Paraphilias

1
Paraphilias
2
DSM-IV

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

3
Paraphilias

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

4
Fetishes

• Sexual arousal by
• using or thinking about an inanimate object
• viewing a particular part of the body
• Common items
• womens clothing (shoe, stockings, underpants,
  bras)
• feet

5
Fetishes

• Characteristics
• male
• 25 homosexual
• Causes
• temporal lobe abnormalities
• 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)
• women not classically conditioned (Letourneau
  ODonohue, 1997 Meston Rachman, 1994)

6
Fetishes

• Dear Dr. E,
• I'm dating a man with a foot fetish. He has
  never asked me to do anything with my feet, but
  he watches foot fetish videos. Is this healthy?
• J, St. Louis
• Dear J,
• You're in a better position to answer your
  question than I am. How are you and your friend
  getting along? Does his fascination with feet
  interfere with your relationship? How well does
  he function at work and at home? If he's
  functioning well and you're getting along, you
  probably don't have anything to worry about. Some
  people get aroused by eyes, some by breasts, some
  by lags. What do you have against feet?

7
Transvestites Transvestic Fetishism

• Sexual arousal by dressing in clothes of the
  opposite sex
• crossdressing

8
Transvestites Transvestic Fetishism

• Characteristics
• broad age range
• broad religious affiliation
• well educated
• in committed relationships
• parents
• heterosexual
• began before age 10

9
Transvestites Transvestic Fetishism

• Causes
• Family
• positive paternal role model
• negative maternal relationship
• associated with learning disabilities
• temporal lobe abnormalities

10
Sex Offenders

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

11
Courtship Disorders

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

12
Voyeurism

• Characteristics
• youngest child
• few sisters
• good relationship with parents
• parents with poor relationship
• underdeveloped socially
• later 1st sexual experience
• less likely to marry

13
Voyeurism

• Females
• rare
• peeping fantasies not uncommon (Friday, 1975)

14
Exhibitionism

• Characteristics
• almost exclusively male
• timid/unassertive
• undeveloped social skills
• uncomfortable with anger/hostility
• more likely to be raised in puritanical background

15
Exhibitionism

• Females
• do not derive pleasure
• motivation money (e.g., strippers) or attention
  (e.g., Marti Gras)

16
Frotteurism

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

17
Sadism Masochism

• Sadism sexual arousal by inflicting pain on
  another
• Masochism sexual arousal by having pain
  inflicted upon oneself

18
Sadism Masochism

• History
• masochist (1886) Krafft-Ebing, after Leopold
  von Sacher-Masoch
• sadist (1700s) after Marquis de Sade

19
Sadomasochism (S M)

• Major vs minor sexual sadism
• Sadomasochism (S M)
• pre-determined acts
• 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

20
Sadomasochism (S M)

• Characteristics
• predominantly male
• female 25 prostitutes
• meet through S M magazines
• come from all walks of life, SES, educ. etc
• 1/3 heterosexual, 1/3 bisexual, 1/3 homosexual

21
Major Sexual Sadism

• Seto Kuban (1996)
• sadistic rapist, non-sadistic rapist, controls
• penile volume changes
• Five films
• nonviolent, non-sexual w/ female
• consensual sex w/ female
• non-sexual violence against female
• rape
• violent rape

22
Major Sexual Sadism

• Seto Kuban (1996) continued
• both types of rapist equally aroused by different
  types of sex
• controls differentiated between consensual and
  non-consensual sex
• Temporal lobe abnormalities (Langevin et al.,
  1988)

23
Psychopathic Sexual Sadism

• DSM-IV
• sexual sadism
• antisocial personality disorder (ASPD)
• Serial murderer
• arousal from inflicting pain
• arousal from killing
• Characteristics
• Lack of guilt or compassion for victim
• Euphoria during murder
• mentally disturbed, rarely psychotic

24
Psychopathic Sexual Sadism

• Geberth Turco (1997)
• 387 serial murders
• 248 sexually assaulted victims
• 68 met criteria for sexual sadism ASPD
• childhood aggressiveness
• childhood antisocial behavior
• killing involving sexual violence, humiliation,
  domination and control
• derived pleasure from killing
• examples Ted Bundy, Gary Ridgeway

25
Pedophilia

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

26
Development of Paraphilias
27
Pedophilia

• Physiological characteristics
• higher baseline cortisol, prolactin, body
  temperature
• stronger cortisol response
• disturbance in serotonin regulation --gt OCD

28
Pedophilia

• Freund et al. (1991)
• showed slides of nude male and female children
• pedophiles and controls
• measured penile volume changes
• Results pedophiles less differentiation between
  slide types

29
Treatment of Paraphilias

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

30
Additional Paraphilias

• Bestiality zoophilia
• coprolalia
• coprophilia
• klismaphilia
• mysophilia
• necrophilia
• pedophilia
• scoptophilia
• stigmatophilia

• telephone scatologia
• troilism
• urophilia
• kleptomamia
• pyromania
• salirophilia
• somnophilia
• sotophilia

31
Paraphilia-Related Disorders

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