Compulsive sexual behaviors--difficult aeromedical disposition

Axis I psychiatric disorders generally are considered incompatible with both the issuance and subsequent maintenance of aeromedical clearance certificates. Little doubt exists as to the impact that conditions such as anxiety disorders, mood disorders, or substance-related disorders have on the conduct of safe flight. Nevertheless, different compulsive sexual behaviors (CSBs), which now are thought to share similar origins and associated comorbidity, can similarly affect impulse control, judgment, concentration, and insight. Yet, these conditions frequently are handled administratively (if not legally). Moreover, in practice CSBs fall within a spectrum of behaviors from "normative" nonparaphilic sexuality to more deviant paraphilic behavior. Through the presentation of five selected cases seen at the Naval Operational Medicine Institute, this article explores examiner difficulty in establishing a diagnosis, discusses models useful in understanding the origins of these disorders, and highlights critical elements in establishing aeromedical disposition. The authors conclude that CSBs may be associated with anxiety, dysphoria, a pattern of increased risk taking, a high threshold for arousal, and poor judgment, which may impact the safety of flight. A comprehensive psychiatric evaluation is essential in determining aeromedical disposition, and consideration should be given to reviewing these cases from a medical perspective prior to any administrative disposition.