Sexually inappropriate patients

[getunconcsious]

They're so creepy and weird...I hate dealing with them. I finally finished most of my psych wards months for now (on peds) but just curious how others dealt with these folks. I usually attempted re-direction once or twice then cut off the conversation on rounds if they couldn't (or usually wouldn't) be appropriate. I think this issue actually is a pretty common problem on psych wards and most people don't want to talk about it. I think we need more supervision regarding this type of issue, b/c there are so many bipolar and/or personality disordered peeps on the wards who have poor boundaries and are seductive at baseline. What are yall's thoughts?

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[acuriousstudent]

You don't really say what the problem is. I'd divide the problems up into:

1. The straight guys who expose themselves or talk needless trash to female doctors. You'd deal with them based on their diagnosis (eg, manic or sociopathic or autistic). Firm distance seems to work fine, and I haven't had much of a problem.

2. The straight gals who expose themselves or talk needless trash to male doctors. Their diagnoses may be similar, though the borderline dx becomes big, of course, and if they're good at seductions, the problem for a lot of inexperienced male drs would NOT be so much how to set limits so that they're not creeped out but how to set limits so that they don't overstep boundaries. Guys are so easy...

And then the gay version of the above, and then the undifferentiated object choice primitive folks and then there are the all purpose lonely patients who can induce problems, etc.

 

[kugel]

Honestly, I have not run into flagrant seductive behavior very often.
Much more likely to run into subtle non-sexual seductive behaviors from both genders:
"C'mon, doc. We both know I'm not one of these people. What are the magic words I have to say to get out of here?"
Or...
"You're the nicest doctor here and I really hate to bother you when I can see that you're working so hard, but this pain is going to keep me anxious and pacing all day. If I could just have one dose of Vicodin, then I know I'd be able to sleep and the other medicines would have a chance to work."

Small amount of sexual behavior I've encountered is probably due to equal parts
A) working in a public psychiatric emergency setting which brings in few pt's who are currently organized enough to produce such behaviors, yet think that such behaviors will work.
B) I don't tend to elicit seductive behaviors even in the situations outside work where one would hope for them.

I've learned that my own difficulties thinking straight tend to happen when a pt has a certain combination of traits:
1) physically very attractive
2) intelligent
3) strong work/survival ethic, but recently badly victimized by people or fate.
I tend to be VERY careful about my treatment decisions in such cases, to avoid the possibility of under-diagnosing, under-treating. Although I'm always especially wary of my own biases anytime I like a pt on a personal level, it can be especially hazardous if the pt is also attractive. I often discuss such cases with colleagues and try to get a read as to whether my diagnostic and treatment ideas are sound.

When I dislike a patient, it's much easier for me to keep my biases conscious and therefore avoid unconsciously acting on them.

 

[ronin12]

Actually it is quite variable from simple seduction to outright,hypersexuality. Simple seductive behavior can be found in pts of either sexes and all physicians including non psychiatrists will face it.It is not necessary to have psychiatric diagnosis .

when it comes to hyper sexuality, then usually it is part of organic brain disorders, previous brain injuries(frontal lobe),chronic disorganized schizophrenic ,sexually impulsive.pedophiles etc. In male pts treatment with medroxyprogesterone or female hormones seems to be effective in reducing hypersexual behavior.

 

[billypilgrim37]

The seductiveness is also useful diagnostically. I will never forget the way one manic girl bore a hole through my entire being with the look she gave me. Needless to say, a woman who was not mentally ill has or will ever look at me like that. My wife certainly never will.

So if a woman ever makes my heart flutter again like that, mania will certainly be at the top of my differential.

 

[OldPsychDoc]

You don't really say what the problem is. I'd divide the problems up into:

1. The straight guys who expose themselves or talk needless trash to female doctors. You'd deal with them based on their diagnosis (eg, manic or sociopathic or autistic). Firm distance seems to work fine, and I haven't had much of a problem.

2. The straight gals who expose themselves or talk needless trash to male doctors. Their diagnoses may be similar, though the borderline dx becomes big, of course, and if they're good at seductions, the problem for a lot of inexperienced male drs would NOT be so much how to set limits so that they're not creeped out but how to set limits so that they don't overstep boundaries. Guys are so easy...

And then the gay version of the above, and then the undifferentiated object choice primitive folks and then there are the all purpose lonely patients who can induce problems, etc.

You left out "Trading oral sex for another patient's prn ativan in the restroom and then acting like the staff is crazy for insisting on silly 'no fraternization' rules."

 

[fMRI]

Caveat: Parkinson pts act often overtly sexualized. That's due to their medication -- some find it very difficult to talk about it and don't seem to be able stop acting this out. (BTW, when you do get the time to talk to them seriously, male patients will soon tell you that while they act sexualized, they have difficulties obtaining/maintaining an erection.) As for carers, they find that behavior particularly difficult to deal with.

To get the meds adjusted takes some joint efforts with neuro, best is to curbside your favorite pharmacologist.

 

[Regnvejr]

The seductiveness is also useful diagnostically. I will never forget the way one manic girl bore a hole through my entire being with the look she gave me. Needless to say, a woman who was not mentally ill has or will ever look at me like that. My wife certainly never will.

So if a woman ever makes my heart flutter again like that, mania will certainly be at the top of my differential.

Counter-transferrence is a wonderful diagnostic tool.