Paraphilias - sexual interest other than in copulatory

Paraphilias
Presentation by: Dr. Penny Frohlich
University of Texas at Austin

Definition: According to wikipedia, Paraphilias refers to powerful and persistent sexual interest other than in copulatory or precopulatory behavior with phenotypically normal, consenting adult human partners.


DSM-IV

* 6-months, recurrent, intense, sexually arousing fantasies/sexual urges
* fantasies/urges involve a specific act
* involving:
o non-human objects
o suffering or humiliation of oneself or another
o children or non-consenting persons
* cause significant distress or impairment


Paraphilias

* Fetishes
* Transvestic fetishism
* Voyeurism
* Exhibitionism
* Frotteurism
* Sadism/masochism
* Pedophilia

Fetishes

* Sexual arousal by:
o using or thinking about an inanimate object
o viewing a particular part of the body
o Common items:
+ womens’ clothing (shoe, stockings, underpants, bras)
+ feet
* Characteristics:
o male
o 25% homosexual
* Causes:
o temporal lobe abnormalities
o learned behavior - classical conditioning
+ 5/7 men conditioned to become sexually aroused to a knee length leather boot
+ 3/7 generalized to other shoes (Rachman & Hodgson, 1968)

Transvestites & Transvestic Fetishism

* Sexual arousal by dressing in clothes of the opposite sex
* crossdressing
* Characteristics:
o broad age range
o broad religious affiliation
o well educated
o in committed relationships
o parents
o heterosexual
o began before age 10
* Causes
o Family:
+ positive paternal role model
+ negative maternal relationship
o associated with learning disabilities
o temporal lobe abnormalities

Sex Offenders

* Voyeurism
* Exhibitionism
* Frotteurism
* Preferential Rape Pattern
* Pedophilia
* Psychopathic Sexual Sadism

Courtship Disorders

* Voyeurism:
o “peeping tom”
o sexual arousal by observing nude individuals without their knowledge or consent
o intense urges and recurrent behavior
* Exhibitionism: sexual arousal by exposing genitals to unsuspecting strangers - typically in inappropriate settings
* Frotteurism: sexual arousal by rubbing one’s genitals against others in public
* Preferential rape pattern: prefer rape over consensual sex

Voyeurism

* Characteristics:
o youngest child
o few sisters
o good relationship with parents
o parents with poor relationship
o underdeveloped socially
+ later 1st sexual experience
+ less likely to marry
* Females:
o rare
o peeping fantasies not uncommon (Friday, 1975)

Exhibitionism

* Characteristics:
o almost exclusively male
o timid/unassertive
o undeveloped social skills
o uncomfortable with anger/hostility
o more likely to be raised in puritanical background
* Females:
o do not derive pleasure
o motivation: money (e.g., strippers) or attention (e.g., Marti Gras)

Frotteurism

* Characteristics:
o comorbidity: 79%
o Average number of acts:
+ 849 (Abel et al., 1987)
o in females: molestation secondary to erectile failure, low desire (Sarrel & Masters, 1982)

Sadism & Masochism
* Sadism: sexual arousal by inflicting pain on another
* Masochism: sexual arousal by having pain inflicted upon oneself
* History
o “masochist” (1886) Krafft-Ebing, after Leopold von Sacher-Masoch
o “sadist” (1700s) after Marquis de Sade

Sadomasochism (S & M)

* Major vs minor sexual sadism
* Sadomasochism (S & M)
o pre-determined acts
o activities & themes (Arndt, 1991; Weinberg et al., 1984):
+ flagellation
+ bondage
+ water sports (urophilia, coprophilia, mysophilia)
+ penis and nipple torture
+ master & slave
+ severe boss and naughty secretary
+ queeen and many slavves
+ arrest
+ military training
* Characteristics
o predominantly male
o female: 25% prostitutes
o meet through S & M magazines
o come from all walks of life, SES, educ. etc
o 1/3 heterosexual, 1/3 bisexual, 1/3 homosexual

Major Sexual Sadism

* Seto & Kuban (1996)
o sadistic rapist, non-sadistic rapist, controls
o penile volume changes
o Five films:
+ nonviolent, non-sexual w/ female
+ consensual sex w/ female
+ non-sexual violence against female
+ rape
+ violent rape
* Seto & Kuban (1996) continued
o both types of rapist equally aroused by different types of sex
o controls differentiated between consensual and non-consensual sex
* Temporal lobe abnormalities (Langevin et al., 1988)

Psychopathic Sexual Sadism

* DSM-IV
o sexual sadism
o antisocial personality disorder (ASPD)
* Serial murderer
o arousal from inflicting pain
o arousal from killing
* Characteristics
o Lack of guilt or compassion for victim
o Euphoria during murder
o mentally disturbed, rarely psychotic
* Geberth & Turco (1997)
o 387 serial murders
o 248 sexually assaulted victims
o 68 met criteria for sexual sadism & ASPD
+ childhood aggressiveness
+ childhood antisocial behavior
+ killing involving sexual violence, humiliation, domination and control
+ derived pleasure from killing
o examples: Ted Bundy, Gary Ridgeway

Pedophilia

* Sexual fantasies, urges, or behavior involving children under 14 years old
* prevalence
* Characteristics/Causes:
o 40% homosexual
+ high maternal age
+ low IQ
+ developmental disorder?
o history of childhood sexual abuse (49%) by a male abuser

Development of Paraphilias

* Physiological characteristics:
o higher baseline cortisol, prolactin, body temperature
o stronger cortisol response
o disturbance in serotonin regulation --> OCD
o showed slides of nude male and female children
o pedophiles and controls
o measured penile volume changes
o Results: pedophiles less differentiation between slide types

Treatment of Paraphilias

* 1900 castration, psychosurgery
* Cognitive-Behavioral Therapy - Aversion Therapy
o effective in lowering arousal
o relapse high
* Pharmaceutical
o agents that lower testosterone/produce pharmaceutical castration
o SSRIs

Additional Paraphilias

* Bestiality & zoophilia
* coprolalia
* coprophilia
* klismaphilia
* mysophilia
* necrophilia
* pedophilia
* scoptophilia
* stigmatophilia
* telephone scatologia
* troilism
* urophilia
* kleptomamia
* pyromania
* salirophilia
* somnophilia
* sotophilia

Paraphilia-Related Disorders

* compulsive masturbation
* protracted promiscuity
* dependence on pornography (more common in men)
* dependence on cybersex

Check regarding diagnosing if no distress - with regard to pedophilia etc.


Generalized to:
Family:
Results
pharmaceutical:
Bestiality & zoophilia: sexual arousal through contact with animals
coprolalia: need to hear filthy language to become sexually aroused
coprophilia: need to smell or riew feces to become aroused
klismaphilia: sexual arousal by being given an enema
mysophilia: arousal by filth or filthy surroundings
necrophilia:
scoptophilia: by observing others engaged in sexual intercourse
stigmatophilia: marking body, inserting objects into the body
telephone scatologia: arousal by making obscene phone calls
troilism: arousal by sharing partner and looking on
urophilia: “golden showers” on or watching
kleptomamia; aroused by act of steeling
pyromania: aroused by setting fires, watching fires
salirophilia: injestion of anothers sweet or saliva
somnophilia: having sex with someone who is sleeping
sotophilia: aroused by sight of certain foods.

Paraphilias.ppt