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

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 & 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)

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
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”

9. 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

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 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

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
“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

19. 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

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
difficulty with gender differentiation

26. Development of Paraphilias

27. 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

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
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

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

30. 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.

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