FATİH HİLMİ ÇETİN, Şahnur ŞENER, ELVAN İŞERİ, HANDE AYRALER TANER

Zeka geriliğine bağlı uygunsuz cinsel arayışlar veya transvestik fetişizm: Bir olgu sunumu

Ergenlik döneminin özelliklerinden biri ergenin kendi cinselliğinin farkına varmasıdır. Ergen cinsel davranışları araş- tırırken bazen kendini cinselliğini deneyimlemesine izin veren garip durumlarda bulabilir. Parafililer gibi cinsel davranış sapmaları sıklıkla ergenlik döneminde başlar, transvestik fetişizm de parafililerden biridir. Bu yazıda polikliniğimize annesinin iç çamaşırlarını giyme nedeni getirilen 14 yaşındaki erkek ergen tartışılmıştır. Bu karşıt giyinme davranışı sıklıkla suçluluk ve utanma duygularının eşlik ettiği mastürbasyonla sonlanmakta ve yaklaşık bir yıldır sürmektedir. Ruhsal durum muayenesinde utangaç görünümde, ilgili sorulara savunucu, göz ilişkisinden kaçınmakta ve duygudurumu depresifti. Zeka testinde hafif düzeyde zeka geriliği saptandı. Hastaya depresyonuna yönelik sertralin 50 mg/gün başlandı ve hasta ve ailesiyle haftalık terapi planlandı. Terapinin amacı, hastayı cinsel duygularına uygun davranışın ne olduğu konusunda olabildiğince eğiterek bu davranışının sapma olduğunu anlamasını sağlamaktı. Bu yazıda zeka geriliği ve parafili ilişkisi, transvestik fetişizm ayırıcı tanısı ve psikodinamikleri tartışılmış- tır. Tranvestik fetişizmde erken tanı ve erken girişim başarılı bir tedavi için önemlidir. Ailesel ve ruhsal-cinsel etkenleri ele almanın yanı sıra gençlere cinsel eğitim verilmesinin önemi tartışılmıştır. Aynı zamanda farmakolojik tedavi gereksinmesi ve seçimi literatür ışığında tartışılmıştır. (Anadolu Psikiyatri Derg 2015; 16(6):454-457)

Inappropriate sexual behaviors associated with mental retardation or transvestic fetishism: a case study

One of the characteristics of puberty is awareness of ones own sexuality. While searching in sexual behaviors sometimes put them awkward situations, yet this is how they exercise their sexuality. Deviations in sexual behavior such as paraphilia often begin in adolescence, transvestic fetishism is one of them. In this case report, 14-year-old male patient with mild mental retardation was brought with presenting symptoms of wearing his mothers undergarments. This cross-dressing behavior has been going on for about a year and usually ending with masturbation associated with feelings of relief and quilt. He seemed embarrassed and was defensive to related questions, avoiding eye contacts and his mood was depressive in his mental examination. Mild mental retardation was determinated in his intelligence test. Sertraline 50 mg/day was started for his depression and weekly based therapy with him and his family was outlined. The purpose of the therapy, to make him understand his deviated behavior as well as educate him as what to do appropriately with his sexual feelings. In this paper, relationship between transvestic fetishism and mental retardation, differential diagnosis of transvestic fetishism and psychodynamics of transvestic fetishism are discussed. Last of all, diagnose of transvestic fetishism at an early age and early intervention are important for a successful treatment. The importance of sexual education to youngsters besides dealing familial and psychosexual factors contribute to treatment process are discussed. The need and choice of pharmacological treatment are also discussed in the light of the literature.

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