"Sleeping Beauty paraphilia": deviant desire in the context of bodily self-image disturbance in a patient with a fronto-parietal traumatic brain injury.

BACKGROUND Several case series and reports describe paraphilia as occurring after brain damage, mostly in the frontal lobes and diencephalic structures. Hypersexuality and paraphilic behaviors are also documented in a variety of other neurologic disorders, (e.g., Kluver Bucy syndrome, and more rarely in multiple sclerosis). In multiple sclerosis, hypersexual behavior and paraphilias have been associated with various focal brain lesions in the frontal and temporal lesions when inflammatory demyelination involves the hypothalamus and septal regions. CASE REPORT A case of a patient who developed a particular and progressive sexual deviant behaviour after a head trauma. This men felt sexually aroused from seeing sleeping women as well as from taking care of their hands and nails while they were asleep. The patient was diagnosed with a moderate dysexecutive syndrome characteristic of a frontal disorder and a very specific parietal-related bodily self image disorder characterized by an incomplete mental image of his hands. The clinical hypothesis was that the paraphilia might be related to his post-traumatic disturbed bodily self image and more specifically to its related impulsive needs to complete his hands representation. CONCLUSIONS This case report highlights the potential link between paraphilia, deviant and aggressive sexual behaviour, neurological disturbance and self-representation. The treatment of paraphilias remains very complex, and requires taking into account not only the social and psychological aspects of the disease, but also its organic dimensions.