By Ruwan Laknath Jayakody
Persistent social difficulties experienced by individuals with autism, which may hinder the establishment of sexual partnerships, may also contribute to the development of paraphilic disorders, Sri Lankan psychiatrists have found.
The findings were made in a local case study which found a unique and relatively unrecognised potential association between zoophilia and autism.
The case report titled “Zoophilia in an adolescent with high functioning autism from Sri Lanka” which was published recently in the Australasian Psychiatry Journal was authored by the University of Kelaniya Faculty of Medicine Department of Psychiatry Senior Lecturer Grade II and consultant child and adolescent psychiatrist Dr. Miyuru Chandradasa and Colombo North Teaching Hospital in Ragama Senior Registrar in Psychiatry Dr. Layani Champika.
According to the duo, this is the first case of zoophilia in autism reported from the Asia Pacific region and probably also the first in the world in the case of an individual with high functioning autism.
Paraphilias are defined in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) of the American Psychiatric Association as “any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically (refers to observable characteristics) normal, physiologically mature, consenting human partners.”
Zoophilia is considered as a paraphilic disorder (applied when a clinical presentation is found to cause significant distress or impairment but does not meet the criteria for a specific class) with intense recurrent sexual fantasies, urges, and behaviours involving animals, and according to A. Aggrawal's “A new classification of zoophilia”, this sexual interest could range from pretending to be an animal while having sex, to exclusive intercourse with animals, avoiding human partners.
As noted in B. Holoyda and W. Newman's “Zoophilia and the law: legal responses to a rare paraphilia”, its prevalence is unknown and it is considered to be rare as per limited worldwide reports of such. Reports of zoophilia in autism too are extremely limited and rarer; however, D.C. Kellaher noted in “Sexual behaviour and autism spectrum disorder: an update and discussion”, a reported case of canine zoophilia in a male adolescent.
Autism spectrum disorder is, as per the DSM-V, a neuro developmental disorder with onset in early life. Due to difficulties in social relationships, people with autism are likely to face obstacles in establishing sexual partnerships. In high functioning autism, language and cognitive skills are preserved, despite impaired social communication abilities.
Certain paraphilic disorders listed in the DSM such as paedophilic disorder have been reported in male adolescents with high functioning autism, according to H. Hellemans, K. Colson, C. Verbraeken, R. Vermeiren and D. Deboutte's “Sexual behaviour in high functioning male adolescents and young adults with autism spectrum disorder”.
Dr. Chandradasa and Dr. Champika reported a case of a male adolescent in Sri Lanka with high functioning autism, presenting with features of zoophilia.
Case report
The boy in question was a 17-year-old school student living in a rural area. The boy’s paternal grandparents live in the vicinity and raise a herd of cattle. The boy had deficits in social communication as a toddler with mostly isolated play at the pre-school level, poor sustained eye contact and the lack of imaginative play. There were also features suggestive of restricted repetitive behaviours in the form of lining up toys, delayed echolalia (repetition of speech that takes place when children learn to talk) and an extreme need for sameness when it came to food. He had speech regression during his second year and spoke only single words at two years of age. He was diagnosed with autism spectrum disorder by a psychiatrist at the age of five, and was treated with behavioural interventions. After a few years of follow up, his parents stopped taking him for reviews, primarily due to travel-related costs. Over the years, his speech, social deficits, and restricted, repetitive behaviours improved, but he continued to have difficulties in establishing peer relationships.
In the 12 months preceding the incident in question, the parents had observed the boy spending more time at his grandparents’ cattle house. Even though this behaviour was new and unusual for him, the family had decided not to intervene, as they thought that he was developing a certain warmth towards these animals, which according to them, is rarely seen exhibited by this boy, towards anyone. However, a neighbour had seen the boy seemingly masturbating near the cattle house and had reported this to his mother. Afterwards, his father had warned the boy not to engage in such behaviour publicly. The boy's grandmother had subsequently found him having penetrative intercourse with a heifer.
The adolescent’s parents had immediately taken him to a local healer in the village where he was prescribed a thovil (described by K.A. Kuruppuarachchi and R.R. Rajakaruna in “Psychiatry in Sri Lanka” as a demonic ritual, which is by nature an exorcism, that aims to chase away malevolent spirits that are believed to induce pathological body and mind centred states and involves a ritual that is characterised by dialogue, that is both humourous and fear inducing, between the healer and the drummer who dance wearing colourful demonic masks selected on the basis of the suspected illness, and may last up to 12 hours in the night) in order to relieve him of demonic possessions, which the healer believed to be the cause for this behaviour. Dr. Chandradasa and Dr. Champika opined that the low mental health related literacy of the parents may have contributed to seeking traditional healing in the form of a thovil. The healer had demanded Rs. 40,000 for the procedure, but since the parents had been unable to provide said amount, they had taken him to the local health service the next day. The boy had afterwards been referred to a specialised youth psychiatric service.
After initial denial, the boy had later requested help to stop his urges. Over the previous year, the boy had experienced recurrent, intense sexual fantasies about having sexual intercourse with cattle, watching them mate and masturbating while observing them. Acting on these urges had often led the boy to miss academic activities, and keeping this behaviour a secret had required considerable effort and thereby caused significant distress. He had never had a romantic or sexual relationship with another human. He had watched pornography on the Internet involving humans, but had stated that he did not enjoy it when compared to watching animals. The boy had denied any sexual interest in non-living objects, children, or adult males, and lesser interest in adult females compared to animals. He preferred sexual fantasies and behaviours related to animals more than sexual exposure to humans.
On clinical assessment and evaluation, the boy avoided sustained eye contact and had appeared distressed. There were no significant abnormalities pertaining to mood, thought, perception, or cognition found. When intelligence was assessed using the test of non-verbal intelligence, the boy was found to be of average intelligence. The academic reports and teachers feedback on past performance revealed average language abilities and academic capabilities. The biochemical profile of the sex hormones was also found to be normal.
The boy had been treated by a child and adolescent psychiatrist as an outpatient (according to Dr. Chandradasa and Dr. Champika, due to the lack of inpatient care facilities for adolescents, and as noted by Dr. Chandradasa and Kuruppuarachchi in “Child and youth mental health in post war Sri Lanka” [2017], from among the nine psychiatric beds available countrywide for adolescents, there were none available at the facility where this boy was treated), using cognitive behaviour therapy. The main goals of the said therapy were to reduce inappropriate arousals using techniques such as covert sensitisation and to enhance appropriate arousals through methods such as orgasmic reconditioning, along with the incorporation of the provision of sexual education and social skills training. He was also commenced on an anti-depressant (a selective serotonin reuptake inhibitor), which was titrated to a higher dose after two weeks, and was continued thereafter. According to F. Thibaut, J.M.W. Bradford, P. Briken, F.D.L. Barra, F. Hassler and P. Cosyns's “The World Federation of Societies of Biological Psychiatry guidelines for the treatment of adolescent sexual offenders with paraphilic disorders”, the combination of pharmacotherapy including selective serotonin reuptake inhibitors along with cognitive behaviour therapy has been useful and effective in treating paraphilic disorders among adolescents.
At the three month follow up, the boy had reported better control of his urges and reduced psychological distress, and his parents had not observed any deviant sexual behaviour.
According to “Aspects of sexuality in adolescents and adults diagnosed with autism spectrum disorders in childhood” by L.C. Fernandes, C.I. Gillberg, M. Cederlund, B. Hagberg, C. Gillberg and E. Billstedt, inappropriate sexual behaviours and paraphilias were reported in a quarter of adolescents with autism who participated in the said study.
As explained by Dr. Chandradasa and Dr. Champika, a person with autism might be vulnerable to sexual deviances, as social difficulties may further hinder the establishment of sexual partnerships.
“Even though the teenager was content with his restricted, repetitive behaviours, he was markedly distressed about his deviant sexual urges, thus indicating that his paraphilic disorder presentation was not encompassed by his autism. According to Aggrawal’s classification, this adolescent’s behaviour could be categorised and termed as that of a regular zoophile, describing a person who does not prefer intercourse with humans but instead with animals,” Dr. Chandradasa and Dr. Champika further explained.
As noted by S.M. Fernando, F.P. Deane and H.J. McLeod in “The delaying effect of stigma on mental health help seeking in Sri Lanka”, carers delay seeking help from mental health services due to the fear that their loved ones would be labelled and stigmatised as mentally ill. This could result in, Dr. Chandradasa and Dr. Champika emphasise, the potential exacerbation and progression of the complications.
Since this case report describes a unique association, Dr. Chandradasa and Dr. Champika recommended that further research studies be conducted in multi-cultural settings to explore the nature of paraphilic disorders in individuals with autism spectrum disorder.
Autism and zoophilia: Lankan psychiatrists find potential link
10 Jun 2021
Autism and zoophilia: Lankan psychiatrists find potential link
10 Jun 2021
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