”Recurrent” touching or rubbing against a nonconsenting individual (i.e., multiple vic- tims, each on a separate occasion) may, as a general rule, be interpreted as three or more vic- tims on separate occasions. Fewer victims can be interpreted as satisfying this criterion if there were multiple occasions of touching or rubbing against the same unwilling individ- ual, or corroborating evidence of a strong or preferential interest in touching or rubbing against nonconsenting individuals. Note that multiple victims are a sufficient but not a nec- essary condition for diagnosis; criteria may also be met if the individual acknowledges in- tense frotteuristic sexual interest with clinically significant distress and/ or impairment.
The Criterion A time frame, indicating that signs or symptoms of frotteurism must persist for at least 6 months, should also be interpreted as a general guideline, not a strict threshold, to ensure that the sexual interest in touching or rubbing against a nonconsenting individual is not transient. Hence, the duration part of Criterion A may also be met if there is clear evidence of recurrent behaviors or distress over a shorter but nontransient time period.
Frotteuristic acts, including the uninvited sexual touching of or rubbing against another individual, may occur in up to 30% of adult males in the general population. Approximately 10%—14% of adult males seen in outpatient settings for paraphilic disorders and hypersex- uality have a presentation that meets diagnostic criteria for frotteuristic disorder. Hence, whereas the population prevalence of frotteuristic disorder is unknown, it is not likely that it exceeds the rate found in selected clinical settings.
Adult males with frotteuristic disorder often report first becoming aware of their sexual in- adulthood. However, children and adolescents may also touch or rub against unwilling oth- ers in the absence of a diagnosis of frotteuristic disorder. Although there is no minimum age for the diagnosis, frotteuristic disorder can be difficult to differentiate from conduct-disor- dered behavior without sexual motivation in individuals at younger ages. The persistence of frotteurism over time is unclear. Frotteuristic disorder, however, by definition requires one or more contributing factors that may change over time with or without treatment: subjec- tive distress (e.g., guilt, shame, intense sexual frustration, loneliness); psychiatric morbidity; hypersexuality and sexual impulsivity; psychosocial impairment; and/ or the propensity to act out sexually by touching or rubbing against unconsenting persons. Therefore, the course of frotteuristic disorder is likely to vary with age. As with other sexual preferences, advanc- ing age may be associated with decreasing frotteuristic sexual preferences and behavior.
Temperamental. Nonsexual antisocial behavior and sexual preoccupation/hypersexuality might be nonspecific risk factors, although the causal relationship to frotteurism is uncertain and the specificity unclear. However, frotteurism is a necessary precondition for frotteuristic disorder, so risk factors for frotteurism should also increase the rate of frotteuristic disorder.
There appear to be substantially fewer females with frotteuristic sexual preferences than males.
Conduct disorder and antisocial personality disorder. Conduct disorder in adolescents and antisocial behaviors, and the specific sexual interest in touching or rubbing against a nonconsenting individual should be lacking.
Substance use disorders. Substance use disorders, particularly those involving stimu- lants such as cocaine and amphetamines, might involve single frotteuristic episodes by in— toxicated individuals but should not involve the typical sustained sexual interest in touching or rubbing against unsuspecting persons. Hence, recurrent frotteuristic sexual fantasies, urges, or behaviors that occur also when the individual is not intoxicated sug- gest that frotteuristic disorder might be present.