Since the launch of psychological consultation, many types of sexual psychological disorders have come for consultation, including several rare cases, which may be due to individual symptoms or disease variations. The clinical manifestations are not very typical, but It meets the category of "the way of seeking sexual objects and satisfying sexual desire is different from ordinary people, and there is no outstanding personality disorder". This article discusses the classification and diagnosis of psychosexual disorders according to the classification principles of ICD-10 and CCMD-3, and also refers to the articles by Yang Huayu and Chen Yongping.

Case

Case 1: Male, 20 years old, unmarried, telephone consultation. He said that he fell in love with his student's 61-year-old grandmother while tutoring and had sex with her for a year. More than a year ago, the patient fell in love with the grandmother who was a student and had lived alone for many years. She played with the old man on the bed many times, and made intimate movements such as hugging and kissing with sexual excitement. Then he asked to have sex with the old man and gained the old man's consent by giving free lessons. Although the frequency and intensity of sexual intercourse are less and less due to the age of the other party, the attachment to the old person becomes stronger day by day. If the old person refuses or avoids the old person, he will be sad and sad, and he will take the initiative to look for the old person after not seeing him for a few days. There are girls of the same age around him, but he is not interested. He repeatedly emphasizes his "exclusiveness" for the old man. He learns from books that he is mentally abnormal but is very confused.

Example 2 is a male, 23 years old, bachelor's degree graduate, unmarried, telephone consultation. He said that his father died of illness when he was 11 years old. After that, he lived with his mother in the same bed for a long time. One summer when he was 15 years old, he saw his mother's vagina vaguely exposed while she was taking a nap. Out of curiosity, she lightly lifted her underwear and bra. After being discovered, she was not blamed. Later, similar behavior occurred twice more, accompanied by penile erection. With the help of the mother, he entered the vagina and ejaculated. After that, having sex with the mother became a common thing, and even happened every day during this period. He confessed that he had never considered the other person as his mother during sexual intercourse, and his mother also regarded him as her imaginary boyfriend. In the past 8 years, the patient had caused his mother to have two abortions. Normally, the relationship between mother and child is normal, and life is no different from other people's lives. Now the patient has reached marriageable age, but is not interested in other women. He is afraid that he will neglect his mother after marrying, and he will not be able to fulfill his promise of "having sex once a week" to his mother. He knows that this is "incest", but he sincerely hopes that his future wife will approve it. This matter, otherwise I would rather give up the marriage.

Example 3, male, 32 years old, educated, married, consulted by phone. She said that she needed help with talking on the phone during sexual intercourse for more than half a year. He said that his wife went away to study for a year. During this period, the couple often talked about sexual situations on the phone to satisfy their sexual desires. After the wife returned home, even if the couple lived in the same bed, they would each hold a phone in their hands and tell obscene jokes or imitate them during sex out of fun. I find the sex sounds in movies and TV shows very exciting. In the past six months, the patient felt that if he did not use phone dirty talk during sexual intercourse, he would suffer from low sexual desire, delayed ejaculation, or lack of pleasure. His wife also felt that phone dirty talk could enhance sexual desire and achieve orgasm. Although holding a phone makes movement very inconvenient, But in order to satisfy the sexual life, both parties have to adopt this method. The patient is very confused by such ritual actions that interfere with sexual intercourse and cause inner troubles, and have strong treatment requirements.

Example 4, male, 23 years old, unmarried, college education, consultation by phone and letter. He said that when he was 4 years old, his parents divorced and he boarded a kindergarten. Once, he was asked by a female teacher to lick his toes. The patient cried out of fear, and the female teacher spanked his buttocks with a small wooden stick and told him that if he licked his toes, he would get candy. After a few times, I felt close to the female teacher’s feet, and I always wanted to do something good to make her happy. When he was 18 years old, he had a crush on a 34-year-old woman. He couldn't help but lick and touch her fair feet, and then he had sexual impulses and had sex with her. Gradually, the patient is no longer satisfied with licking and touching the feet, and has developed to asking the other party to step on his body, and it is better to be heavier. After the other party left for some reason, he found two more sexual partners. Without exception, they were women who were much older than him and could even be mothers. They could trample on his body and have his feet licked. Later, because the other party abused her at the same time, such as making her crawl like a dog or being ridden, she left voluntarily. He has reached marriageable age but is not interested in the opposite sex at all. After being persuaded by his family, he reluctantly dated a woman of the same age. He only paid attention to her feet and had an uncontrollable urge to lick and touch her. He had to leave because he was afraid of scaring her. I learned from the book that I was abnormal, and because I couldn't find a matching sexual partner, I had to seek help from a doctor. However, when I asked for aversion treatment, I suggested that it be done by an older female doctor that I liked. It would be best to establish a romantic relationship, such as If you are treated by a male doctor, you will definitely give up.

Example 5, male, 33 years old, educated, married, consulted by phone. He said that he has liked to see other people naked since he was a child. He has been married to his wife for 4 years and has a harmonious sex life. However, he is still interested in film and television scenes and online pornographic pictures. Sometimes he feels that his wife's body is sexy and it would be a pity to only expose it in front of him. Once when he went out, the wind blew up his wife's skirt, exposing her underwear. The patient lifted up her skirt and was scolded by his wife. Instead of feeling embarrassed, he felt irritated. Later, when he went out with his wife, he intentionally or unintentionally exposed his wife's breasts and buttocks and unzipped his own pants. I feel that my sexual desire is strong, and I am even more excited when strangers are present. I have the behavior of briefly exposing my genitals when there are few people around. After being stopped by his wife, he came up with the idea "Why not show the sex photos with his wife to others", and then he openly took selfies of his sex photos with his wife and took them to be developed and exposed, with the purpose of letting the staff see them. In the past year, the patient has increasingly felt that he has a strong sexual desire to flirt with his wife outdoors, the number of thoughts and behaviors of exposing his genitals has also increased, and his behavior tends to be bold. Once, I even made sexual intercourse with my wife and ejaculated while a stranger was watching me. I felt more comfortable than ever before. But he never dared to expose his vagina to strangers alone. Every time he had to have his wife present to stimulate his sexual desire, he finally couldn't control his thoughts and behaviors of exposing his vagina. Patients have full ability to identify this abnormal behavior of seeking sexual desire, and feel guilty afterwards, but often have difficulty controlling themselves.

Discussion

Example 1 is a male teenager falling in love with an older woman. Although the other party is of the opposite sex, according to Yang Huayu's [4] principle of normal sexual partners, she is already past the childbearing age and should be considered too old. Moreover, the patient is People of the same age are not interested in people of the opposite sex, but only look for older people, with whom they have a deep emotional attachment. The author believes that this can be diagnosed as "gerontophilia".

Example 2 had sexual intercourse with his mother and had difficulty establishing a normal love and marriage relationship with members of the opposite sex of the same age, which reflects the patient's error in selecting sexual objects. The prohibition of sexual intercourse between blood relatives exists as an objective requirement of the ecological and social environment and has been observed by people for a long time. The patient has sufficient ability to identify his antisocial psychology and behavior, but it is difficult to control it. The author believes that this case can be diagnosed as "sexual orientation disorder".

Example 3 uses obscene language on the phone to enhance sexual excitement. Generally speaking, he does not want the other party to know his identity. Example 3 is a couple, and it is indeed relatively rare to rely on obscene language on the phone. The obsession with phone obscenity has already It has become the most important source of sexual stimulation, or a necessary condition for achieving a satisfactory sexual response. Therefore, the author believes that it can be classified into the category of "other sexual preference disorders" and diagnosed as "Telephone Tourette Syndrome".

Example 4 has foot fetish, Oedipus complex and masochism at the same time, and neither one is dominant. According to CCMD-3 and ICD-10, the most common polyphasic sexual preference disorder is a combination of fetishism, transvestism and masochism. Although Case 3 does not have transvestism, there is more than one sexual preference at the same time. The disorder should be classified as "polyphasic sexual preference disorder".

The key difference between Case 5 and exhibitionism syndrome is that the patient is always accompanied by his wife, who stimulates the patient’s sexual desire, and then the exposure thoughts and behaviors occur. The exposure partner can be his wife or someone else. A stranger has the desire to have sex with his wife, the "exposure partner", but not with anyone else, but still has a tendency to expose his genitals to strangers or people in public places, and has a recurring and persistent tendency. I have also discovered this urge. It is difficult to control and rejected by the self, so the author believes that it can be diagnosed as "exhibitionism syndrome".