Fetishism due to methamphetamine (glass) abuse: a case report.

BACKGROUND: Fetishism is a type of paraphilia. The focus of sexual arousal in fetishism is oriented towards inanimate objects. Sexual arousal and craving are some of the reasons the youth resort to crystal (glass). Drug abuse may cause disorders in sexual function. CASE REPORT: The patient was a 41 years old man. He married in age 22 years and experienced frequent intercourses with his wife from which he gained pleasure and it was his preferable method. Her wife left ten years ago. The patient started crystal administration through insufflations since seven months ago. Simultaneous with crystal abuse, wearing women's underwear was the only medium through which the patient reached sexual orgasm. DISCUSSION: A lot of psychological symptoms related to new substances (for example glass) are new to psychiatrists treating dependency in medical clinics. Fetishism may coexist with addiction as comorbidity. Another point to be mentioned is that, symptoms of fetishism increased and decreased with more and less glass administration, indicating that symptoms of paraphilia emerge as a result of glass use. In addition, prior to glass use, the patient maintained normal sexual tendencies, had experienced sexual intercourse and did not suffer from any type of paraphilia.

Introduction

Fetishism is a type of paraphilia, frequently observed in males. The initiation of this disorder is rooted in adolescence. The focus of sexual arousal in fetishism is oriented towards inanimate objects such as shoes, gloves, tights, and women’s underwear, all being closely associated with the body. The patient masturbates while wearing women’s underwear, as a preferable method of sexual arousal and has no desire to have intercourse with women. The patient reaches orgasm by these objects, which is his preferable method. The sexual activity can be either directly focused on the fetish, such as masturbation by shoes, or otherwise be used in sexual intercourse such as asking the partner to wear a specific object.1,2

Drug abuse may impact in sexual function.3 Among the mentioned substances is crystal (glass) which its use has been increased recently.4 This substance found its way to the West in the past years and to Iran recently. Facility of purchase and decreasing price are the reasons for the rise in crystal abuse.5 The substance bears the scientific name of ‘methamphetamine’; it also goes by the names of crystal, meth, glass, and ice, the main reason for which is that when placed in the vicinity of heat, it evaporates similar to ice.6 Crystal (glass) is found in the form of bitter and odorless white powder, easily soluble in alcoholic as well as non-alcoholic drinks.1,2

Its routes of administration are insufflations, intake, injection, and/or smoking which immediately causes a state called ‘rush’ or ‘flash’.6 Sexual arousal and craving are some of the reasons the youth resort to crystal (glass), continuation of which; however, causes destructive effects on sexual ability and function with a possibility of psychological diseases.3,7-10 Short-term and, recently, long-term psychoses as well as resistance caused by this substance have been reported. The major symptoms of the mentioned psychoses are delusions (jealousy, paranoia) and visual and auditory hallucinations.4

According to clinical observations, the authors believed the profile of crystal’s (glass) psychological symptoms are far more extensive. For instance, to the author’s knowledge, no case was reported concerning paraphilia incidence in a direct relationship with drug abuse. The observed patient, however, suffered from fetishism.

Case Report

The patient was a 41 year-old, unemployed, divorced male, with high school diploma, residing in Kerman (one of the central Iranian cities). According to his biography concerning sexual background, he experienced his first ejaculation in 14 years old by masturbation and frequently masturbated through the age of 22 years. He married in 22 and experienced frequent intercourses with his wife from which he gained pleasure and it was his preferable method. He commenced drug abuse from the age of 20 years and was involved in different types of substances. Her wife left ten years ago. The patient has started crystal (glass) administration through insufflations since seven months ago and has been taking crystal only since. Simultaneous with crystal abuse, wearing women’s underwear has been the only medium through which the patient reached sexual orgasm. The desire rose with increasing crystal administration. He has masturbated since, wearing women’s underwear, as a preferable method of sexual arousal. Subsequent to crystal (glass) dependency, he has had no desire to have intercourse with women. No instances of paraphilia were seen in his previous records, he is not suffering from any specific psychiatric disease nor is he taking specific medications.

Discussion

A lot of psychological symptoms related to new substances are new to psychiatrists who treat drug dependency in medical clinics. When crystal, as a modern industrial substance by the scientific name of methamphetamine, finds its way into the central neural system (CNS), it causes the sudden release of dopamine from the brain which stimulates brain cells and increases or creates excitements.8,11,12 Sexual arousal is one the reasons which lures youngsters into using these substances.11 Considering the fact that crystal operates as a brain stimulant, this question arises as to whether its use causes emergence of the hidden desires of a disorder, or otherwise, is per se an agent of different disorders such as fetishism. As for the first case, if crystal revealed the hidden desires, the authors would be able to trace back the desires of the patient in his adolescence. Paraphilia, at times, emerge to provide a novel experience, usually in adolescence, hence are not recurrent.

A number of cases of paraphilia are seen accompanied by other psychiatric disorder such as schizophrenia and personality disorders.13 Fetishism may coexist with dependency as comorbidity.14,15 Another point to be mentioned is that, symptoms of fetishism increased and decreased with more and less crystal administration, indicating that symptoms of paraphilia emerge as a result of crystal use.

Additionally, prior to crystal use, the patient maintained normal sexual tendencies, had experienced sexual intercourse and had not suffered any type of paraphilia. According to clinical observations, the profile of crystal’s psychological symptoms is far more extensive. A lot of psychological symptoms related to new substances (for example glass) are new to psychiatrists treating dependency in medical clinics.