The treatment of fetishism and socially inappropriate sexual behavior in a young male with dull normal intelligence.

A young adult male with dull normal intelligence who had a fetish to female undergarments and was engaging in socially inappropriate sexual behavior was evaluated and treated in a multimodal treatment approach. Mild and diffuse encephalopathies were noted through EEG recordings. No definite epileptiform abnormalities or focal supratentorial lesions were seen and the pattern was consistent with patients with post-encephalitis. Treatment of this patient involved the use of anti-androgen and antianxiety pharmacotherapy along with counseling to provide basic sex education and specific education for socially accepted sexual behavior. Follow-up evaluation several yrs later indicated good treatment results. This case illustrates potential sources of sexually deviant behavior and treatment options. Promising new drug treatments are available which act as sexuoerotic tranquilizers as well as treatments for underlying or concomitant psychiatric disorders. In this case, however, family dynamics and poor sex education seemed to account for most of this patient's difficulties. Counseling and psychoeducation proved to be quite effective in resolving problematic behavior.