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DOI: 10.1176/appi.books.9781585622665.32506
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A white man in his mid-30s, in prison for molesting prepubescent girls, volunteered for an interview with a sex researcher. He had been reared in a rural area by lower-middle-class parents with a grammar-school education. His mother, who was extremely prudish, frightened her son with tales of venereal disease and the dire consequences of masturbation and impressed upon him that all sexual activity was nasty and that men were "beasts." He therefore felt guilty about his heterosexual urges and his preadolescent heterosexual play and with puberty at age 12 ceased all heterosexual activity. Masturbation had begun a year before puberty and ceased a year after puberty, evidently because of the maternal warnings. During adolescence he was shy and fearful of females, although he desired them. Girls accused him of being "tied to his mother's apron strings."
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4 r+ H, n5 `% s* [) o/ u8 M- ^) ?, x, xHe had always been sexually aroused by the sight of stallions and mares copulating and sometimes fantasized about animal contact while masturbating. He had heard of animal contact from his peer group, and, as a substitute for masturbation, he engaged in coitus with cows almost daily from age 13 to age 18. Some affectional component developed, such as one might have for a pet animal. However, he never found the idea of sexual activity with an animal as exciting as the idea of sexual activity with a girl.
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$ @+ y- O! R9 m3 f" _- u( ?0 UWhen he was 18, an epidemic of brucellosis appeared among the farm animals in the region, and the young man associated this mentally with venereal disease—concerning which he had a deep horror, instilled by his mother. He therefore terminated his animal contacts. Lacking any adult heterosexual activity, and afraid to masturbate or engage in animal contacts, the young man reverted to his preadolescent pattern (which had been very gratifying) and began seeking contact with prepubescent girls. This led to his arrest and imprisonment.
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  ^  Z! G5 y( x! T- A+ O) A2 {}4 j" I. @. Y3 B0 UThe Institute for Sex Research at Indiana University, founded by Alfred C. Kinsey, was asked to submit a case for this book of Zoophilia, a specific Paraphilia Not Otherwise Specified that is recognized by DSM-IV-TR. A computer search of their extensive files of thousands of people interviewed between 1938 and 1963 revealed 96 cases involving intensive sexual activity with animals, but in not a single case was the animal contact or the fantasy of contact with animals the preferred source of achieving sexual excitement. Unlike the other Paraphilias, sexual activity with animals may always be a second choice, as it was in this case. Apparently there are no cases in which the idea of sexual activity with an animal is more exciting than the idea of sexual activity with a human.
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The behavior that led to this young man's incarceration involved sexual activity with prepubescent girls. Therefore, the most likely diagnosis at the time of his arrest is Pedophilia, Sexually Attracted to Females (see DSM-IV-TR), with a history of Paraphilia Not Otherwise Specified (Zoophilia) (see DSM-IV-TR). When he was younger he apparently was attracted to adolescent girls. Therefore, we would also specify Nonexclusive Type to indicate that his sexual attraction was not limited to children.

DOI: 10.1176/appi.books.9781585622665.32517
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In addition to having amnesia, Mr. Saunders has assumed a new identity as Mr. Tate. Because there is no suggestion that the two distinct identities or personality states are alternating in recurrently taking control of this man's behavior, Dissociative Identity Disorder (Multiple Personality Disorder) is ruled out.
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  V3 y' b8 ]" I7 a$ JThe critical role of psychological factors in the patient's amnesia becomes more apparent when we learn that just before the development of his symptoms, on top of increasing difficulties at work, he had a violent argument with his son. The additional feature of sudden, unexpected travel away from his home justifies the diagnosis of Dissociative Fugue (see DSM-IV-TR).

DOI: 10.1176/appi.books.9781585622665.32530# a# ]1 P0 f$ ^0 G1 b( j" l& r+ G5 ~

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At that time, shortly after his girlfriend had rejected him for another man, he began to think that male co-workers were mak-ing homosexual advances toward him. He began to fear that he was homosexual and that his friends believed he was homosexual. He finally developed the conviction that he had a disorder of the reproductive system, that he had one normal testicle that produced sperm and that his other testicle was actually an ovary that produced eggs. He thought that this was evidence that a "woman's body resides inside my man's body." He began to gamble, and was convinced that he had won $400,000 and was not paid by his bookie and that he was sought after by talk show hosts to be a guest on their shows and tell his unusual story (all not true). He claimed that he had a heightened awareness, an "extra sense," and that sounds were unusually loud. He had difficulty sleeping at night, but no appetite disturbance.
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On admission, Kevin's speech was somewhat rapid, and he jumped from topic to topic. His affect was neither irritable, euphoric, nor expansive. He said he was now seeking treatment because "there is a war between my testicles, and I prefer to be male."2 j: l9 Q( F# V) t- Y
6 f3 c. S& c7 l+ P: D  I# {}4 N& J, V( b6 fDuring high school Kevin had been a poor student with poor attendance. He claims always to have had many friends. He has never received psychiatric treatment. He admits to occasional marijuana and cocaine use in the past, but denies any use of hallucinogens.9 o+ R( K& |" K( z# k
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Kevin is the oldest child in a family of six children. His parents met when they were both patients in a psychiatric hospital.
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DSM-IV-TR Casebook Diagnosis of "Eggs"& j3 z4 t9 ?- s8 m- o; g& @
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