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Paraphilia

Paraphilia

Sexual feelings or behaviors that may involve sexual partners that are not human, not consenting, or that involve suffering by one or both partners.

To diagnose an individual with a paraphilia, the psychologist or other diagnostician must confirm recurrent, intense, sexually arousing feelings, fantasies, or behaviors over a period of at least six months. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), it is not uncommon for an individual to have more than one paraphilia.

Bestiality

Bestiality is a term that describes sexual feelings or behaviors involving animals. Termed zoophilia by the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), this is a relatively uncommon disorder. The disorder does not specify an animal or category of animals; the person with zoophilia may focus sexual feelings on domesticated animals, such as dogs, or farm animals, such as sheep or goats.

Exhibitionism

Exhibitionism is the exposure of genitals to a nonconsenting stranger. In some cases, the individual may also engage in autoeroticism while exposing himself. Generally, no additional contact with the observer is sought; the individual is stimulated sexually by gaining the attention of and startling the observer.

Masochism (Sexual)

Masochism is a term applied to a specific sexual disorder but which also has a broader usage. The sexual disorder involves pleasure and excitement produced by pain , either inflicted by others or by oneself. It usually begins in childhood or adolescence and is chronic. Masochism is the only paraphilia in which any noticeable number of women participateabout 5 percent of masochists are female. The term comes from the name of a nineteenth century Austrian writer, Leopold von Sacher-Masoch, whose novels often included characters who were obsessed with the combination of sex and pain.

In the broader sense, masochism refers to any experience of receiving pleasure or satisfaction from suffering pain. The psychoanalytic view is that masochism is aggression turned inward, onto the self, when a person feels too guilty or afraid to express it outwardly.

Pedophilia

Pedophilia involves sexual activity with a child, generally under age 13. The Diagnostic and Statistical Manual of Mental Disorders describes a criterion that the individual with pedophilia be over 16 years of age and be at least five years older than the child. Individuals with this disorder may be attracted to either males or females or both, although incidents of pedophilic activity are almost twice as likely to be repeated by those individuals attracted to males. Individuals with this disorder develop procedures and strategies for gaining access to and trust of children.

Sadomasochism

Sadomasochism applies to deviant sexual behavior in which an individual achieves gratification either by experiencing pain (masochism) or inflicting it on another (sadism).

In psychoanalytic theory, sadism is related to the fear of castration, while the behaviorist explanation of sadomasochism is that its constituent feelings are physiologically similar to sexual arousal. Separate but parallel descriptions are given for sexual sadism and sexual masochism in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The clinical diagnostic criteria for both are recurrence of the behavior over a period of at least six months, and significant distress or impairment of the ability to function as a result of the behavior or associated urges or fantasies. Either type of behavior may be limited to fantasies (sometimes while one is engaged in outwardly nondeviant sex) or acted out with a consenting partner, a non-consenting partner, or in the case of masochism, alone. Sadomasochism occurs in both males and females, and in both heterosexual and homosexual relationships.

Sadistic activities, which may express dominance or inflict pain and /or humiliation on the other person, include restraint, blindfolding, whipping, burning, rape , stabbing, strangulation, and even death. Masochists may seek to be the object of some of these acts as well as other types of humiliation, including forced cross-dressing. A particularly dangerous and fatal masochistic practice is hypoxyphilia, which consists of deliberately cutting off one's oxygen supply through mechanical or chemical means. Both sadistic and masochistic fantasies usually begin in childhood, and the disorders usually manifest in early adulthood. When associated with anti-social personality disorder , it may result in serious injury to others or death.

Voyeurism

Voyeurism is a paraphilia in which a person finds sexual excitement in watching unsuspecting people who are nude, undressing, or having sex. Voyeurs are almost always male, and the victims are usually strangers. A voyeur may fantasize about having sex with the victim but almost never actually pursues this. The voyeur may return to watch the same stranger repeatedly, but there is rarely physical contact.

Voyeurs are popularly known as "peeping Toms," based on the eleventh-century legend of Lady Godiva. According to the story, Tom was a tailor who "peeped" at Lady Godiva as she rode naked through the streets of Coventry, England, in a sacrificial act to get her husband to lower taxes. Tom was struck with blindness for not looking away like everyone else did.

Incidence and treatment

Psychologists estimate that a greater percentage of people experience sexual deviance than is officially reported. This is because many people who carry out sexual deviations do not consider their activities to be deviant. For instance, sadomasochists have group meetings, workshops, and large gatherings and have become something of a subculture. They do not typically think of themselves as needing therapy or treatment.

People who seek treatment for paraphilias often do so because they have been cited for illegal activity or because they are afraid they may do something illegal and be caught for it. Many different treatments have been tried with paraphilias, from medication to group therapy , to eliminate the behavior. Psychologists report low success rates, especially among criminally charged child molesters. Behavior modification is most likely to succeed when a combination of therapy, aversion technique (using electric shock or visualization to change pleasure experience), and medication is employed.

See also Pedophilia

Further Reading

Baumeister, Roy F. Escaping the Self: Alcoholism, Spirituality, Masochism, and Other Flights from the Burden of Selfhood. New York: Basic Books, 1991.

Caplan, Paula J. The Myth of Women's Masochism. Toronto: University of Toronto Press, 1993.

Carnes, Patrick. Out of the Shadows: Understanding Sexual Addiction. 2nd ed. Center City, MN: Hazelden Educational Materials, 1992.

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Paraphilias

Paraphilias

Definition

Paraphilias are sexual feelings or behaviors that may involve sexual partners that are not human, not consenting, or that involve suffering by one or both partners.

Description

According to the Diagnostic and Statistical Manual of Mental Disorders (known as the DSM) fourth edition text revised (DSM-IV-TR ), the manual used by mental health professionals to diagnose mental disorders, it is not uncommon for an individual to have more than one paraphilia. The DSM-IV-TR lists the following paraphilias: exhibitionism , fetishism , frotteurism , pedophilia , sexual masochism , sexual sadism , transvestic fetishism , and voyeurism . The DSM-IV-TR also includes a category for paraphilia not otherwise specified, which is the category for the less common paraphilias, including necrophilia, zoophilia, and others.

Exhibitionism

Exhibitionism is the exposure of genitals to a nonconsenting stranger. In some cases, the individual may also engage in autoeroticism while exposing himself. Generally, no additional contact with the observer is sought; the individual is stimulated sexually by gaining the attention of and startling the observer.

Fetishism

People with this disorder achieve sexual gratification with the use of objects, most commonly women's under-garments, shoes, stockings, or other clothing items.

Frotteurism

Individuals with this disorder are gratified by touching or rubbing a non-consenting person. This behavior often occurs in busy, crowded places, such as on busy streets or on crowded buses or subways.

Pedophilia

Pedophilia involves sexual activity with a child, generally under age 13. The DSM-IV-TR describes a criterion that the individual with pedophilia be over 16 years of age and be at least five years older than the child. Individuals with this disorder may be attracted to either males or females or both, although incidents of pedophilic activity are almost twice as likely to be repeated by those individuals attracted to males. Individuals with this disorder develop procedures and strategies for gaining access to and trust of children.

Sexual masochism

Masochism is a term applied to a specific sexual disorder but which also has a broader usage. The sexual disorder involves pleasure and excitement produced by pain, either inflicted by others or by oneself. It usually begins in childhood or adolescence and is chronic. An individual with this disorder achieves gratification by experiencing pain. Masochism is the only paraphilia in which any noticeable number of women participate about 5% of masochists are female. The term comes from the name of a nineteenth-century Austrian writer, Leopold von Sacher-Masoch, whose novels often included characters who were obsessed with the combination of sex and pain.

In the broader sense, masochism refers to any experience of receiving pleasure or satisfaction from suffering pain. The psychoanalytic view is that masochism is aggression turned inward, onto the self, when a person feels too guilty or is afraid to express it outwardly.

Sexual sadism

A sadistic individual achieves sexual gratification by inflicting pain on another person.

In psychoanalytic theory, sadism is related to the fear of castration, while the behaviorist explanation of sadomasochism (the deviant sexual practice combining sadism and masochism) is that its constituent feelings are physiologically similar to sexual arousal. Separate but parallel descriptions are given for sexual sadism and sexual masochism in the DSM-IV-TR. The clinical diagnostic criteria for both are recurrence of the behavior over a period of at least six months, and significant distress or impairment of the ability to function as a result of the behavior or associated urges or fantasies. Either type of behavior may be limited to fantasies (sometimes while one is engaged in outwardly nondeviant sex) or acted out with a consenting partner, a non-consenting partner, or in the case of masochism, alone. Sadomasochism occurs in both males and females, and in both heterosexual and homosexual relationships.

Transvestic fetishism

This disorder is characterized by heterosexual males who dress in women's clothing to achieve a sexual response. The activity may begin in adolescence, and in secret; later, as an adult, the man may dress as a woman completely and in public. Not all men who cross-dress are unhappy with their gender, but some are. In a small minority of men with transvestic fetishism, gender dysphoria (unhappiness with original gender) may emerge, and those men may eventually seek hormonal treatments or surgical sex reassignment to enable them to live permanently as women.

Voyeurism

Voyeurism is a paraphilia in which a person finds sexual excitement in watching unsuspecting people who are nude, undressing, or having sex. Voyeurs are almost always male, and the victims are usually strangers. A voyeur may fantasize about having sex with the victim but almost never actually pursues this. The voyeur may return to watch the same stranger repeatedly, but there is rarely any physical contact.

Voyeurs are popularly known as "peeping Toms," based on the eleventh-century legend of Lady Godiva. According to the story, Tom was a tailor who "peeped" at Lady Godiva as she rode naked through the streets of Coventry, England, in a sacrificial act to get her husband to lower taxes. Tom was struck with blindness for not looking away like everyone else.

Uncommon paraphilias

BESTIALITY. Bestiality is a term that describes sexual feelings or behaviors involving animals. Termed zoophilia by DSM-IV this is an uncommon disorder. The disorder does not specify an animal or category of animals; the person with zoophilia may focus sexual feelings on domesticated animals, such as dogs, or farm animals, such as sheep or goats.

NECROPHILIA. Necrophilia is a term that describes sexual feelings or behaviors involving corpses.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statsistical Manual of Mental Disorders. Fourth edition, text revised. Washington DC: American Psychiatric Association, 2000.

Baumeister, Roy F. Escaping the Self: Alcoholism, Spirituality, Masochism, and Other Flights from the Burden of Selfhood. New York: Basic Books, 1993.

Caplan, Paula J. The Myth of Women's Masochism. Toronto: University of Toronto Press, 1993.

Carnes, Patrick. Out of the Shadows: Understanding Sexual Addiction. 3rd ed. Center City, MN: Hazelden Educational Materials, 2001.

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Frotteurism

Frotteurism

Definition

Frotteurism is a disorder in which a person derives sexual pleasure or gratification from rubbing, especially the genitals, against another person, usually in a crowd. The person being rubbed is a victim. Frotteurism is a paraphilia, a disorder that is characterized by recurrent intense sexual urges and sexually arousing fantasies generally involving objects, the suffering or humiliation of oneself or one's partner (not merely simulated), or children or other nonconsenting persons.

Description

The primary focus of frotteurism is touching or rubbing one's genitals against the clothing or body of a nonconsenting person. This behavior most often occurs in situations that allow rapid escape. Frottage (the act of rubbing against the other person) is most commonly practiced in crowded places such as malls, elevators, on busy sidewalks, and on public transportation vehicles.

The most commonly practiced form of frotteurism is rubbing one's genitals against the victim's thighs or buttocks. A common alternative is to rub one's hands over the victim's genitals or breasts.

Most people who engage in frottage (sometimes called frotteurs) usually fantasize that they have an exclusive and caring relationship with their victims during the moment of contact. However, once contact is made and broken, the frotteur realizes that escape is important to avoid prosecution.

Causes and symptoms

Causes

There is no scientific consensus concerning the cause of frotteurism. Most experts attribute the behavior to an initially random or accidental touching of another's genitals that the person finds sexually exciting. Successive repetitions of the act tend to reinforce and perpetuate the behavior.

Symptoms

In order for the disorder to be clinically diagnosed, the symptoms must meet the diagnostic criteria as listed in the professional's handbook, the Diagnostic and Statistical Manual of Mental Disorders . These symptoms include:

  • Recurrent, intense, or sexually arousing fantasies, sexual urges, or behaviors that involve touching and rubbing against a nonconsenting person.
  • The person has acted on these sexual urges, or the fantasies or urges cause significant distress to the individual or are disruptive to his everyday functioning.

Demographics

Males are much more likely to engage in frotteurism than are females. Females are the most common victims of frotteurism. Most acts of frottage are peformed by those between 15 to 25 years of age. After the age of 25, the acts decline.

Diagnosis

Most people with frotteurism never seek professional help, but people with the disorder may come into the mental health system as a result of a court order. The diagnosis is established in an interview between the person accused of frotteurism and the mental health professional (a psychiatrist or a psychologist , for example). In the interview, the individual acknowledges that touching others is a preferred or exclusive means of sexual gratification. Because this acknowledgment can bring criminal charges, the disorder is underdiagnosed and its prevalence is largely unknown. In some cases, other people besides the accused may be interviewed, including observers or the victim.

Treatments

For treatment to be successful, the frotteur must want to modify existing patterns of behavior. This initial step is difficult for most people with this disorder to take.

Behavior therapy is commonly used to try to treat frotteurism. The frotteur must learn to control the impulse to touch nonconsenting victims. Medroxyprogesterone, a female hormone, is sometimes prescribed to decrease sexual desire.

Frotteurism is a criminal act in many jurisdictions. It is usually classified as a misdemeanor. As a result, legal penalties are often minor. It is also not easy to prosecute frotteurs as intent to touch is difficult to prove. In their defense statements, the accused often claim that the contact was accidental.

Prognosis

The prognosis for eliminating frotteurism is poor as most frotteurs have no desire to change their behavior. Since frotteurism involves nonconsenting partners and is against the law in many jurisdictions, the possibility of embarrassment may deter some individuals.

Prevention

Most experts agree that providing guidance as to behavior that is culturally acceptable will prevent the development of a paraphilia such as frotteurism. The origin of some instances of frotteurism may be a truly accidental contact that becomes associated with sexual gratification. There is no way to predict when such an association will occur.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition, text revised. Washington DC: American Psychiatric Association, 2000.

Gelder, Michael, Richard Mayou, and Philip Cowen. Shorter Oxford Textbook of Psychiatry. 4th edition. New York: Oxford University Press, 2001.

Kohut, John J., Roland Sweet. Real Sex: Titillating but True Tales of Bizarre Fetishes, Strange Compulsions, and Just Plain Weird Stuff. New York, Plume, 2000.

Wilson, Josephine F. Biological Foundations of Human Behavior. New York: Harcourt, 2002.

PERIODICALS

Eiguer, A. "Cynicism: its function in the perversions." International Journal of Psychoanalysis 80, no. 4 (1999): 671-684.

Rosler, A., and E. Witztum. "Pharmacotherapy of paraphilias in the next millennium." Behavioral Science Law 18, no. 1 (2000): 43-56.

Seelig, B. J., and L. S. Rosof. "Normal and pathological altruism." Journal of the American Psychoanalytic Association 49, no. 3 (2001): 933-959.

ORGANIZATIONS

American Medical Association. 515 N. State Street, Chicago, IL 60610. Telephone: (312) 464-5000. Web site: <http://www.ama-assn.org/>.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. FAX (202) 682-6850. Web site: <http://www.psych.org/>.

American Psychological Association. 750 First Street NW, Washington, DC, 20002-4242, Telephone: (800) 374-2721 or (202) 336-5500. Web site: <http://www.apa.org/>.

L. Fleming Fallon, Jr., M.D., Dr.P.H.

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sexual deviation

sexual deviation (seks-yoo-ăl) n. any sexual behaviour regarded as abnormal by society. The deviation may relate to the sexual object (as in fetishism) or the activity engaged in (for example, sadism and exhibitionism).

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