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According to the DSM-IV, in order to be diagnosed with a paraphilia, one must demonstrate the following features:. The DSM-IV lists eight types of paraphilic disorders but in practice, individuals displaying one paraphilia very often also exhibit other paraphilic behaviors. Incarcerated pedophiles often report, for example, that they have also engaged in other paraphilic behaviors e.
The presence of paraphilic behavior may represent an underlying sexual impulsivity disorder that is characterized by sexual compulsivity and hypersexuality, and in some cases, aggression Kafka, Back to top. Most fetishists are male and nearly one in four are homosexual. Common fetish items include shoes and lingerie and common materials include rubber and leather. Fetishists become aroused by stealing the object, viewing the object, or masturbating with the object.
Most fetishists are aroused by a of different objects. The etiology of fetishism is not known. Two reported cases of fetishism have been associated with abnormalities in the temporal lobe.
In one case the patient had temporal lobe epilepsy and in the other the fetish behavior was linked to the development of a temporal lobe tumor Wise, Some evidence suggests that fetishism may be a learned behavior that when a normal sexual stimulus is paired with the fetish item. When the slide of the boot was later shown alone, five of the seven men demonstrated penile erection, indicating that a boot fetish had been conditioned. The conditioned fetish was shown to generalize to other types of shoes in three of the men. That is, the men also became aroused when shown a slide of a high-healed black boot and a low-healed black shoe.
A similar study was conducted in women to determine whether women could also be conditioned to become sexually aroused to a stimulus. Subjects were randomly ased to repeatedly view an erotic film paired with a light stimulus versus an erotic film alone. This suggests that sexual arousal is not readily classically conditioned in women and may explain why, like other paraphilias, fetishism occurs almost exclusively in men.
A distinction is drawn between transvestism cross-dressing and transvestic fetishism. A variety of people cross-dress but the behavior is not considered a fetish unless the cross-dressing is associated with sexual feelings. For example, transsexuals, or people who feel that their external sex does not match their internal gender identity, may cross-dress in order to feel more congruent with their gender identity but do not find the cross-dressing sexually arousing.
Similarly, homosexual males may cross-dress e. Very few studies have been published regarding transvestic fetishism and those that have often grouped transvestic fetishists with transvestites who experienced little to no sexual arousal from cross-dressing. Doctor and Prince surveyed 1, male transvestites between and A few cases have reported of men with transvestic fetishism who had fathers or brothers who also cross-dressed. A of studies have been published examining psychosocial causes of transvestic fetishism but most have serious methodological flaws that limit drawing confident conclusions.
Some such studies suggest that adolescents with transvestic fetishism tendencies may have a history of separation from and hostility towards their mothers. Pedophilia is defined as intense and repeated sexually arousing fantasies, urges, or behaviors involving sexual activity with children, typically less than 14 years old American Psychiatric Association, Since few pedophiles are likely to openly admit their preference, it is difficult to estimate the prevalence of pedophilia in the general population.
Furthermore, individuals who feel sexual attraction to children may resist the temptation due to societal pressures, yet may nonetheless experience sexual fantasies involving children. Recent evidence suggests that pedophilia may be associated with homosexuality, mental retardation, and high maternal age. When sexual orientation, intellectual functioning, and maternal age were measured in male sex offenders, high maternal age and low intellectual functioning were ificantly associated with homosexual pedophilia.
The association between low intelligence and pedophilia suggests that pedophilia may reflect a developmental disorder. The association between high maternal age and pedophilia is unclear, although is may reflect differences in birth order as homosexuality is associated with being later born discussed below under gender identity disorder Blanchard et al. Some researchers have speculated that hood history of sexual abuse contributes to an adult preference for sexual activity with children. In a large sample of men who were child sex offenders, Freund et al.
Freund and Kuban domination and submission are not paraphilic because child sex offenders according to whether they demonstrated phallometric increased penile volume preference to photographs of nude children versus adults. They found that child sex offenders who demonstrated preference for children were ificantly more likely to have hood history of sexual abuse. Pedophiles may have difficulty with gender differentiation. Freund et al. The pedophiles demonstrated less differentiation between stimuli containing males versus females as compared to non-pedophiles.
Although this pattern of undifferentiated arousal has also been noted in a case study of a year-old woman with multiple paraphilias Cooper et al. Pedophiles may differ from non-pedophiles on several physiological dimensions as well. Baseline plasma cortisol, prolactin, and body temperature were ificantly higher in pedophiles than controls.
When both groups were administered a serotonin agonist, mCPP, versus placebo, plasma cortisol levels were more elevated and remained elevated longer for pedophiles compared to controls. The pedophiles reported experiencing side effects e. Consistent with these findings, some researchers have speculated that pedophilia may be associated with disturbances in serotonin-related aggression and impulsivity Maes et al.
It has also been suggested that pedophilia may be a subtype of obsessive-compulsive disorder; a problem that is marked by repetitive, irrepressible behavior associated with serotonin disregulation Balyk, InKrafft-Ebing coined the term, masochist, after Leopold von Sacher-Masoch, who wrote novels depicting men being humiliated and bound by females. The term, sadism, was derived from writings of the Marquis de Sade, an 18 th century author who wrote stories depicting sexual torture and brutality.
A distinction is drawn between minor versus major sexually sadistic acts.
Minor sexually sadistic acts would include, for example, humiliation and bondage of a willing sexual masochist while major sexually sadistic acts would involve acts such as sexual torture and rape of an unwilling participant. The key distinction here is whether the victim was consenting or not. Female sexual masochists and sadists are outed by male sexual masochists and sadists and in many cases, the females are prostitutes who specialize in sadomasochism. One study found domination and submission are not paraphilic because approximately a quarter of female sexual sadists are prostitutes Breslow et al.
The majority of respondents reported that they met partners through sadomasochism advertisements, clubs, or bars. The respondents came from all ages, socioeconomic backgrounds and levels of education. About a third of respondents reported fetishisms e.
Very few studies have been conducted examining sexual sadists who target unwilling victims. Seto and Kuban examined penile volume changes in seven sadistic rapists compared to 14 non-sadistic rapists and 20 controls. The subjects were presented audiotapes depicting five different scenarios: 1 nonviolent, nonsexual interaction with a female, 2 consensual sexual activity with a female, 3 nonsexual violence against a female, 4 rape, and 5 violent rape.
Compared to controls, the sadistic rapists and non-sadistic rapists were equally aroused by the different types of sexual contact — they were less likely to differentiate between consensual sexual activity, rape, and violent rape.
A subset of sexual sadists may have abnormal endocrine activity although hormone levels typically do not differ between sexual sadists and controls. Gross examination of brain functioning revealed no differences between sexual sadists and controls, but more careful examination revealed a subtle but ificant difference in the right temporal lobe. One sexual sadist had a slow growing tumor in the left frontal-temporal lobe, likely present since childhood. Another had enlargement of the ventricles, a condition typically associated with schizophrenia and suggestive of overall brain atrophy.
In short, temporal lobe abnormalities may be implicated in sexual sadism, but more information is needed before any strong conclusions can be made Langevin et al. Serial killing, which is often reported in the media and dramatized in movies, may reflect comorbid sexual sadism and antisocial personality disorder. Geberth and Turco examined records of serial murderers within the United States and found that had sexually assaulted their victims. Of these, they determined that 68 met DSM-IV criteria for both sexual sadism and antisocial personality disorder in other cases, sufficient data was not available to make a determination.
These 68 individuals displayed a pattern of behavior characterized by childhood aggressiveness and antisocial behavior, and a pattern of killing involving sexual violence, humiliation, domination and control. Examination of their records suggests that these 68 individuals engaged in sexual violence and killing because they derived pleasure from it.
Voyeurism, exhibitionism, and frotteurism may be different behavioral expressions of a single underlying courtship disorder. The overt behaviors differ, but can also be conceptualized as different stages on a continuum — different degrees of proximity to the victim.
Voyeurism involves viewing the victim from a distance, exhibitionism involves approaching the victim, and frotteurism involves physically touching the victim. The preference for rape over consensual sexual activity termed the preferential rape pattern may represent the forth phase in the courtship disorders Freund et al. A high degree of comorbidity exists between these disorders and even when no overt comorbid behavior is present, some evidence suggests that presence of one disorder predisposes to another such disorder Freund et al.
Most men, if given the opportunity to view a woman disrobing, would not avert their eyes. Voyeurs tend to be the youngest child in the family. Compared to other sex offenders and controls, voyeurs have fewer sisters, have a good relationship with both parents, but have parents who do not have a good marital relationship. Voyeurs are often underdeveloped socially and sexually. They tend to engage in sexual activity later than other groups, and are less likely to marry than controls and other sex offenders Smith, The more sexually experienced a voyeur, the more frequently he is likely to engage in peeping behavior Langevin et al.
Some evidence suggests that voyeurs may be predisposed to other paraphilias as well e. Friday interviewed domination and submission are not paraphilic because from all ages teen to retirement and walks of life and found that women expressed fantasies about peeping and, in some cases, engaged in actual peeping behavior. Learning theorists have suggested that voyeurism develops when the subject is provided a voyeuristic opportunity, and then subsequently masturbates while fantasizing about the experience.
Exhibitionism occurs almost exclusively in men. A very few cases of female exhibitionists have been reported in the literature, but the characteristics of these women differed from typical male exhibitionists. Male exhibitionists tend to be timid and unassertive men who have underdeveloped social skills and who are uncomfortable with angry or hostile feelings.
Some studies suggest that exhibitionists were more likely to have been raised in a sexually puritanical background. Behavioral theory proposes that exhibitionism develops as a result of a learned behavior that is subsequently reinforced. This theory has been applied successfully to the treatment of exhibitionism i.
Attempts to identify a physiological cause of exhibitionism have thus far been unsuccessful. The majority of published articles on this disorder group frotteurism with other paraphilic disorders or report cases of men with multiple paraphilias, including frotteurism. Abel et al. It is unclear whether true frotteurism in women exists, perhaps in part because of the decreased likelihood that male victims would view the behavior as unwelcome or threatening. A handful of case reports of sexual molestation of men by women have been reported in the literature. Although these cases do not represent female frotteurism, they suggest that it is feasible that rare cases of female frotteurism may exist, but are rarely reported.
In West Germany, psychosurgery, which involved removing the nucleus ventromedialis of the hypothalamus, was used as a treatment for male sex offenders. Published reports of these practices rarely provided sufficient information to determine whether this intervention was successful in eliminating the inappropriate sexual behavior.
Of course there are serious consequences to performing such extreme and permanent techniques. Cognitive-behavioral therapies, such as aversion therapy, are often used to treat paraphilias. The arousing stimulus is paired with an aversive stimulus such as a shock or noxious odor until the paraphilic behavior no longer produces sexual arousal. A review of the handful of studies and case reports published, suggest that aversion therapy alone is effective in reducing arousal, but that relapse rates are high Kilmann et al.
More recently, other forms of cognitive-behavioral therapy such as covert sensitization or orgasmic reconditioning are being used. The belief is that orgasm, being an intensely pleasurable sensation, will serve to reinforce the more accepted sexual fantasy.
Few well-controlled treatment outcome studies have been published, however, making it difficult to determine whether these types of interventions are effective. It is not yet clear how successful these techniques are in eliminating the behavior although a few reports indicate that they can be highly successful for some patients. Pharmacological interventions include hormonal supplements or psychotropic medications.
Hormonal treatments are deed to inhibit deviant sexual behavior by reducing sexual drive and sexual arousal. They include the following: 1 estrogen; 2 medroxyprogesterone acetate MPAwhich lowers plasma testosterone and reduces gonadotropin secretion; 3 luteinizing hormone-releasing hormone agonists LHRH agonistswhich produce the pharmacological equivalent of castration by ificantly inhibiting gonadotropin secretion; and 4 antiandrogens such as cyproterone acetate CPAwhich blocks testosterone uptake and metabolism.
Treatment outcome studies suggest that these treatments are effective in reducing deviant sexual behavior provided that the treatment regimen is maintained, although more well-controlled treatment outcome studies are needed before the true effectiveness of these treatments can be determined. Psychotropic medications that affect the serotonin systems have recently been used to treat paraphilias.
Clinical studies suggest that SSRIs such as Prozac are effective in reducing paraphilic arousal and may be effective in reorienting arousal to more socially acceptable scenarios. The effectiveness of SSRIs in reducing paraphilic fantasies and behaviors suggests that these disorders may have an obsessive-compulsive component, as SSRIs are often used to treat obsessive-compulsive disorders.
As with hormone treatments, however, more well-controlled treatment outcome studies must be conducted before the true effectiveness of these treatments can be determined Bradford, About Us Cindy M. Meston, Ph. Sexual Paraphilias Cindy M.
Production Team.Domination and submission are not paraphilic because
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