Skoptic syndrome: the treatment of an obsessional gender dysphoria with lithium carbonate and psychotherapy

Article Abstract:

Skoptic syndrome is a term applied to a particular obsessive body-image disorder, usually affecting males, in which the primary and secondary sex characteristics are perceived as annoying or even disgusting. The extreme form of this obsession can lead to desires for self-mutilation or castration. Two cases are reported where a psychotropic drug used in the treatment of other obsessive-compulsive disorders, lithium carbonate, was given to moderate the intensity of the drive for castration. The first case involved a 23-year-old academic who had occasionally dressed as a girl since childhood and wished he had a vagina. Although he eventually married, he was divorced after two years. Sexually, he felt that his male hormones led him to waste time masturbating and were the cause of sexual impulses that made him view women as 'sexual beings,' an idea he found repugnant. He attended group psychotherapy, and was treated with imipramine, which seemed to temporarily diminish the intensity of his desire to become neutered. Eventually, he was put on lithium, and his compulsion decreased to the extent that he became less depressed. A second case, also a 23-year-old male with an intense desire to eliminate his genitals, was similarly treated. The patient, who was uncomfortable with his genitals and was unable to find pleasure even in masturbation, was treated with lithium while participating in psychotherapy. Although both patients have considered sex-reassignment, they differ from transsexuals in that their desire is not to become women, but rather to be free of their own masculinity. The authors suggest that viewing skoptic syndrome as an obsessive-compulsive disorder is useful, and treatment with lithium can contribute to the success of the long-term goals of psychotherapy by reducing potentially dangerous drives toward self-mutilation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Body image, Masculinity, Reproductive organs, Male, Male genitalia, Castration

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Use of lithium carbonate in the treatment of autoerotic asphyxia

Article Abstract:

Autoerotic asphyxia describes a condition of self-induced strangulation during masturbation. Previous studies have been primarily concerned with cases of accidental death arising from this ritualized sexual behavior. The causes and treatment of the compulsive behavior have not been thoroughly examined. A 26-year-old single man was admitted to a psychiatric clinic complaining of suicidal feelings and concern over his compulsive and admittedly dangerous form of masturbation. His behavior included such acts as putting plastic bags over his head and binding his face and body, presumably to exacerbate the intensity of orgasm. As similar compulsive sexual disorders have been successfully treated with a mood-controlling substance, lithium carbonate, the patient in this case was put on a regimen of lithium therapy. The compulsive behavior disappeared, and the effects of the treatment have been long-lasting, with minimal side effects. Lithium carbonate is useful in eliminating life-threatening compulsive behavior, allowing the patient to become more receptive to long-term psychotherapy.

Health aspects, Case studies, Tranquilizing drugs, Tranquilizing agents, Lithium, Lithium (Metal), Psychosexual disorders, Masturbation, Autoerotic death, Autoerotic asphyxia

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Supervised treatment of an obsessional patient by a psychiatric resident utilizing psychotherapy and pharmacotherapy

Article Abstract:

Obsessional disorder, characterized by an excessive preoccupation with particular thoughts or ruminations, is a psychiatric condition that is difficult to treat. The therapeutic approach can often be enhanced by the collaboration of more than one strategy, such as a combination of psychotherapy and psychopharmacology (drug therapy). The case history of a obsessional patient, a man in his late 30's, is presented, along with comments from the psychiatric resident in charge of his treatment. The case and the treatment strategy employed by the resident are discussed. Resistance to alternative treatment strategies may develop from the preference of a therapist for a particular approach. The thorough examination of an individual case illustrates the significant influence that innovations in neurobiology may have on therapeutic approaches. The importance of considering multiple factors in formulating treatment strategy is also emphasized. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Usage, Psychiatry, Case method, Case teaching method

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