Compulsive Masturbation treated with Escitalopram

Abstract

Mastrubation is a normal part of psychosexual development. The habit becomes troublesome when it takes the turn to compulsive masturbation. The article provides a case report of compulsive masturbation that was successfully treated with Escitalopram along with behaviour modification, supportive psychotherapy and family therapy.

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INTERNATIONAL JOURNAL OF PHARMACOLOGY AND THERAPEUTICS
ISSN 2249 – 6467
64 Volume 3 Issue 3 2013 www.earthjournals.org
CASE REORT
COMPULSIVE MASTURBATION TREATED WITH
ESCITALOPRAM
Avinash De Sousa
CONSULTANT PSYCHIATRIST,DESOUSA FOUNDATION,MUMBAI.
ABSTRACT
Mastrubation is a normal part of psychosexual development. The habit becomes troublesome
when it takes the turn to compulsive masturbation. The article provides a case report of
compulsive masturbation that was successfully treated with Escitalopram along with behaviour
modification, supportive psychotherapy and family therapy.
Keywords – Masturbation, Compulsive
INTRODUCTION
Masturbation can be defined as a
person’s achieving sexual pleasure which
usually results in orgasm by himself or
herself and is also termed as auto-eroticism.
It is a normal activity that is common in all
stages of life from infancy to old age, a
viewpoint that has both proponents and
critics. It is very often a normal precursor of
object related sexual behaviour.
Moral taboos against
masturbation have generated myths that it
causes mental illness or decreases sexual
potency [1]. However no scientific data
supports such claims. Compulsive
masturbation is a symptom of emotional
disturbance not because it is sexual but
because it is compulsive.
Compulsive masturbation has
been described as a non paraphilic sexual
disorder [2]. The D.S.M.-IV (1994)
classification however has no mention of
these disorders [3]. The I.C.D. –10
classification (W.H.O., 1992) have a
diagnostic category termed ‘excessive
sexual desire’ and compulsive masturbation
may fall into this category [4].
CASE REPORT
A 35 year old male from an urban
Indian family in Mumbai presented with a
history of excessive uncontrollable
frequency of masturbation since the past 6
months and wanted desperately to quit the
habit. He lived in a middle class family with
his parents. His parents were working while
he was an IT professional. He was over-
protected and over-pampered from an early
age. He had started masturbating at the age
of 14 years and had significant guilt
associated with the habit since it started.
Presently, this habit had affected his work
and he used to remained preoccupied with
sexual thoughts most of the day. He also had
become irritable, used to back answer his
parents and was having physical weakness
and depressed mood which he attributed to
his masturbation habit. His distress was
great as he was thinking of getting himself
castrated, vasectomized and if needed even
undergoing a penile amputation to help him
get rid of the habit.
Initially at the age of 14, his
frequency of masturbation was once or twice

INTERNATIONAL JOURNAL OF PHARMACOLOGY AND THERAPEUTICS
ISSN 2249 – 6467
65 Volume 3 Issue 3 2013 www.earthjournals.org
a week. His parents used to return late from
office and he had the whole afternoon alone
to himself at home. He started watching
pornographic movies a8 months ago to pass
his time as and the frequency increased from
once or twice a week to three to four times a
week and then daily as he started watching
pornographic movies daily. He then started
masturbating even in his room as he was
constantly fantasizing about sexual thoughts
even when working. Thus he started
masturbating two to three times a day and
used to spend long hours in the bathroom.
Since the past 5 months the frequency has
increased to 10-12 times per day and there
were times when he masturbated even in a
public bathroom or in the office bathroom.
There was however no exhibitionism at any
point of time shown by the patient. He used
to spend 2-3 hours a day in the act. His
office work suffered due to the same and he
had been reprimanded for the time he spent
in the bathroom of the office.
On assessment a detailed history
was taken and a mental status examination
was conducted. There were personality
problems that surfaced in the course of the
interview. He had an inferiority complex
and had always felt inferior to his peers at
school and in his locality. He expressed a
desire to be ahead of them. He was from a
conservative background and hence there
was not much knowledge about sex
conveyed to him by his parents. He had a
feeling that knowing about sex would make
him superior. This made him watch
pornographic movies that increased the
frequency of his masturbation. Masturbation
was a means of relief to the anxiety he
perceived for being inferior to his peers.
History revealed that there was marked
anxiety prior to the act that was relieved
when the act was completed. There was no
history of major medical or surgical illness
as well no positive family history of any
mental illness. All routine pathology
investigations were carried out that yielded
normal results. An electroencephalogram
revealed a normal tracing. This was done to
rule out organicity as well as epilepsy that
may have presented with this form of sexual
behaviour as has been reported [5].
The patient was diagnosed as
having an Impulse Control Disorder Not
Otherwise Specified as per the D.S.M.-IV
Classification (A.P.A., 1994) and the
diagnosis was conveyed to the parents. He
was started on Fluoxetine 20mg/day that
was increased to 40mg/day in a span of 3
weeks and then to 60mg//day in another 2
weeks. With Fluoxetine at 40mg/day he was
masturbating much less around twice a day,
but was starting to develop symptoms of
akathisia that is common with the drug and
hence we were reluctant to increase the dose
of the drug. He was then shifted to
Escitalopram 5mg per day which was
increased to 20mg per day and the patient
was also simultaneously on behaviour
modification therapy like positive
reinforcement for desirable patterns of
behaviour and individual sessions of
supportive psychotherapy to build his self
esteem and reducing the inferiority complex
he possessed. At the end of 6 weeks his
masturbatory frequency had decreased from
8-10 times a day to 3-4 times a week. His
mother had stopped her work to make
herself available in the afternoons which
was the time when the habit had started thus
providing supervision to her child. Family
therapy was instituted at this point of time
and family dynamics as well as family
interaction was focused upon. He has good
work performance presently and his
irritability and depressive features are
absent.
DISCUSSION
Compulsive sexual behaviour has
been classified socially deviant and non
socially deviant hypersexual behaviours [6].
Compulsive Masturbation falls into the latter
category. There is scarcity of literature on

INTERNATIONAL JOURNAL OF PHARMACOLOGY AND THERAPEUTICS
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the subject even in extensive reviews on
compulsive sexual behaviour [7-9].
The disorder itself is rare. Though
males come more often for treatment, the
gender distribution of this unwanted
behavior is unknown. Cases studied
report that 75% of the men had major
depression as a co-morbid diagnosis. A
prevalence of histrionic and passive
aggressive personality disorders was also
found to be high in these subjects [2,8].
Critical to good treatment
response is the obtaining of information with
meticulous care of the behavior to be
treated. Embarrassment, mistrust and
ambivalence must not interfere with this
part. An assessment of the patient’s sexual
experiences and attitudes towards sexuality
must be explored prior to starting treatment.
The patient’s motivation for
treatment must be established. Treating the
pre-morbid condition is also a pre-requisite
to help the patient in overcoming his sexual
problem. No trials of drugs in the form of
therapy for this disorder are available. The
selective serotonin reuptake inhibitors
(SSRIs) have been found useful in the
management of these patients [10]. Of these
Fluoxetine has been reported in a case report
[11]. Naltrexone has been used in most cases
published with a greater degree of success
[12-13]. There is a report of the combined
use of SSRIs and Naltrexone in the
successful management of compulsive
masturbation [14].
Psychotherapy as a form of
intervention is a must in every case and must
be administered after taking into account the
sexual complaint, the co-morbid conditions,
the cultural background and the life
experiences of the individual. Behavior
therapy in the form of cognitive behavior
therapy, covert sensitization and systematic
desensitization has been reported useful
[15].
This case responded to a
combination of Escitalopram and the
combined use of supportive psychotherapy
and behaviour modification techniques.
Family therapy was instituted at a later
stage. Thus in the treatment of compulsive
masturbation we feel that it is necessary in
order to obtain a recovery, that a variety of
interventions be used in a proper manner
looking at the patient holistically and aiming
to change not only biology but also
environmental factors as well as family
dynamics. Every case must be tackled on an
individual basis and choice of interventions
decided accordingly.
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