Improvement of schizophrenia with electroconvulsive therapy and serum brain‐derived neurotrophic factor levels: Lack of association in a pilot study

WE ENCOUNTERED A patient with Williams syndrome who exhibited glove fetishism and committed recurrent theft of gloves. Williams syndrome is a congenital disorder characterized by mental retardation, congenital cardiovascular anomalies, and unique facial features (‘elfin face’). The cause of this syndrome is a micro-deletion of chromosome 7 (7q 11.23). The literature contains no previous reports of fetishism occurring in Williams syndrome. The patient was a 22-year-old man. Both the patient and his mother gave verbal informed consent to participate in this case report. His mother raised him independently from the age of 1 year, after her divorce. He began to exhibit developmental delay around the age of 1 year. At the age of 3, he was diagnosed with Williams syndrome by a pediatrician. As a child, he also displayed excessive friendliness and hyperactivity. Impulsivity and inattention were not prominent. The mother was very busy because of financial constraints and the family did not have regular opportunities to consult health professionals. At around 5 years of age, the patient saw a heroine on a children’s television program; she was wearing white gloves while fighting enemies. From this point, he was keen to collect gloves and photographs of gloves. At age 18, he watched a pornographic video in which a woman wearing gloves masturbated men to ejaculation. He started to visit prostitutes and requested that they wear gloves while stimulating him to ejaculation. At the age of 18, 19, 21, and 22 years, the patient assaulted women in order to rob them of their gloves. He was arrested by the police each time. The patient’s score on the Wechsler Adult Intelligence Scale– Revised (WAIS-R) at the age of 22 years indicated moderate intellectual disability (full-scale IQ < 40, verbal IQ = 51, performance IQ < 46). Medical assessment revealed distinctive features of Williams syndrome, such as elfin face, supravalvular aortic stenosis and excessive friendliness and hyperactivity. He was open about his sexual predilections, and exhibited neither defiant nor destructive attitudes. The diagnosis was confirmed by identifying the microdeletion of chromosome 7q (11.23). Patients with Williams syndrome have been reported to exhibit ‘persistence’ and ‘obsession’. This patient’s keen interest in gloves was consistent from early childhood. In addition to this cognitive profile unique to Williams syndrome, the family and social environment of the patient should be noted. The mother’s unavailability due to her work and the lack of professional support by health professionals created a difficult situation for the family, in which she had to raise a troubled child without assistance. Due to social isolation, the mother had been unable to provide the son with sufficient emotional support or the necessary discipline. This challenging environment created poor interpersonal relationships and ineffective judgment about socially acceptable behaviors. These disadvantages and the unique cognitive profile of Williams syndrome contributed to the transformation of the childhood obsession with gloves into inadequate adult sexual behavior.