Psychopathology - Paraphilias

Paraphilic Disorders

are patterns of sexual behavior in which individuals experience intense sexual arousal primarily associated with atypical objects, situations, or individuals that cause distress or impairment.

• Misplaced sexual attraction and arousal focused on inappropriate people or objects

Exclusive Paraphilic Disorder

Individual needs to have object to achieve orgasm

Preferred Paraphilic Disorder

Object does not have to be there, but person prefers it is there for orgasm

Optional Paraphilic Disorder

Individual can orgasm without the object, but it enhances the experience. Can achieve orgasm with or without object

Paraphilic Disorder has a high comorbidity with

Anxiety, mood, and substance use disorders

Paraphilic disorders manifest through …

Fantasies, urges, arousal, or behavior

Paraphilia is only considered disordered if

• When the individual experiences clinically significant distress or impairment in functioning.

• Acts on urges with a non-consenting individual

Causes of Paraphilic Disorders

May include biological, psychological, and social factors that influence sexual development.

• Deficits in typical sexual experiences

• Relationship difficulties in childhood or adolescence

• Suppressing unwanted fantasies may paradoxically increase them

Fetishtic Disorder

Sexual attraction to nonhuman objects

• Objects can be inanimate and/or tactile

• Ex: Hair, feet, shoes

Voyeuristic Disorder

A paraphilic disorder characterized by the act of observing unsuspecting individuals who are nude, undressing, or engaging in sexual activities, typically for the purpose of sexual arousal.

• Risk associated with “peeping” may intensify sexual arousal

Exhibitionistic Disorder

A paraphilic disorder characterized by the act of exposing one's genitals to unsuspecting individuals, often for the purpose of sexual arousal. Victims are usually strangers and the behavior may be linked to a desire for shock or attention.

• Element of thrill and risk is necessary for sexual arousal

Frotteuristic Disorder

A paraphilic disorder involving the act of touching or rubbing against a non-consenting person for sexual pleasure, often in crowded places.

Transvestic Disorder

A paraphilic disorder characterized by the act of cross-dressing for sexual arousal, often involving the wearing of clothing typically associated with the opposite gender. This behavior can be motivated by a desire for sexual excitement or to fulfill a fantasy.

• Males may (rarely) show highly masculine compensatory behaviors

• Most do not show compensatory behaviors

• Many are married and the behavior is known to spouse

• Not inherently pathological; only considered disordered if it causes significant distress or impairment

Sexual Sadism Disorder

A paraphilic disorder characterized by the act of deriving sexual pleasure from inflicting physical or psychological pain on another person. This behavior must result in significant distress or impairment to be considered disordered.

Sexual Masochism Disorder

A paraphilic disorder characterized by the act of deriving sexual pleasure from being humiliated, beaten, or otherwise made to suffer by another person. This behavior must cause significant distress or impairment to be deemed disordered.

Sadistic Rape

Sexual assault involving physical or psychological pain inflicted on the victim for the perpetrator's arousal. This act is characterized by the use of force and results in substantial trauma to the victim.

• Most rapist do not show paraphilic patterns of arousal - rape is about angry power and control

• Rapists tend to show sexual arousal to violent sexual and non-sexual material

Pedophilic Disorder and Incest

A paraphilic disorder involving sexual attraction to prepubescent children or sexual activity with a close relative.

• Vast majority of sufferers are male

• Rare, but not unheard of, in females

• Many sufferers do not act on desires and some engage in compensatory behavior

Hebephilia

A paraphilic interest in sexual attraction towards early adolescent individuals, typically aged 11 to 14. Distinct from pedophilia, which refers to attraction to prepubescent children.

Ephebophilia

A paraphilic interest in sexual attraction towards late adolescents, typically aged 15 to 18.

Neither are in the DSM due to lack of research

Hebephilia and Ephebophilia

Pedophilia Features

• Incestuous males may be aroused by adult women

• Male pedophiles are usually not aroused by adult women

• Some rationalize behavior - consider activity to be an act of affection or teaching experience

• Often engage in moral compensatory behavior

Statuatory Rape in North Carolina

Statutory rape in North Carolina is defined as sexual intercourse with a person under the age of consent, which is 16 years old. This crime does not depend on whether the minor gave consent.

14-27.23

A person is guilty of statutory rape if the person is at least 18 years of age and engages in vaginal intercourse with a victim who is a child under the age of 13 years

Psychosocial Interventions of Paraphilic Disorders

• Target deviant and inappropriate sexual associations

• Convert sensitization - imagining aversive consequences to form negative associations with deviant behaviors (ex: pedophilia)

• Orgasmic Reconditioning - Masturbation to appropriate (adult) stimuli

Why are incarcerated offenders are difficult to treat?

Incarcerated offenders are difficult to treat due to lack of motivation, limited access to continuous therapeutic programs, and potential denial of their behavior or conditions, which hinders the therapeutic process.

• High relapse rates

• Chronic course

Drug Treatments for Pedophilia

• Cyproterone Acetate (“Chemical Castration”): a hormonal treatment that reduces libido by blocking testosterone effects, helping manage urges in individuals diagnosed with pedophilia.

• Depo-Provera: Reduces testosterone. Most useful for dangerous sexual offenders; some take the drug to avoid going to prison

Gender Dysphoria

A psychological condition where a person experiences significant distress due to a mismatch between their assigned gender at birth and their experienced or expressed gender identity, often leading to a desire to transition.

Gender Identity usually begins between the ages of

18-36 months

Gender Dysphoria is more common in

Males. 5-14 per thousand versus 2-3 per thousand in females

Gender dysphoria rates are __ across cultures

Similar

Causes of Gender Dysphoria

• No clear biological causes identified, but likely has genetic component

• Studies have found that 62-70% of variance in gender expression is explained by genetics

• Exposure to certain hormones in the womb (Ex: Higher levels of testosterone may masculinize a female fetus)

Treatment for Gender Dysphoria

• Sex Reassignment Surgery

  • Must be psychologically/socially stable and live as desired gender for several years first

  • 75% report satisfaction with new identity

  • Female-to-male conversions adjust better

Treatment of Intersexuality

Often treated with surgery at birth; subsequent gender dysphoria may need to be addressed

Gender Nonconformity in Children

• Common and may not lead to gender dysphoria

• Can lead to negative social experiences

• Conflict between affirming child’s identity and encouraging cis-gender behavior to improve social adjustment

• Treatment should be individualized to specific child’s needs and environment