Clomipramine and a case of exhibitionism.
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An obsessive-compulsive patient was treated with modified analytic therapy to enable him to complete his first college year. As an assistant professor, he returned 19 years later complaining of retarded ejaculation. Traditional psychotherapy (52 sessions) failed to resolve the problem. After eight sessions of solo sex therapy, the ejaculatory dysfunction was mastered.
An apparently successful treatment of a male with a long history of dyspareunia is discussed. The case is unique not only because the subject was male but also in that the etiology was functional. The case demonstrates the multicausal nature of dyspareunia as well as the need for an approach utilizing both a psychodynamic and behavioral methodology.
We report the successful use of lithium carbonate to promptly extinguish life-threatening behavior in a case of autoerotic asphyxia occurring in a 26-year-old male. In addition to his paraphilia, the patient met the DSM-III-R criteria for dysthymia, and had an avoidant personality disorder secondary to verbal, physical and sexual abuse inflicted during childhood and adolescence.
The phenomenological and psychodynamic differences between obsessive preadolescents and obsessive adults are pointed out. Case material shows how an effective therapeutic alliance on psychoanalytic lines can be established quite early with preadolescents. The therapy can be shortened mainly by opening up sexual subjects connected with the onset of puberty, and by working through the guilt engendered by the ambivalent relations this age group has with its parents.
The author contends that a primary cause of sexual problems is failure to teach children about sex before they reach adolescence. Physical and mental growth are nurtured and supported throughout infancy and childhood, while sexual development is stifled or distorted. As a result children reach adolescence with their natural eroticism maimed. The author pleads for a basic change in the attitudes of adults, so that parents will begin to teach their children about sexuality. By adolescence children should be prepared to understand and accept their capacity for sexual expression and be fully aware of when and how it might or might not be appropriate.
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We have presented an analysis of findings from a ten-year observational study of infants in their second year of life, with a focus on boys. Tracing the sexual development and its relation to development in the object relations and cognitive spheres, we found similarities between boys and girls and sharp differences as well. These latter become evident shortly after the discovery of the anatomical difference. We believe that the differences in reaction to this momentous event account for the greater trouble the girl has in the rapprochement crisis. Our direct observational studies of infants served to clarify many of the preoedipal dynamic currents which in turn affect the form of the oedipal constellation. We have established some sets of conditions which are likely to lead to a negative or positive form or oedipal attachment, and have described the typical and some of the atypical patterns of preoedipal development in both sexes.