Paraphilias

learn and explore the world of Paraphilia and its dysfunctions

1. Abnormal Psychology Welcome Introduction Of Paraphilia

2. Abstract There is a great deal of controversy concerning paraphilia, and defining what is normal versus deviant or disordered, given that this is to some degree dependent on cultural views of acceptability . I n this topic, we will outline the issues and describe recent progress in contributing factors and other sociological issues that affect generally in PARAPHILIA.

3. Paraphilia Abnormal Sexual Behaviors

4. Definition and classification According to the Diagnostic and Statistical Manual Disorder, Fourth Edition, Text Revision (DSM IV-TR) or to the International Classification of Mental Diseases (ICD-10th), paraphilias are defined as sexual disorders which are characterized by “ recurrent, intense, sexually arousing fantasies, sexual urges or behaviours, generally involving called “ paraphilia not otherwise specified ” .

5. GENERALLY involving; non human objects , the suffering or humiliation of oneself or one’ s partner, or children or other non-consenting persons that occur over a period of 6 months ” (criterion A), which “ cause clinically significant distress or impairment in social, occupational, or other important areas of functioning ” (criterion B ).

6. B rief History The term paraphilia comes from the Greek prefix “ para ” meaning AROUND OR BESIDE and “ philia ” an ancient Greek word for love . The term paraphilia first appeared in the third version of the DSM classification. In the first version of the DSM published in 1952, sexual deviations were conceptualized as a subclass of sociopathic personality disturbance.

7. Paraphilias PARA meaning “abnormal” and PHILIA meaning “attraction”, Literally, “Abnormal Attraction”

8. Paraphilia - Unusual Sexual Behaviours A paraphilia is distinguished by a preoccupation with the object or behaviour to the point of being dependent on that object or behaviour for sexual gratification. In most cases, types of sexual activity outside the boundaries of the paraphilia lose their arousal or satisfaction potential unless the person fantasizes about the paraphilia at the same time.

9. Causes of Paraphilia Unclear It is unclear what causes a paraphilia to develop. Psychoanalysts theorize that an individual with a paraphilia is repeating or reverting to a sexual habit that arose early in life. Behaviourists suggest that paraphilias begin through a process of conditioning. Nonsexual objects can become sexually arousing if they are repeatedly associated with pleasurable sexual activity.

10. Paraphilias Causes 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 some research has indicated that the behaviors will reduce as the individual ages. Most individuals with paraphilias are MEN .

11. Cont … Although biological factors play a role in some paraphilias , researchers have yet to identify a specific biological or biochemical cause. Instead, psychological factors seem to be central. In most cases, one or more events occurred during childhood that led the individual to associate sexual pleasure with that event (or object) thus resulting in the development of a paraphilia.

12. Paraphilias : Clinical and Forensic Considerations A content analysis of these materials would likely provide a reasonably accurate indication of the prevalence of these paraphilias —at least the legal ones. With the exception of those who are in legal trouble, most, but not all, persons with paraphilia probably do not seek treatment. Indeed, it has been argued that the impact of the mandatory reporting laws enacted for certain sexual crimes has further decreased the number of individuals seeking voluntary treatment.

13. Forensic considerations Simply having paraphilia is, obviously, not illegal. Acting in response to paraphilic urges, however, may be illegal and in some cases subjects the person with paraphilia to severe sanctions. The distinguishing phenomenological characteristic of paraphilias is an intense craving or urge to fantasize or engage in some form of sexual expression that most people would not find erotic. Most people simply do not experience such cravings. These urges are often difficult and, in some cases, may even be impossible to control. It is this putative lack of impulse control that underlies the insanity defense in trials alleging sexually criminal behavior. Such defenses are based on impaired mental capacity and are sometimes, although infrequently, successful.

14. Types of paraphilias While DSM-IV-TR does not classify paraphilias other than by erotic focus, it is clear from clinical practice that they may be either exclusive or nonexclusive as well as egosyntonic or egodystonic . Patients with the exclusive form of a paraphilia may not be able to be sexually aroused by anything other than their paraphilic imagery or behavior. By contrast, patients with the nonexclusive form may be aroused by other sexual fantasies, stimuli, and behaviors, although their paraphilias may interfere with their overall sexual experiences.

15. Comorbidity The paraphilias do not always occur in the absence of other psychopathology. Many paraphilic patients show evidence of major Axis I mental illnesses including affective disorders, substance abuse disorders, schizophrenia, other psychotic disorders, dementia, and other cognitive disorders. Paraphilias can occur within the context of Axis II disorders such as borderline or antisocial personality disorders and mental retardation, and Axis III disorders, such as temporal lobe epilepsy or brain trauma

16. Prevalence Prevalence rates for paraphilias are difficult to obtain due to changes in criterion over time and between cultures. surveyed a sample of 1,915 German men aged 40-79 and found 62.4% reported at least one paraphilia-associated sexual arousal pattern, and that this caused distress in only 1.7% of cases.

17. In terms of more standardized studies, most data are based on criminal reports or studies using clinical populations referred for legal reasons, rather than for self-help in the general population. However, prevalence rates are still difficult to report with any certainty, and this is further underpinned by the contentious nature of paraphilia definitions.

18. Characteristics of persons with a Paraphilia Usually lasts for 6 months. Always thinking to carry out their unusual behavior. Overly obsessed that if the individual cannot get to their desired object, they get stressed. The individual will lose sight of other goals and concentrate of the fulfillment of their sexual desires if worse. It causes intense personal distress or impairment in social, work and other areas of life functioning. Except for Sexual Masochism, almost all cases of Paraphilia Involve MEN.

19. But Keep in Mind!! Paraphilias are not fleeting whims or daydreams about unusual sexual practices but are conditions that last at least 6 months.

20. Types of paraphilias Both the ICD-10 and DSM-IV include eight specific paraphilias outlined with additional ‘not otherwise specified (DSM-IV), unspecified (ICD-10), other specified paraphilic disorder and unspecified paraphilic disorder (DSM-5)’ categories. Table 1 outlines paraphilias included in the DSM-IV and subsequent changes in DSM-5. There are numerous paraphilias . Some of the major types are:

21. Fetishism Fetishism is where a person feels a strong recurrent sexual attraction to a nonliving object. People with this are always preoccupied with the object of desire, and they become dependent to it as an object for sexual gratification. Objects include shoes, gloves, underwear, stockings, swimsuits, etc.

22. Partialism Another variant of Fetishism. People with Partialism are solely interested in the sexual gratification from a specific body part, examples are feet, neck, underarms, back, etc.

23. Characteristics of Fetishism They do unusual actions to the desired object, like sucking, smelling, fondling, rubbing, burning and cutting. Have no desires to intercourse with the partner with the desired object, rather, they would masturbate to the desired object. It involves compulsive rituals that are beyond the control of the individual, which can cause distress and interpersonal problems.

24. Transvestic Fetishism A syndrome found only in males. A disorder in which a man has an uncontrollable urge to wear a woman’s clothing, as primary means of achieving sexual gratification. This sexual gratification has a compulsive quality, and consumes a lot of emotional energy. Sometimes accompanied by masturbation.

25. Characteristics of Transvestic Fetishism Has recurrent urges and desires to wear woman’s clothing or cross dressing to achieve sexual gratification. The fantasies and sexual urges cause significant distress and/or impairment.

26. Voyeurism The word comes from the term VOIR, meaning “To See” A sexual disorder where an individual compulsively seeks sexual gratification from observing nudity or sexual activity of others who are unaware that they are being watched. This disorder is more common in men. The term “Peeping Tom” usually refers to voyeur.

27. Exhibitionism The person has intense sexual urges and arousing fantasies involving the exposure of genitals to a group of stranger/s. He/she does not expect a sexual reaction from the stranger but finds the shock or fear in the onlooker to be arousing Have the fantasy that the onlooker will be sexually aroused.

28. CONT… Compulsive act of inappropriately exposing one's sex organs to unsuspecting strangers for the purpose of sexual arousal and gratification. Also known as "indecent exposure" and "flashing," this paraphilia is found almost exclusively in males and the peak age of occurrence is reported to be in the twenties.

29. Sexual Masochism and Sexual Sadism Sexual Masochism Comes from the name of an Austrian Writer Leopold Baron von Sacher-Masoch . Who is known for his novels about men being sexually humiliated by women. A Masochist is someone who seeks pleasure from being subjected to pain. Sexual Sadism The term Sadism comes from the name of French author Marquis de Sade, who wrote extensively about obtaining sexual enjoyment from inflicting cruelty. Both terms were coined by Krafft-Ebing, a german physician.

30. Sexual Masochism Disorder marked by an attraction to achieving sexual gratification by having painful stimulation applied to one’s own body, either alone or with a partner. Men and women with this disorder achieve sexual satisfaction by such means like binding, ropes, whips, or injuries.

31. Sexual Sadism The converse of Sexual Masochism. It involves deriving sexual gratification from activities that harm, or from urges to harm, another person. Seeing or imagining another’s pain excites the sadist. In contrast to Sexual Masochism, which does not require a partner, sexual sadism clearly requires a partner to enact sadistic fantasies. Sadomasochist is the term where in a person does both Sadist and Masochist roles, or inflicting and receiving pain.

32. Sadomasochism A paraphilia that combines sadistic and masochistic roles in sexual interaction. Sadism is the intentional infliction of pain on another person or the threat to do so, for sexual excitement. Masochism is a condition in which a person derives sexual gratification from being subjected to pain or to the threat of pain

33. Characteristics of an S and M Sadists Have the urge and desire, and recurrent sexual fantasies of inflicting pain, seeing physical pain and humiliation of another person Masochists Have the urge and desire and recurrent sexual fantasies of receiving pain, submissive to punishments, and other acts of humiliation.

34. Pedophilia “The most disturbing disorder you will study in this book” Pedophilia is where an adult (16 yrs. Above) has uncontrollable sexual urges to sexually immature children (13 below) Persists from months to even years. Forms of sexual acts against children include kidnapping, sexual abuse, fondling, and penetration or intercourse.

35. Types of Pedophilia Situational Molesters Normal Sexual development and interest. But when stress calls for it, they sometimes want to become sexual with a child Preference Molesters Pedophillic behavior is already ingrained in the individual’s lifestyle, clear preference for children, esp. Boys, and will do anything (even marry) to hide his behavior, and clearly sees nothing wrong with his unusual behavior. Child Rapist A violent childabuser whose behavior is an expression of hostile sexual drives.

36. Bestiality Engaging in sexual contact with animals. When the act or fantasy of sexual activity with animals is a repeatedly preferred or exclusive means of sexual gratification, it is called ZOOPHILIA.

37. Frotteurism Derived from the word ‘ Frotter ’ meaning ‘ To rub’ Refers to the masturbation that involves rubbing against another person. Frotteur has recurrent sexual desires on rubbing into people. Targets of Frotteurs are not consenting people, rather they target strangers.

38. Characteristics of a Frotteur Obsessed with the rubbing of selves to unsuspecting strangers, finding it sexually pleasurable. Often acts quickly, or undetected. Fantasizes that they are in an intimate relationship with the stranger. Treatment includes extinction and covert conditioning.

39. Examples of Paraphilias Coprophilia - deriving sexual pleasure from contact with feces. Klismaphilia - deriving sexual pleasure from the use of enemas. Urophilia - deriving sexual pleasure from contact with urine. Autagonistophilia - having sex in front of others. Somnaphilia - having sex with a sleeping person. Stigmatophilia - deriving sexual pleasure from skin piercing or a tattoo. Autonepiophilia - wearing diapers for sexual pleasure.

40. Examples of Paraphilias Telephone Scatologia - making obscene phone calls, such as describing one’s masturbatory activity, threatening to rape the victim, or trying to find out the victim’s sexual activities. Necrophilia - deriving sexual gratification from viewing or having sexual contact with a corpse. Zoophilia - having sex with animals or having recurrent fantasies of sex with animals.

41. Abnormal Psychology Welcome Continuation Of Paraphilia Treatment

42. Treatment There is an abundance of small studies and case reports regarding a variety of pharmacological and psychological treatments within sex offender populations, as captured by the researchers, such as pedophilia , exhibitionism and rape. The research into treatment of other ‘non-criminal’ paraphilias is negligible, it is reliant on voluntary disclosure, which is very rare, and justification for treatment of such is still very much debatable

43. Group therapy in this setting is designed to help paraphilic individuals break through the denial they so commonly exhibit by surrounding them with other patients who share their condition. Once these individuals begin to admit that they have a sexual divergence, the therapist can begin to address individual issues that may have led to the sexual disorder. Group therapy

44. Cognitive- behavioral therapy Cognitive- behavioral therapy (CBT) involves applying behavioral therapy techniques to modify sexual deviations by altering patients’ distorted thinking patterns and making them cognizant of the irrational justifications that lead to their undesirable sexual behaviors

45. CBT TREATMENT 7-step approach Aversive conditioning with ammonia or (masturbatory ) satiation Confrontation of cognitive distortions (especially effective in groups) Victim empathy (showing videos of victims and the consequences they experience from the patient’s act) Assertiveness training (including social skills training, time management, and structuring) Relapse prevention (identifying antecedents to the behavior [high-risk situations] and ways of disrupting these antecedents) Surveillance systems (family associates who help monitor patient behavior ) Lifelong maintenance

46. Psychotherapy Psychotherapy is not the most effective form of treatment for pedophilia; however, it still is important to teach pedophiles what is at the root of their problems.

47. Individual expressive-supportive psychotherapy Individual expressive-supportive therapy requires a psychologically minded patient who is willing to focus on the paraphilia. The therapist should not set unrealistically high goals but must break through the denial

48. Pharmacologic Therapy Pharmacologic interventions may be used to suppress sexual behaviour . These treatments may offer genuine help to a variety of patients with paraphilic disorders;

49. Surgical Interventions Psychosurgery using stereotaxic tractotomy and limbic leucotomy may be performed. This is an invasive, irreversible procedure that was used on a small number of subjects, primarily in Germany. Some success has been reported in the treatment of pedophilia , hypersexuality , and exhibitionism. Given its emotional, physical, and intellectual adverse effects, as well as the availability of suitable pharmacologic interventions, this procedure is not likely to be widely used.

50. Family-Systems Theory Family systems therapy has been tried in homes where incest has occurred and it is desired by all family members to reunite or keep the family intact. This type of therapy needs to be insight oriented.

51. Conclusion Empirical studies indicate that the most effective treatment as far as physical sexual abuse is concerned resides in the castration methods – either physical, which is illegal, or chemical. The reason these methods are effective, is not because the illness is being cured, but rather because the sexual desire of the male is being inhibited.