Paraphilias

Introduction

Paraphilia refers to sexual perversions. Freud invented the word: Para (along side of/adjacent to) Philia (to love).

3 components of sexuality

(1) Gender
(2) Orientation
(3) Intention - behaviors individual wants to do or have done to them. Paraphilia is a distortion of this.

Homosexuality is not a disorder of sexual intention

Epidemiology

male dominated - 20:1
age of onset - puberty; Peak of paraphilic behavior - 15-25 years
symptoms are often egosyntonic, so usually don’t seek medical help

Paraphilic Behaviors (DSM-IV syndromes)

(1) Criminal Behaviors

Exhibitionism - Recurrent urges to show genitalia in public; flashers

Voyeurisim - Watching, spying, peeping

Pedophilia - Children or young adolescents sex partners

Frotteurism - Touching/rubbing against non-consenting strangers

Sadism - Causing pain or suffering or dominating another person

(2) Non-Criminal Behaviors

Masochism - choosing to experience, pain, suffering, or humiliation (most commonly seen in women)

Hypoxyphism - plastic bag/noose use during sexual activity (500-1000 deaths/year in US)

Transvestic Fetishism - cross-dressing usually in the clothing of women, males have to be heterosexual

In homosexual population cross-dressing is involved with a Gender Identity Disorder.

Fetishism - use of an inanimate object for arousal. Shoes, etc.

Non-DSM-IV Paraphilias

Telephone Scatologica - obscene phone calling

Zoophilia - animals

Necrophilia - corpses

Urophilia - urination

Klismaphilia - enemas

Coprophilia - defecation

Characteristics of Paraphilia

General Characteristics

Longstanding urges, at least six months - if have sex with sheep once, not zoophilic
unusual erotic behavior or imagery which is highly arousing
imagery or behavior leads to clincially significant distress
Felt pressure to act out the fantasy
Eroticism contains aggression and is unconsciously dehumanized
Sexual dysfunction often present when paraphilic behavior or imagery is lacking (desire deficiency, arousal problems, orgasmic inhibition)

Defects in Psychological Intimacy

limited ability to form attachment to a partner; unable to neutralize aggression toward partner
difficulty containing anxiety over closeness
limited expectation of enhancing self through intimacy
limited motivation to engage in intimate sexual relationships

Paraphilic Psychodynamics - impairment of bonding, eroticized aggression, childhood emotional trauma, castration anxiety, poor parent-child relationships, sexual or physical abuse, unconscious struggles with gender identity

Relevant terminology

Sexual deviance - any expression of sexuality that society views as nonconventional for a given population

Sexual offender - anyone whose sexual behavior involves a criminal offense of victimization

Treatment

institutionalized treatment for only the most severe cases - hospital or prison
most treatment is delivered in outpatient settings:

individual and group therapies
pharmacotheray - SSRIs, testosterone lowering agents such as medroxy-progesterone (Provera)
treatment focus on co-morbidities: depression, anxiety, substance abuse

Nonparaphilic Sexual Compulsion - (Sex Addiction)

Obsessive sexual thoughts

Compulsive sexual behavior - downloading porn all day long, masturbating >5 times/day

Social impairment prevents intimacy and causes distractions

Erotic thoughts and behavior are not unusual

DSM-IV calls it "Sexual Disorder NOS"