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Ask the Mental Health Expert Archives 2001-2004

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Compulsive Masturbation

Q. I am a school psychologist. We have a 9-year-old female, 3rd grader, who almost constantly bounces on her foot which is in the genital area. She has a history of masturbation since kindergarten. It has been a really big problem. Sometimes it seemed to be quite intense with her eyes in a trance. The bouncing is her alternative replacement behavior after being approached about sliding herself back and forth across the edge of her desk seat.

The parents are very difficult to approach. They do not trust the school. The whole family is strange, suspicious, etc. I was asked to evaluate the child and they refused for me to even talk briefly with her. I just don't know if there is abuse or could it be something else. I just hate that she continues this in the third grade and at such a frequent rate. Can you advise anything?

A. I can certainly appreciate your concern about this child! The current situation does not serve her best interests, nor is it conducive to good classroom order and concentration. There are several diagnostic possibilities that could account for this behavior--only a thorough neuropsychiatric evaluation would pin the diagnosis down.

Compulsive masturbation in a child may be part of a pervasive developmental disorder, such as autism; it may represent a true obsessive-compulsive disorder; or, given the trance-like episode, the masturbatory movements could reflect an atypical epileptiform state, such as complex partial seizures. However, none of these diagnoses rules out the possibility of an abusive home situation that may be contributing to the girl's behavior. If you are concerned about abuse, you may be required to file the appropriate report with your state department of social services (or child protective services), which would then (one hopes!) initiate an investigation.

Of course, this could have huge legal repercussions, and it may be prudent to discuss this with your supervisor and/or school legal counsel. If you really have no basis for suspecting abuse, and are simply raising this as a theoretical matter, perhaps there is a way you could persuade the parents to initiate a medical/neurological evaluation of the child--if they refuse, and you believe that the health and well-being of the child is at stake, you may then need to approach DSS with your concerns.

Ideally, of course, you would gradually build rapport and trust with the girl's parents, so that your recommendations don't seem to be coercive or hostile--but from the sounds of things, this won't be easy. In the mean time, would it be possible to work on a behavioral modification plan that the girl's classroom teachers could follow, with the aim of reducing these behaviors? Good luck with this difficult case.

May 2003

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