Official websites use. Share sensitive information only on official, secure websites. To the Editor: Paraphilias are a complex and heterogeneous group of disorders in which sexual deviance is regarded as a medical phenomenon. Case report. Mr A, a year-old white man, sought help for depression and suicidal ideations. On a detailed interview, the patient revealed his involvement in sexual acts that make him guilty. He reported that he participates in sadomasochistic activity with his partner, that has been involved in sadistic and masochistic activities for the last 2 years, and that he was not involved in those acts prior to that.
Mr A presented with scars on his arms and chest that were very deep and in different stages of healing. At the time of admission, he reported remorse and depression related to such acts. He was involved in recurrent, intense sexually arousing fantasies and behaviors. There was physical and psychological suffering of self and partner, and these urges and behaviors had been present for the last 2 years.
The fantasies and urges were causing impairment in his social, occupational, and other areas of function. On physical examination, nothing significant was noted except for the aforementioned deep-seated scars in different stages of healing over the chest and arms. No scars were noted on the legs or back. His chest was clear to auscultation bilaterally, and no rhonchi, rales, or wheezing was appreciated. S1 and S2 were heard, and no murmurs were appreciated.
On chest x-ray, no infiltrates were observed. A head computed tomography scan showed no acute hemorrhages or masses. His urine drug screen was negative; blood alcohol level was less than 0. Most of the laboratory results were within normal range. His complete blood cell count and liver function tests revealed no abnormalities, as did urinalysis.
Blood cultures and urine cultures were negative. The patient reported that he felt better in the next couple of weeks. He reported fewer urges, and the behavior abated; at follow-up after 4 weeks and 8 weeks, Mr A reported abatement of paraphilic tendencies and amelioration of his depressive symptoms. He was also offered psychotherapy, which he declined because of financial problems.
