Role of Fluoxetine in compulsive masturbation

INTRODUCTION: Compulsive sexual behavior disorder (CSBD), defined as a persistent pattern of failure to control intense sexual urges and impulses; resulting in repetitive sexual behaviours over extended periods, resulting in marked socio-occupational impairment, previously found a mention in DSM-IV under Sexual addictions but was omitted in DSM-V. ICD-11 proposes to include it under impulse control disorders. There is dearth of literature regarding prevalence & treatment (SSRIs, naltrexone, hormonal therapy-limited to case reports & series) of CSBD. We present a case of compulsive masturbation in child with Intellectual Developmental Disorder (IDD) treated with Fluoxetine in combination with behaviour therapy. CASE DETAILS: A 9yr 10 months old male child, a known case of moderate IDD was brought with complains of excessive touching and rubbing of genitalia with hands and on bed in both private and public settings. On stopping this behavior, would retort with agitation and violence. He was in prepubertal stage on Sexual Maturity rating (SMR) examination. Child was admitted and started on Fluoxetine 20mg, once a day, optimized to 40mg after 15 days combined with behaviour therapy. Improvement was observed in form of significant reduction in frequency of touching and rubbing of genitalia and in irritability over a period of 10 weeks. CONCLUSION: The case highlights the possible role of serotonin in CSBD and thus the role of SSRIs in its management. There is need for further research about various neurotransmitter systems involved in CSBD and the therapeutic role of appropriate pharmacological agent.