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-intense + persistent sexual interests other than sexual interest in genital stimulation or prepatory fondling with phenotypically normal, physically mature, consenting human partners -sometimes paraphilias concern the person's erotic activities, whereas others concern the person's erotic targets

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paraphilia

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-paraphilias that cause distress or impairment to the person or when the satisfaction of a paraphilia has caused harm or risk of harm to another person -abnormal sexual desires typically involved extreme or dangerous activities -these disorders are sometimes associated with criminal activities

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paraphilic disorder

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1) disorders based on anomalous (deviating from expected or normal) target preferences 2) disorders based on anomalous (deviating from expected or normal) activity prefences

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what are the two groups that paraphilic disorders are classified into?

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-when sexual fantasies, urges, or behaviors are associated with targets that deviate from what is considered normal or expected -most common target/object = women's lingerie -person with the disorder would find the underwear/lingerie ALONE arousing -BUT, not everything the person identifies as "sexy" indicates the presence of deviant sexual arousal ex. 1) fetishistic disorder 2) transvestic disorder 3) exhibitionist disorder/pedophilic disorder

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Paraphilic disorders based on anomalous target preferences

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-recurrent + intense sexual arousal (fantasies, urges, or behaviors) that involves nonliving objects or a highly specific focus on non-genital body parts -most common - women's underwear, stockings, footwear, etc. -sexual arousal occurs by looking at or fondling, rubbing, licking, etc. the object -***the sexual/arousal behavior MUST be accompanied by clinically significant distress or impairment in order to be considered a disorderd

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fetishistic disorder

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-recurrent + intense sexual arousal that results from cross-dressing and is accompanied by significant distress or impairment -occurs almost exclusively in men -not every man who cross dresses suffers from this disorder (ex. female impersonators)

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transvestic disorder (cross-dressing)

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-recurrent + intense sexual urges, sexually arousing fantasies, or behaviors involving sexual activity directed towards a prepubescent child or children -diagnosis is appropriate if person acts on their urges but denies distress or functional impairment -pedophile + child molester are not synonymous -someone with pedophilia could have urges or fantasies involving sexual activity with children, but never act on them (unlike a child molester)

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pedophillic disorder

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-fondling + genital exposure -perpetrators can be familial (incest) or non-familial -girls are more often victims than boys -not considered a criminal act if the person DOESN'T act on their urges/fantasies -(less common acts) intercourse

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most common pedophilic acts

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when the offender + child are related

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Incest

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-29% natural parents -29% other parents -40% other caretakers

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prevalence of pedophilic acts with boys/girls

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-has few victims -offends repeatedly with the same victim -offends in victim's home -mean age of victim is 8 years old -is also attracted to older women -is commonly married -has had behavior since adulthood -low income, unemployed, alcoholic, lower IQ, psychopathic

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characteristics of mens pedophilic acts with girls

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-has many victims (up to hundreds) -offends only once with a victim -offends away from victim's home -mean age of victim is 10 years old -not attracted to adults of either sex -single -has had behavior since adolescence -stable/employed, average IQ, "immature," prefers company of children rather than adults

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characteristics of mens pedophilic acts with boys

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-some behaviors in this category may elicit temporary startle reactions or annoyance from the victims -Also, some behaviors are not only deviant sexual behaviors but also criminal offenses -Exhibitionistic Disorder -Frotteuristic Disorder -Voyeuristic Disorder -Sexual Masochism Disorder -Sexual Sadism Disorder

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Paraphilic Dysfunctions Based on Anomalous Activity Preferences

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-recurrent + intense sexual arousal involving exposing one's genitals to an unsuspecting person -may also include the act of masturbation in front of a stranger -the shock of the victim is sometimes the sexually arousing component -most often the perpetrator is male -"high victim" crime -less likely than others to see their behavior as harmful to the victim

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Exhibitionist Disorder

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-recurrent + intense sexual arousal in the form of urges, fantasies, or behaviors that involve touching or rubbing against a non-consenting person -usually the person fantasizes about a positive emotional relationship with the victim -the behavior occurs in public places such as crowded buses or subways -areas of contact are usually thighs, buttocks, genitals, or breasts -occurs almost exclusively in young adult men/adolescents who have many victims and are rarely arrested

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Frotteuristic Disorder

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-involves sexually arousing urges, fantasies, etc. that are associated with seeing an unsuspecting person naked, undressing, or engaging in sexual activity -to be considered a disorder, must cause significant distress or person must perform voyeuristic acts -people with the disorder typically have limited social skills, limited sexual knowledge, + problems with intimacy

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Voyeuristic Disorder

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-recurrent + intense sexual arousal that occurs as a result of being humiliated, beaten, bound, or otherwise made to suffer -the events actually occur and are not stimulated -pain from being slapped, spanked, or whipped -humiliation from wearing a diaper, licking shoes, urinated on, self-mutilation, etc. -activities can lead to injury or death, BUT couples also sometimes have a mutual agreement to partake in these behaviors

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Sexual Masochism Disorder

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-involved infliction of pain or humiliation, but the physical or psychological influence is inflicted on another person -most common in males -in some cases, sadistic acts may be nonconsensual -most people who engage in sexual sadism have previously engaged in sexual masochism

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Sexual Sadism Disorder

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-people with a paraphilic disorder often have more than 1 -among a group of sex offenders with a paraphilic disorder: 29% had 2 disorders, 14% had 3 -people with paraphilic disorders are often indistinguishable from other people in nonsexual areas of functioning -they do not seek out pain/humiliation in other types of activities -men with transvestic disorder are actually happy with their biological sex + gender identity -their behaviors, occupations, + hobbies are those typical of other heterosexual males -***sometimes these disorders can result in death (sexual masochism and sexual sadism disorder)

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Functional Impairment of paraphilic disorders

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-people don't want to admit their behaviors to a stranger -also don't want to admit their behaviors b/c it could lead to criminal charges -because of this, the only info. there is about the disorders comes from people who seek/are referred to treatment -prevalence estimates are confusing + conflicting -BUT, we DO know that the disorders are rare -***almost all people with paraphilic disorders are male (but can be found in women) -BUT, in sexual masochism, women prefer less pain than men

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Sex, Race, + Ethnicity for paraphilic disorders

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-ex. exhibitionist disorder is only considered a paraphilic disorder when cultural norms require that you wear clothes to cover your genitals -BUT, in some tropical areas where exposing your genitalia is the norm, this disorder may not be diagnosed

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cultural factors involved in paraphilic disorders

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-most common age of onset = adolescence--> young adult -children are usually the victim -but very young boys have been known to sexually molest younger children -perpetrators used coercion to commit the offenses + also knew their victim

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Developmental Factors in Paraphilic Disorders

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-some theories involve the role of endocrine abnormalities, but data have failed to document differences between people with paraphilic disorders -neuroanatomical + neurochemical studies HAVEN'T detected brain abnormalities -few data supports the role of genetics

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Biological Theories for the Cause of Paraphilic Disorders

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-commonly held belief is that people who abuse children were abused as a child themselves -***BUT, this is not supported

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Psychosocial Theories for the Cause of Paraphilic Disorders

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-ex. if someone engages in a paraphilic disorder, and achieves sexual release, engaging in that behavior is reinforced and likely to be repeated -***BUT, this is not supported

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Behavioral Conditioning Theories for the Cause of Paraphilic Disorders

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-in order to be diagnosed, there needs to be significant distress or functional impairment -***people with paraphilic disorders often aren't motivated to change their behavior b/c the behavior is VERY reinforcing -the pleasurable state is likely to be repeated -***people who seek treatment do it b/c the legal system mandates it -people discontinue treatment once legal oversight is over -clinicians use plethysmorgraphy + photoplethysmography to measure sexual arousal (in order to measure efficacy of the interventions)

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Treatment of Paraphilic Disorders

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-penile plethysmography (for males) -vaginal photoplethysmography (for females) -***measures levels of arousal before and after intervention

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What do clinicians use to measure sexual arousal in order to determine the efficacy of interventions?

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-measures changes in penile tumescence (when blood vessels are enlarged)/blood flow when the man is shown sexually arousing or non-arousing stimuli -stimuli consists of nude photos of males + females of all ages against a plain background -***by identifying patterns of sexual arousal, this method can distinguish between sexual + nonsexual offenders and between rapists + child molesters and non-offenders -this method also predicts violent recidivism (tendency to re-offend) among sex offenders

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How is penile plethysmography conducted?

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1) potential exploitation of children (because nude photos are used) 2) researchers have to worry about transmission of HIV/AIDS when the plethysmograph is used 3) device is very intrusive (placed directly on penis) 4) some men can "beat" the machine + control their physiological response to appear less aroused

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Ethical, social, + medical concerns surrounding the method of penile plethysmography

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visual reaction time task

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New assessment strategy to be used instead of the penile plethysmography

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-measures the length of time that people look at slides of males + females (of all ages) who are wearing bathing suits -theory is that people will look longer at pictures they find sexually arousing

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Visual Reaction Time Task

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1) Surgical Castration 2) Pharmacological Interventions

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Biological Treatments for Paraphilic Disorders

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When the testes are removed (but this is no longer used)

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Surgical Castration

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1) SSRIs 2) Antiandrogens

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Examples of Pharmacological Interventions

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-since the paraphilic disorders are compulsive in nature, these had some promise due to their efficacy in treating OCD -but ultimately, the efficacy was not established

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SSRIs

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-the goal is to reduce sexual drive -drugs inhibit lutenizing hormone secretion, which lowers testosterone levels -as long as person continues to take meds (but there are sig. side effects + high recidivism rate) -the drug controls pedophilic disorder, exhibitionist disorder, + voyeuristic disorder

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Antiandrogens

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1) Behavioral Therapy and CBT 2) Learning Theory

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Psychosocial Treatments for Paraphilic Disorders

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-Behavioral Therapy and CBT -reduces recidivism (chances to re-offend) rates compared to programs that use other approaches or compared to offenders who do not receive treatment due to lack of financial + therapeutic resources

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What is the most common Psychosocial treament for paraphilic disorders?

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1) Eliminating or decreasing inappropriate sexual arousal 2) Enhancing appropriate sexual interest and arousal -treatment is based on classical + operant conditioning

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What are the two parts of Learning Theory for treatment of paraphilic disorders?

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1) Satiation 2) Covert Sensitization 3) Olfactory Aversion 4) Cognitive-Behavioral group therapy 5) Cognitive-Behavioral treatment

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Examples of ways to decrease or eliminate inappropriate sexual arousal (1st step of learning theory)

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-involves exposing the person to the arousing stimuli + continuing that exposure for an extended period until the stimuli no longer produce positive, erotic feelings -a # of sessions must be conducted until even any initial sexual arousal is eliminated

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Satiation

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-similar procedure in which the individual is asked to imagine doing the deviant act but also visualize the negative consequences that result from it -the scene is presented to patient for a period of time and over repeated sessions until the patient's urges to engage in the deviant behavior have been eliminated

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Covert Sensitization

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-pairing of unpleasant, but harmless odors (ex. ammonia) with either sexual fantasies or sexual behaviors -application of classical conditioning theory -typically the person presented with deviant sexual stimuli and then inhales ammonia fumes, which causes burning + watering eyes, runny nose, + coughing -***within repeated pairings, the deviant sexual behavior is suppressed

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Olfactory Aversion

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-intervention includes psychoeducational groups, anger management, assertiveness training, human sexuality, communication training, control of deviant sexual arousal, + relapse prevention

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Cognitive Behavioral Group Therapy

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1) Cognitive Restructuring 2) empathy training

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Cognitive Behavioral Treatments (examples)

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when distorted or faulty cognitions are identified + more adaptive positive thoughts are substituted

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Cognitive Restructuring (description)

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teaches offenders to recognize the harmful aspects of their behavior + put themselves in the place of the victim to build empathy toward him/her

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empathy training (description)

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1) Social Skills Training 2) Couples Therapy 3)Sex Ed. -sex is a biological drive + eliminating deviant sexual urges/behavior will be ineffective unless the person finds a more appropriate sexual outlet

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Examples of ways to enhance appropriate sexual interest + arousal (2nd step of learning theory)

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teaches the person basic social conversation skills (ex. initiating and maintaining conversations, using assertive behavior, + developing dating skills to establish relationships with appropriate adults

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Social Skills Training (description)

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