Are Sadomasochism and Hypersexuality in Autism Linked to Amygdalohippocampal Lesion?

Introduction. Pathologies of the amygdala and the hippocampus have been argued to be critically involved in autism as well as in sadomasochism. In line with Kluver and Bucy syndrome, clinical observations, animal models and a few case reports emphasize that temporal brain changes are important for the etiopathogenesis of sexual deviant behaviour. In particular, the amygdalohippocampal region has been linked to hypersexuality, transvestitism and fetishism. While cases and studies are rare, the impact of amygdalohippocampal changes in criminal behaviour remains unclear so far. Aim. To demonstrate the impact of subcortical neurobiological changes in the etiopathogenesis of autism and sadomasochism. Methods. We report on a forensic psychiatric inpatient due to murderer with autism and sadomasochism who had amgdalohippocampal abnormalities bilaterally. Studies on the neurobiological underpinnings of autism and of sadomasochism are reviewed in particular regarding amygdalohippocampal region. Results. In this patient, MRI scan showed hypointensities in amygdala-hippocampal complex bilaterally medial to both cornua inferiores corresponding to an amygdalo-hippocampal atrophy. Conclusions. In line with the literature, this case report links autism and sadomasochism to amygdalohippocampal pathology emphasising its impact in the etiopathogenesis of both disorders. Further research is needed to elucidate the interaction of amygdalohippocampal changes, disturbed emotion precessing and sex offenses. Muller JL. Are sadomasochism and hypersexuality in autism linked to amygdalohippocampal lesion? J Sex Med 2011;8:3241-3249.