Compulsive Masturbation Treated with Selective Serotonin Reuptake Inhibitors

Abstract

Masturbation can be defined as a person's achieving sexual pleasure which usually results in orgasm by himself or herself (autoeroticism). Masturbation is a normal activity that is common in all stages of life from infancy to old age, but this viewpoint was not always accepted. Freud believed that neurasthenia was caused by excessive masturbation. In the early 1900s, masturbatory insanity was a common diagnosis in hospitals for the criminally insane in the United States. Masturbation is abnormal when it is the only type of sexual activity performed in adulthood, when its frequency indicates a compulsion or sexual dysfunction, or when it is consistently preferred to sex with a partner [1]. Compulsive masturbation does not have a distinct code in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition D.S.M.-V (2013) but can be classified as other specified sexual dysfunction [2]. The I.C.D.–10 classifications (W.H.O., 1992) ha ve a diagnostic category termed “excessive sexual desire” and compulsive masturbation may fall into this category [3]. Compulsive sexual behavior has been characterized as a behavioral addiction and an obsessive-compulsive spectrum disorder. It has been quantified using the statistic of total sexual outlet (number of orgasms/week). People with compulsive sexual behavior referred for treatment generally show a total sexual outlet of >7 [4]. Early psychological injury, from sexual abuse, physical abuse, exposure to violence, attachment trauma, or early sexualization, is at the root of sexually compulsive behavior [4,5]. Compulsive sexual behavior frequently has associated comorbidities of current mood disorders 33%, anxiety disorders 42% , substance disorders 29% and Personality disorders 46% [6,7]. Physical injury in compulsive masturbation is common. Patients with this disorder may masturbate 5-15 times a day and loneliness is felt keenly after an orgasm. This disorder can interfere in occupational, social, interpersonal, and intimacy functioning. Many different agents have been cited in case reports as helpful in treating compulsive sexual behavior: lithium, buspirone, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), atypical antipsychotics, naltrexone, and topiramate have all been reported to be helpful in treatment of sexual compulsivity [4].