Paraphilias

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

Paraphilias Fetishes Transvestic fetishism Voyeurism Exhibitionism Frotteurism Sadism/masochism Pedophilia

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

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 & O’Donohue, 1997; Meston & Rachman, 1994) Generalized to: high-heeled black boot low-heeled black shoe did not generalize to: short brown boot brown sting sandal golden sandal women: erotic film with light stimulous, question: perhaps the wrong stimulous? Conditioned to different stimulous? erotic film with male’s voice (Meston)

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?

Transvestites & Transvestic Fetishism Sexual arousal by dressing in clothes of the opposite sex crossdressing

Transvestites & Transvestic Fetishism Characteristics: broad age range broad religious affiliation well educated in committed relationships parents heterosexual began before age 10 Characteristics: 1032 surveyed broad age range broad religious affiliation (24 catholic, 38 protestant, 3 jewish, 10 agnostic well educated - 65% with BA or higher in committed relationships - 83% wives knew, 28% accepted behavior parents heterosexual 87%; began before age 10: 76% “father provided good masculine image”

Transvestites & Transvestic Fetishism Causes Family: positive paternal role model negative maternal relationship associated with learning disabilities temporal lobe abnormalities Family: positive paternal role model negative maternal relationship - seperation/hostility - serve as a means to gain connection with females associated with learning disabilities temporal lobe abnormalities

Sex Offenders Voyeurism Exhibitionism Frotteurism Preferential Rape Pattern Pedophilia Psychopathic Sexual Sadism

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 one’s genitals against others in public Preferential rape pattern: prefer rape over consensual sex Viewed on a continuum different degrees of proximity to the victim common variable: preference for eliciting an alarmed reaction - not lack of interest in intercourse high comorbidity

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

Voyeurism Females: rare peeping fantasies not uncommon (Friday, 1975)

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

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

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)

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

Sadism & Masochism History “masochist” (1886) Krafft-Ebing, after Leopold von Sacher-Masoch “sadist” (1700s) after Marquis de Sade “masochist” (1886) Krafft-Ebing, after Leopold von Sacher-Masoch wrote novels depicting men being humiliated and bound by females “sadist” (1700s) after Marquis de Sade wrote stories depicting sexual torture and brutality

Sadomasochism (S & M) Major vs minor sexual sadism 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

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

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

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)

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

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

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 difficulty with gender differentiation

Development of Paraphilias

Pedophilia Physiological characteristics: higher baseline cortisol, prolactin, body temperature stronger cortisol response disturbance in serotonin regulation --> OCD stronger cortisol response: cortisol went higher and remained high longer following administration of serotonin agonist, more side effects too: dizzy, restless

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 Results: this is particularly interesting in light of the findings by Chivers et al - that males either become aroused by male or female stimuli - but not both - the exception may be pedophiles

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 1900 castration, psychosurgery (to hypothalamus) SSRIs: effectiveness suggests paraphilias have and OCD like element pharmaceutical: good outcome studies unavailable at present

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

Paraphilia-Related Disorders compulsive masturbation protracted promiscuity dependence on pornography (more common in men) dependence on cybersex