Sexual Disorders Notes

Sexual Disorders

Learning Objectives

  • Understand paraphilias, including their defining features, characteristics, psychological perspectives on origins and treatment, main types of sex offenders, and psychological problems of sexual victimizers.

  • Define gender identity disorder of childhood and its causes.

  • Understand the nature of transsexualism and non-transsexual gender identity disorder.

  • Define sexual dysfunction.

  • Understand the main types of sexual dysfunctions, their defining characteristics, and features.

  • Understand the nature and effectiveness of sex therapy.

  • Identify the changes/differences between DSM-4 and DSM-5 regarding sexual disorders.

PARAPHILIAS : Paraphilias are unusual sexual interests that may involve objects, situations, or people that are not typically considered sexual—and can cause harm or distress.

Example: Being sexually aroused by non-consenting people or non-living objects.

Note: Some paraphilias are illegal or harmful (like pedophilia), while others are only diagnosed if they cause distress or impair life.

Sexual Disorders Categories

  • Paraphilic Disorders

  • Gender Identity

  • Sexual Dysfunctions - problems w/ sexual response or dysfunction such as failure to erect or orgasm.

Abnormal Sexual Behavior

  • Causes harm to other people.

  • Causes an individual to experience persistent or recurrent distress or impairment in important areas of functioning.

Compulsive Sexual Behavior - doing something again and again

  • Also called hypersexuality, hypersexuality disorder, or sexual addiction.

  • Characterized by excessive preoccupation with sexual fantasies, urges, or behaviors that are difficult to control.

  • Causes distress or negatively affects health, job, relationships, or other parts of life.

Paraphilias Definition

  • "Para" meaning 'Faulty' or 'Abnormal', and "Philia" meaning "Attraction".

Paraphilias Elaborated

  • Persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature.

  • Common paraphilias include: pedophilia (sexual focus on children), exhibitionism (exposure of genitals to strangers), voyeurism (observing private activities of unaware victims) (getting sexual satisfaction while spying on others such as spying someone who is changing clothes). and frotteurism (touching or rubbing against a nonconsenting person).

Paraphilias - Key Features

  • Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving:

    • Non-human objects

    • Children or other non-consenting persons

    • Suffering or humiliation of oneself or a partner

Characteristics of Persons with Paraphilia

  • Usually lasts for at least 6 months.

  • Persistent thoughts about carrying out unusual behaviors.

  • Obsessive focus; stress occurs if the desired object is unattainable.

  • Potential loss of sight of other goals, concentrating on fulfilling sexual desires.

  • Causes intense personal distress or impairment in social, work, and other areas of life functioning.

  • Almost all cases of paraphilia involve men, except for sexual masochism.(satisfaction from being hurt)

Examples of Paraphilias

  • Telephone Scatologia: Making obscene phone calls, such as describing one’s masturbatory activity, threatening to rape the victim, or trying to find out the victim’s sexual activities.

  • Necrophilia: Deriving sexual gratification from viewing or having sexual contact with a corpse.

  • Zoophilia: Having sex with animals or having recurrent fantasies of sex with animals.

  • Coprophilia: Deriving sexual pleasure from contact with feces.

  • Klismaphilia: Deriving sexual pleasure from the use of enemas. ( a liquid inserted to the rectum)

  • Urophilia: Deriving sexual pleasure from contact with urine.

  • Autagonistophilia: Having sex in front of others.

  • Somnaphilia: Having sex with a sleeping person.

  • Stigmatophilia: Deriving sexual pleasure from skin piercing or a tattoo.

  • Autonepiophilia: Wearing diapers for sexual pleasure.

Telephone Scatologia Details

  • Often involves masturbation during the call or while dreaming about the telephone speech.

  • Usually completed after the connection is over.

Necrophilia Details

  • Pathological fascination with dead bodies.

  • Often takes the form of a desire to engage with them in sexual activities, such as intercourse.

Zoophilia Details

  • The perpetrator gets sexual pleasure in having sex with animals.

Urolagnia Details

  • Also known as urophilia or, more colloquially, a golden shower or watersports.

  • A paraphilia in which sexual excitement is associated with the sight or thought of urine or urination.

Diagnosis of Paraphilic Disorders

  • Must be distinguished from nonpathologic use of sexual fantasies, behaviors, or objects as stimuli for sexual excitement.

  • Studies that may be considered in the assessment of a patient with a paraphilic disorder include the following:

    • HIV screen

    • Hepatitis panel

    • Unscheduled DNA synthesis

    • Computed tomography (CT)

    • Magnetic resonance imaging (MRI)

    • Penile strain gauge

    • Abel assessment for interest in paraphilia

    • Phallometric testing

    • Electroencephalography (EEG)

Specific Paraphilias

  • Voyeurism: watching an unsuspecting/non-consenting individual who is either nude, disrobing, or engaging in sexual activity

  • Exhibitionism: exposing one’s genitals to an unsuspecting person

  • Frotteurism: touching or rubbing against a non-consenting person

  • Sexual masochism: being humiliated, beaten, bound, or otherwise suffering

  • Sexual sadism: the physical or emotional suffering of another person

  • Pedophilia: sexual activity with a prepubescent child (usually 13 years old or younger)

  • Fetishism: a sexual fascination with nonliving objects or highly specific body parts (partialism). Examples of specific fetishisms include somnophilia (sexual arousal by an unconscious person) and urophilia (deriving sexual pleasure from seeing or thinking about urine or urinating)

  • Transvestism: cross-dressing that is sexually arousing and interferes with functioning

  • Autogynephilia is a subtype of transvestism that refers specifically to men who become aroused by thinking or visualizing themselves as a woman.

Important Consideration

  • Paraphilias are not fleeting whims or daydreams about unusual sexual practices but are conditions that last at least 6 months.

Pedophilia Details

  • Pedophilia is where an adult (16 years and above) has uncontrollable sexual urges toward sexually immature children (13 and below).

  • Persists from months to even years.

  • Forms of sexual acts against children include kidnapping, sexual abuse, fondling, and penetration or intercourse.

Types of Pedophilia

  • Situational Molesters: Normal sexual development and interest but may engage in sexual activity with a child when stressed.

  • Preference Molesters: Pedophilic behavior is ingrained in the individual’s lifestyle; they have a clear preference for children (especially boys), may marry to hide the behavior, and see nothing wrong with it.

  • Child Rapist: A violent child abuser whose behavior expresses hostile sexual drives.

Treatment for Pedophilia

  • No one best treatment exists.

  • Clinicians may target the endocrine system, using testosterone-reducing drugs to ease sexual excitement among males.

  • Psychologists may explore the problem's roots in the abuser's childhood, early life experiences, and other factors.

Exhibitionism Details

  • The person has intense sexual urges and arousing fantasies involving exposing genitals to a group of strangers.

  • They do not expect a sexual reaction from the stranger but find the shock or fear in the onlooker to be arousing.

  • Have the fantasy that the onlooker will be sexually aroused.

Treatment for Exhibitionism

  • Usually a multi-faceted approach involving reliance on learning principles, like counter conditioning or aversive conditioning.

  • Treatment aims to unlearn the connection between sexual behavior and exhibitionist behavior.

Fetishism Details

  • Fetishism is where a person feels a strong recurrent sexual attraction to a nonliving object.

  • People with this are always preoccupied with the object of desire, and they become dependent on it as an object for sexual gratification.

  • Objects include shoes, gloves, underwear, stockings, swimsuits, etc.

Partialism Details

  • Another variant of Fetishism.

  • People with Partialism are solely interested in sexual gratification from a specific body part; examples are feet, neck, underarms, back, etc.

Characteristics of Fetishism

  • They do unusual actions to the desired object, like sucking, smelling, fondling, rubbing, burning, and cutting.

  • Have no desires for intercourse with a partner involving the desired object; rather, they would masturbate to the desired object.

  • Involves compulsive rituals beyond the individual's control, causing distress and interpersonal problems.

Treatment for Fetishism - Orgasmic Reconditioning

  • Orgasmic reconditioning refers to a learning procedure to help clients (patients) strengthen appropriate patterns of sexual arousal by pairing appropriate stimuli with the pleasurable sensations of masturbation.

  • It is a sex therapy technique in which a person switches fantasies just at the moment of masturbatory orgasm to try to condition themselves to become excited by more conventional fantasies.

  • Orgasmic reconditioning is a behavioral intervention geared toward a relearning process in which the individual associates sexual gratification with appropriate stimuli.

Frotteurism Details

  • Derived from the word ‘Frotter,’ meaning ‘To rub.’

  • Refers to masturbation that involves rubbing against another person.

  • A Frotteur has recurrent sexual desires for rubbing into people.

  • Targets of Frotteurs are non-consenting people; they target strangers.

Characteristics of a Frotteur

  • Obsessed with rubbing themselves against unsuspecting strangers, finding it sexually pleasurable.

  • Often acts quickly or undetected.

  • Fantasizes that they are in an intimate relationship with the stranger.

  • Treatment includes extinction and covert conditioning.

Sexual Masochism and Sexual Sadism

  • Sexual Masochism – Comes from the name of an Austrian Writer Leopold Baron von Sacher-Masoch, who is known for his novels about men being sexually humiliated by women. A Masochist is someone who seeks pleasure from being subjected to pain.

  • Sexual Sadism – The term Sadism comes from the name of French author Marquis de Sade, who wrote extensively about obtaining sexual enjoyment from inflicting cruelty.

  • Both terms were coined by Krafft-Ebing, a German physician.

Sexual Masochism Details

  • Disorder marked by an attraction to achieving sexual gratification by having painful stimulation applied to one’s own body, either alone or with a partner.

  • Men and women with this disorder achieve sexual satisfaction through means like binding, ropes, whips, or injuries.

Sexual Sadism Details

  • The converse of Sexual Masochism. It involves deriving sexual gratification from activities that harm or from urges to harm another person.

  • Seeing or imagining another’s pain excites the sadist.

  • In contrast to Sexual Masochism, which does not require a partner, sexual sadism clearly requires a partner to enact sadistic fantasies.

  • Sadomasochist is the term wherein a person does both Sadist and Masochist roles, or inflicting and receiving pain.

Characteristics of Sadists and Masochists

  • Sadists:

    • Have the urge and desire and recurrent sexual fantasies of inflicting pain, seeing physical pain, and humiliation of another person.

  • Masochists:

    • Have the urge and desire and recurrent sexual fantasies of receiving pain, being submissive to punishments, and other acts of humiliation.