in people with paraphilic disorders. Additionally, they found reduced levels of DOPAC, which is associated with affective disorders. These findings may indicate a biological mechanism in these disorders and support further research in interventions that target specific neurotransmitters.

Below are several statistics on frotteuristic disorder: 

• Frotteurism may be underreported, but some studies estimate that between 7.9% to 35% of people may experience frotteuristic sexual interests at some point. These interests may differ from frotteuristic disorder, which causes distress in oneself or others. 
• Perpetrators of frotteuristic behaviors often repeatedly engage in non-consensual touching, with an average of 901 survivors reported per offender.
• A study of young female train passengers in Tokyo found that more than 66% had experienced acts of frotteurism.   
• One study using a combination of talk therapy and an SSRI medication (fluoxetine) for 51 people with paraphilic disorders achieved nearly 95% remission of symptoms. Talk to your doctor before considering a medication.