戀物症在司法精神鑑定

Fetishism in Forensic Psychiatric Evaluation

目的：戀物症個案在行為時是否因精神障礙而符合刑法第19條標準，常有爭議。本文報告一名因竊盜罪被起訴的戀物症個案。病例報告：一位47歲已婚男性，青少年時期即開始發展出戀物行為，壓力與負面情緒常加劇其戀物行為，數年來連續竊取超過1000件女性內衣。結論：精神鑑定時需考慮戀物症是否合併其他精神疾患或有衝動控制困難。戀物症有獨特精神病理學，具有專業可治療性。我國治療以認知行為治療及兩性教育為主，美國常用抗憂鬱劑或抗雄性激素等藥物治療。

Objective: In this article, we present a forensic patient whose fetishistic behaviors apply to reduced criminal responsibility. Case Report: A 47-year-old married man developed fetishism for female undergarments during his adolescent age. Stress and negative emotional states frequently provoked more paraphilic behaviors. He was accused of theft due to stealing more than one thousand pieces of female undergarments. Conclusion: Insanity defense may be successful if the fetishist has another comorbid mental illness or diffi culties in impulse control over paraphilic urges. Experts such as psychiatrists are important in successful treatment. Major treatment modalities in Taiwan include cognitive-behavioral approaches and sex education. In USA, pharmacotherapy such as antidepressants or antiandrogens is proved effective.