Some behaviors, such as child molestation, can clearly fit the first criterion (causing harm to others) without necessarily causing distress or impairing other functioning in the individual who does these things. It is important to consider context, as well as customs and mores which change over time, when evaluating the normality of a given sexual behavior.
Most people with paraphilias are male.
Information about the incidence of paraphilias is limited, primarily because people with them are too ashamed or embarrassed to seek help, or have no interest in changing.
Pedophilia is a disorder in which an adult (16 years or over) has uncontrollable sexual urges toward sexually immature children. Because of the extreme harm to innocent victims, this is perhaps the most widely investigated paraphilia.
Situational molesters are primarily interested in relationships with adults (and therefore are not pedophiles). However, in certain contexts, such as during a stressful time, they experience a strong impulse to become sexual with a child. Afterward, they feel distress over what they have done. For the preference molester , pedophilic behavior is ingrained into his personality and lifestyle. He has a clear preference for children, especially boys. He sees nothing wrong with his behavior. The child rapist is a violent abuser whose behavior is an expression of hostile drives.
Another model applies to sexual aggressors, in general, but seems particularly suited for examining pedophilia. The physiological sexual aggressor experiences deviant sexual arousal patterns. The cognitive sexual aggressor plans his sexual aggression, which is more likely acquaintance rape or incest, less impulsive and violent than other kinds. The affective sexual aggressor lacks affective control. His sexual aggression is opportunistic, unplanned, and often violent. The sexual aggressor with developmentally-related personality problems has a long history of personality and adjustment difficulties, family and interpersonal conflicts, and childhood victimization. They tend to engage in violent sexual aggression and have the poorest treatment prognosis.
Many pedophiles were sexually and emotionally abused as children, in which case they were once victims, then grew up to become abusers. However , most abused children do not grow up to become pedophiles. There appears to be a strong antisocial element in the personalities of child molesters, especially among those who prey on unrelated children.
One biologically based diagnostic tool is the p enile plethysmograph which measures blood flow to penis. In this case, the individual is measured when shown sexually arousing pictures of children to record his physical response.
Clinicians and researchers working within a biological perspective focus on finding somatic treatment to reduce sexual urges, such as by reducing testosterone using antiandrogens or the female hormone progesterone , or by surgical removal of the testes. Hypothalamotomy: Destroying ventromedial nucleus of the hypothalamus to change the individual’s sexual arousal patterns. Limited effectiveness. None of these procedures eliminate sexual arousal or the ability to have intercourse.
Electroshock is used as a form of aversive therapy in which the pedophile receives shock when he demonstrates a sexual reaction to children. Other aversive conditioning might involve talking about his practices to an audience that then ridicules him. In relapse prevention , the therapist helps the client identify problem situations and develop strategies to help avoid and cope more effectively. Group therapy has been found to reduce the number of repeat offenses.
The paraphilia of exhibitionism differs from socially sanctioned displays as would be found at a nudist beach or strip club. One treatment is covert conditioning , a behavioral method in which the client imagines feeling shame when acquaintances observe him engaging in exhibitionistic behavior.
A fetish is a strong, recurrent attraction to a nonliving object. The most common fetishistic objects are ordinary items of clothing. Fetishists may fondle or wear the object, wear it during sexual encounters, or masturbate with it.
The frotteur seeks out crowded places, such as buses or subways, where he can select an unsuspecting victim, then usually rubs up against the person until he ejaculates. He acts quickly and is prepared to run.
People with this condition have recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving real or simulated acts of being humiliated, beaten, bound, or made to suffer in other ways. The term comes from 19 th Century writer Leopold Baron von Sacher-Masoch (1836-1895) .
Sexual sadism is the converse of sexual masochism in that it involves inflicting pain rather than receiving it. The term comes from 18 th Century French author Marquis de Sade . In rare cases, individuals with sexual sadism commit homicide. The vast majority of masochists and sadists never seek treatment.
Fetishistic cross-dressing is often accompanied by masturbation or fantasies in which the man imagines that other men are attracted to him as a woman, and yet the man sees himself as a man and is heterosexual in orientation. Relatively few seek professional help. They are reluctant to give up their cross-dressing behavior.
The voyeur derives sexual gratification from observing the nudity or sexual activity of people who are unaware they are being observed . The voyeur feels frustrated and incapable of establishing a regular sexual relationship with the person he observes. The colloquial term “Peeping Tom” refers to the character Tom the Tailor, the only one in town to look during Lady Godiva’s nude ride. Therapy might focus on self-esteem issues.
Paraphilias NOS (Not Otherwise Specified) include a variety of conditions in which the person views, has recurrent fantasies about, or has sexual contact with unusual stimuli.
Most paraphilias emerge during adolescence, although there is usually a connection with events or relationships in early childhood. Once established, they tend to be chronic. Although biological factors play a role in some paraphilias, psychological factors seem to be central; in most cases, one or more learning events have taken place in childhood involving a conditioned response that results in a paraphilia. Treatment depends on the nature of the paraphilia and may include a biological component (such as medication), a psychological component (such as psychotherapy), and a sociocultural component (such as group or family therapy).
An individual’s gender identity may or may not match the assigned (biological) sex . Gender roles: A person’s behaviors and attitudes that are indicative of maleness or femaleness in one’s society. Gender identity disorder is more commonly called transsexualism .
Many individuals with gender identity disorder feel deeply depressed because of the “prison” in which they live. They become increasingly isolated and may prefer activities in which gender has no bearing.
Females exposed to increased androgens before birth are more likely to display stereotypically male gender roles. In rare cases, chromosomal abnormalities are found in which male-to-female transsexuals have an extra X chromosome. Boys with gender identity disorders are acutely sensitive to various sensory stimuli and to their parents’ affect. Psychological theories focus on factors such as the role of a parent's preference for a child of the other gender, the impact of early attachment experiences, and parents' unintentional reinforcement of cross-gender behavior. For some mothers, disappointment with the birth of yet another boy may negatively influence her relationship with younger sons. Birth order findings: Later-born boys have this more often, and they’re likely to have more brothers than sisters. Sociocultural theories consider various ways in which American society idealizes men and women according to certain stereotypical variables. Various factors influence the choice of intervention, with the most extreme method involving sex reassignment surgery.
Clinical work greatly depends on the age of the individual. The older they are, the more ingrained the condition will be.
Most studies evaluating the effectiveness of sex reassignment surgery indicate psychological improvement following the surgery. The people dissatisfied post-surgery tend to focus on unalterable bodily characteristics, such as large hands and feet, the persistence of the Adam’s apple, and the quality of their voice. Selection criteria have been developed to ensure that individuals seeking sex reassignment are appropriate candidates.
The National Health and Social Life Survey found sexual dysfunction reported by 43% of women and 31% of men. Sexual dysfunctions are usually related to other life problems: relationship, past experiences, depression, physical illness, substance abuse. Clinicians must determine whether the dysfunction has a psychological cause (such as depression or relationship problems) or results from a combination of psychological and physical factors. Masters & Johnson (1966, 1970) identified four phases of the sexual response cycle: arousal , plateau , orgasm , and resolution . Sexual dysfunctions are associated with the arousal and orgasm phases, and with initial sexual desire.
Individuals who experience lifelong hypoactive sexual desire disorder lack any interest in sexuality from the onset of puberty. Such cases are less common than those of individuals who develop this in adulthood after stress or interpersonal difficulties.
Aversions: Responses of discomfort or dislike to a particular object or situation. Masters & Johnson identified the four primary causes. Typically, the individual has sexual activity only once or twice a year, if that often. This is a source of strain in long-term, monogamous relationship.
Female sexual arousal disorder: A sexual dysfunction characterized by a persistent or recurrent inability to attain or maintain the normal physiological and psychological arousal responses during sexual activity. Male erectile disorder: A sexual dysfunction marked by a recurrent partial or complete failure to attain or maintain an erection during sexual activity. Also known as impotence . As with other sexual dysfunctions, arousal disorders may be lifelong or acquired; generalized or situational; due to psychological or physical factors. More than half the cases of erectile dysfunction are attributable to physical problems of a vascular, neurological, or hormonal nature, or to impaired functioning causes by drugs, alcohol, and smoking.
Female (or male) orgasmic disorder: A sexual dysfunction in which a woman (or man) experiences problems in having an orgasm during sexual activity. 8% of women have never had an orgasm at all. The individual’s concern over the problem or interpersonal difficulties that emerge in his or her close relationship result in psychological distress.
Due to premature ejaculation, the man feels little or no satisfaction. This is more common in younger men, perhaps associated with lack of maturation and experience. Behavioral treatments include the squeeze technique and the stop-start procedure .
Dyspareunia: A sexual dysfunction affecting both males and females that involves recurrent or persistent genital pain before, during, or after sexual intercourse. Vaginismus: A sexual dysfunction that involves recurrent or persistent involuntary spasms of the musculature of the outer part of the vagina.
In recent years, increasing attention has been given to the fact that bodily processes, such as illness, reactions to medications, diet, and even sleep, can cause and aggravate sexual difficulties. Many chemical substances, both medications and illicit drugs, can affect sexual functioning. For this reason, there is a DSM-IV category called substance-induced sexual dysfunction . Low testosterone is associated with sexual dysfunction. For both genders, depression is associated with a reduction in sexual desire and performance; unfortunately, many antidepressants further diminish sexual activity.
Treatment varies depending on the cause, the specific problem, and influencing factors. For example, if a man’s erectile problems are due to psychological factors, individual or couple therapy is recommended. When the cause is physical, several somatic interventions may be used, such as medication or surgery.
The effectiveness of sex therapy has not been adequately researched.
TREATMENT Masters & Johnson recommend sensate focus : The partners take turns stimulating each other in nonsexual but affectionate ways at first, then gradually progress over a period of time toward genital stimulation.