(647) Paraphilic Disorders and Other Psychiatric Comorbidities: A Case Report

Introduction According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR; APA, 2022), paraphilia is defined as any intense and persistent sexual interest other than sexual interest in genital stimulation or fondling with phenotypically normal, physically mature, consenting human partners. Paraphilia does not necessarily warrant clinical intervention or treatment. Paraphilic Disorders (PDs) are paraphilias that cause negative impacts to the individual and/or involve harm or risk of harm to others. These are complex and heterogeneous pathologies with multifactorial etiology, involving features of addictive, impulsive, and obsessive-compulsive disorders, or a pattern of hypersexuality. Objective Examine the occurrence of paraphilic disorders in conjunction with additional psychiatric comorbidities. Methods Case report followed by a brief review of the literature. Results A., 68-year-old retired male, married, with history of childhood sexual abuse, suicide attempts during adulthood and a traumatic brain injury (TBI), currently contributing to an organic brain syndrome (OBS). Neuroimaging reveals an area of cortico-subcortical encephalomalacia in the left frontal region, suggestive of a sequelae of traumatic origin. Neuropsychological evaluation further indicates an executive/frontal predominant cognitive deficit. In 2024, the patient self-referred to a Clinical Sexology consultation, reporting a significant lack of impulse control and frequent intrusive sexual thoughts. Further exploration revealed multiple adult-life behaviours consistent with PDs which reportedly began in early adulthood. Initially he engaged predominantly in voyeuristic behaviours which evolved into frotteuristic acts, involving both female colleagues and unknown women. More recently, he has reported fantasies involving fat fetishism, gerontophilia, and mastophilia (currently restricted to the realm of imagination), which have been a source of personal distress and have negatively impacted his marital relationship. He additionally reports current erectile dysfunction and anejaculation while during the onset of his sexual activity at age 17, he experienced symptoms suggestive of premature ejaculation. In addition to ongoing regular psychotherapy sessions, pharmacological treatment was initiated (sertraline 200 mg/day, cyproterone acetate 50 mg twice a day, valproate 500 mg/day and clonazepam 2 mg/day). Conclusions Intervention with individuals who have PDs is difficult, as they rarely seek help, either due to the stigma associated with these pathologies, denial of the condition or a lack of motivation to change. Moreover, maintaining voluntary follow-up is uncommon. Given the multifactorial etiology of PDs, with genetic, hormonal, and brain-related influences that are still largely unknown, the lack of consensus regarding the possibility of changing paraphilic sexual interests represents an additional barrier to treatment. Psychotherapeutic intervention using cognitive-behavioral techniques is considered the first-line approach for these patients to help them develop the ability to control their impulses or replace the focus of sexual arousal with non-paraphilic fantasies. Additionally, antidepressants such as selective serotonin reuptake inhibitors may be used in mild cases or in juvenile paraphilias, not only due to their primary mechanism of action but also because of their side effect profile. Hormonal therapy may also be considered when deemed appropriate, given the severity of the disorder or the risk posed to the individual or others, requiring close monitoring to control potential side effects. Disclosure No