Paraphilias (1)
Paraphilias (1)
○ Fantasies
○ Sexual urges
○ Behaviors
● Typically involve:
○ Nonhuman objects
● DSM-5 Distinction:
○ Paraphilias = Unusual sexual interests
● Often includes:
○ Compulsive qualities
Prevalence
○ Reluctance in self-disclosure
1. Fetishism
3. Voyeurism
4. Exhibitionism
Comorbidity
Core Characteristics
● Recurrent, intense sexually arousing:
○ Fantasies
○ Urges
○ Behaviors
● Focus involves:
Gender Differences
● Predominantly male
Diagnostic Threshold
● Object must be:
● Many men have fetish-like interests (e.g., lingerie), but do not meet criteria
Behavioral Expression
● Common practices:
Etiological Hypothesis
● Classical conditioning and social learning:
○ Fantasies
○ Urges
○ Behaviors
● Onset: Adolescence
● Involves:
○ With autogynephilia: Stronger link to gender dysphoria and desire for sex
reassignment
○ "Attracted not by the women outside them, but by the woman inside them"
○ 3% of men and 0.4% of women reported at least one erotic cross-dressing episode
Case Illustration
● Example highlights:
3. VOYEURISTIC DISORDER
Definition and Diagnostic Criteria (DSM-5)
○ Fantasies
○ Urges
○ Behaviors
● Involves observing:
○ Exhibitionism
○ Sadomasochism
○ Cross-dressing (Transvestism)
● Shyness and social inadequacy can lead to voyeurism as a substitute for relationships
● Lack of solid prevalence data, but considered one of the most common paraphilias
● Urban behaviors:
○ Driving by schools or bus stops, exposing while in the car, and speeding off
● Typically:
● Sometimes:
○ Children or adolescents
○ Voyeurism
○ Sadomasochistic interests
○ Cross-dressing
● Associated psychological features:
Behavioral Characteristics
● Sometimes involves:
○ Suggestive gestures
○ Masturbation
● More commonly:
○ Only exposure
Diagnostic Basis
Contextual Elements
○ Voyeurism
○ Exhibitionism
● Concern:
● Term derived from Marquis de Sade (1740–1814), known for extreme cruelty
● Related but less severe pattern: Bondage and Discipline (B & D)
Prevalence
● Small minority engage in nonconsensual, serious, sometimes fatal sadistic acts (Chang
& Heide, 2009; Dietz et al., 1990; Krueger, 2010)
● Examples of inflicted pain: whipping, biting, cutting, burning; from fantasy to mutilation
and murder
● Sadism and masochism may co-occur in the same individual (Kirsh & Becker, 2007)
Comorbidity
○ Narcissistic
○ Schizoid
○ Antisocial (Kirsh & Becker, 2007)
● Study of 20 sexually sadistic serial killers responsible for 149 murders in US & Canada
(Warren et al., 1996):
○ Murders were consistent, reflecting sexual arousal from pain, fear, panic
○ Control over victim’s life and death produced a “God-like” sense of exhilaration
Notorious Cases
○ Murdered 30+ women, targeted type: women with long hair parted in the middle
● Sexual sadism is a key concern for criminology, law enforcement, forensic mental health
● Proposed improvements:
7. SEXUAL MASOCHISM
Origin and Definition
● Masochists usually:
● Occurs in both men and women (Baumeister & Butler, 1997; Sandnabba et al., 2002)
Sadomasochistic Community
● Example:
○ Men bound and whipped by women called “dominatrixes”
○ Dominatrixes wear leather or rubber outfits, paid to inflict pain and humiliation
sexually
● Most members are high functioning and do not appear to suffer from their sexual
interests
● Autoerotic asphyxia:
○ Involves self-strangulation
○ Some speculate oxygen loss intensifies orgasm, but little evidence supports this
● Coroners in major U.S. cities find many deceased cases with masochistic pornography
or sexual paraphernalia
● Estimated accidental deaths in the U.S. per year: 500 to 1,000 (LeVay & Baldwin, 2012)
8. PEDOPHILIA
Definition and Diagnosis
○ Adult with recurrent, intense sexual urges or fantasies about sexual activity with a
prepubertal child
○ Acting on desires is not necessary if urges cause distress (see “DSM-5 Criteria”
on p. 410)
● Penetration and force often injurious but usually a byproduct, not goal (unlike sadists)
● Minority of pedophilic men are also sexual sadists (Cohen & Galynker, 2002)
● About two-thirds of victims are girls, typically ages 8–11 (Cohen & Galynker, 2002)
● Rate of homosexuality among pedophiles higher than in general population (Seto, 2008)
● Homosexual pedophilic offenders tend to have more victims than heterosexual pedophilic
offenders (Blanchard et al., 2000; Cohen & Galynker, 2002)
● Majority of pedophiles have used childhood pornography (Seto, 2004)
○ Pedophilic men show greater arousal to pictures of nude or partially clad girls
than matched nonoffenders
○ Some respond equally to children, adolescents, and/or adults (Seto, 2004; Seto et
al., 1999)
Psychological Characteristics
● Many pedophilic molesters are shy, introverted, but desire mastery or dominance
● Some idealize childhood traits such as innocence, unconditional love, simplicity (Cohen
& Galynker, 2002)
Neurobiological Findings
○ 81% of complainants male; 40% involved children ≤12 at abuse start (John Jay
College, 2004)
○ At least 400 priests charged in 1980s; $400 million in damages by early 1990s
(Samborn, 1994)
○ Mandatory removal policies adopted for priests known to have had sexual contact
with minors
○ 2005: Cardinal Francis George removed 11 priests for sexual misconduct
● German study: 30% of men seeking help never had sexual contact with children; most
had viewed child pornography (Neutze et al., 2011)
CAUSAL FACTORS AND TREATMENTS FOR PARAPHILIAS
Individual Explanations and Anecdotes
○ Raises questions:
Theoretical Explanations
○ Classical Conditioning:
○ Instrumental Conditioning:
○ Social Learning:
○ Limitation: Fails to explain why only a minority develop fetishes despite common
exposure