SET 11 - Paraphilic Disorders

List and describe the eight paraphilic disorders recognized in the DSM-5.

1. Voyeurism: Observing an unsuspecting / non-consenting person.

2. Exhibitionism: Exposing genitals to an unsuspecting person.

3. Sexual Sadism: Inflicting suffering on another person.

4. Pedophilia: Children who have not entered puberty.

5. Fetishism: Nonliving objects or non-genital body parts.

6. Frotteurism: Touching or rubbing against someone.

7. Sexual Masochism: Humiliated, bound, made to suffer.

8. Transvestism: Cross-dressing for sexual purposes.

Describe the nature of paraphilias and how they manifest.

It’s common for someone with a paraphilia to be male, have more than one paraphilia, have comorbid mental health problems, and have both paraphilic and non-paraphilic sexual interests.

Distinguish between paraphilic interest, paraphilia, and paraphilic disorder.

A paraphilic interest is simply an unusual sexual interest. A paraphilia is when that interest becomes long-standing, persistent, and necessary for sexual enjoyment. A paraphilic disorder is diagnosed when a person has recurrent, intense sexually arousing fantasies, urges, or behaviours involving this interest for ≥6 months, and these cause distress or impairment, or have been acted on with a non-consenting partner.

Identify biological factors implicated in paraphilias.

• Low IQ.

• Poor memory.

• Left-handedness.

• Less dense white matter in brain regions.

• TBI before age 13.

Identify psychological factors implicated in paraphilias.

• Conditioned arousal (acquired through classical conditioning and reinforced through operant conditioning).

• Attempts to suppress sexual thoughts.

• Higher-than-average sex drive.

Identify social and developmental factors implicated in paraphilias.

• Difficulties developing relationships with same-age peers.

• Early sexual experiences.

• Early sexual victimization.

Summarize the clinical features and diagnostic requirements of pedophilic disorder.

Diagnosed when a person experiences attraction towards prepubescent children that is distressing, impairing, or has been acted on. It can be exclusive (children only) or non-exclusive (attraction to children + adults).

Describe the assessment process of pedophilic disorder, including when it happens and the sources of information used by clinicians.

Assessment typically happens after a sexual offence has been committed, often as part of a forensic evaluation, because very few individuals seek help or self-identify due to shame, stigma, and fear of consequences. Sources of information include self-report, legal history, or even phallometry.

Describe interventions to decrease arousal to children in the treatment of pedophilic disorder.

• Aversive Conditioning: Pairing children with something bad.

• Covert Sensitization: Thinking about the consequences.

Describe interventions to increase arousal to adults in the treatment of pedophilic disorder.

• Organismic Reconditioning: Pairing sexual pleasure with adults.

Describe interventions to control or manage arousal in the treatment of pedophilic disorders.

• Medications: SSRIs and anti-androgens = “chemical castration.”

• CBT: Challenge pedophilic cognitions.

Describe ethical issues for clinicians when working with individuals with pedophilic disorder.

Under the Child, Youth, and Family Enhancement Act, clinicians have a legal duty to report when they have reasonable and probable grounds to believe that a child is “in need of intervention,” meaning the child has been or is at risk of being abused or sexually abused by a guardian. In cases where someone has already offended, their offence can count as “reasonable and probable grounds,” and when there is no offence history, simply disclosing pedophilic attractions may also count as “reasonable and probable grounds.”