Paraphilias Flashcards
Current Perspective
- often misunderstood as a catch-all depiction for any unusual sexual behavior
- it’s a subtle but cortical difference that makes it possible for an individual to engage in consensual atypical sexual behavior without inappropriately being labeled with a mental disorder
- there’s a difference between atypical human behavior and behavior that causes mental distress to a person or makes the person a serious threat to the psychological and physical well-being of other individuals
- legal implications of paraphilic disorders are important; however updates were made to reflect the latest science and effective clinical practice
DSM 5 Criteria for Paraphilias
most people with atypical sexual interest do not have mental disorder. To be diagnosed with a paraphilic disorder, DSM5 requires that people with these interests:
-feel personal distress about their interests, not merely distress resulting from society’s disapproval or;
-have a sexual desire or behavior that involves another person’s psychological distress, injury, or death or a desire for sexual behaviors involving unwilling persons or person unable to give legal consent
-paraphilias don’t require or justify psychiatric treatment in themselves
-paraphilic disorder is a “paraphilias that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm to others
-template for paraphilic disorders involving Nonconsenting Victims (i.e. Voyeurisitic Disorder, Exhibitionist, Frotteuristic, Sexual Sadism) except Pedophilic Disorder:
A: over a period of at least 6 months: recurrent and intense sexual arousal (insert type here) as manifested by fantasies, urges and behaviors
B: the individual has acted on these sexual urges with a nonconsenting person or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Voyeuristic Disorder
A: over a period of at least 6 months: recurrent and intense sexual arousal from observing an unsuspected person who is naked, in the process of disrobing, or engaging in sexual activity as manifested by fantasies, urges or behaviors
B: the individual has acted on these secular urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or important areas of functioning
C: FOR THIS ONLY: the individual experiencing the arousal and/or acting on the urges is at least 18 years of age
Exhibitionistic Disorder
A: over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person as manifested by fantasies, urges or behaviors
B: the individual has acted on these urges with a nonconsenting person or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Frotteuristic Disorder
A: Over a period of at least 6 months: recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person as manifested by fantasies, urges or behaviors
B: the individual has acted on these sexual urges with a nonconsenting person or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Sexual Sadism Disorder
A: over a period of at least 6 months: recurrent and intense sexual arousal from the physical or psychological suffering of another person as manifested by fantasies, urges or behaviors
B: the individual has acted on these sexual urges with a nonconsenting person or the sexual urges have caused clinically significant distress or impairment in social, occupational or other important areas of functioning
Paraphilias DSM5 (consenting Pod criteria)
Not involving nonconsenting victims (sexual masochism, fetishistic disorder, and transvestism disorder)
A: over a period of at least 6 months, recurrent and intense sexual arousal (insert type here)
B: the individual has acted on these sexual urges with a consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Sexual Masochism
A: over a period of at least 6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges or behaviors
B: the individual has acted on these urges with a consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C: with asphyxiophilia: if the individual engages in the practice of achieving sexual arousal related to restriction of breathing
Fetishistic Disorder
A: over a period of at least 6 months, recurrent and intense sexual arousal from the use of non living objects or a highly specific focus on nongenital body parts as manifested by fantasies, urges or behaviors
B: the individual has acted on these sexual urges with a consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C: the fetish objects are not limited to articles of clothing used in cross-dressing (as in Tranvestic Disorder) or devices specifically designed for the purpose of tactile genitalia stimulation
Transvestic Disorder
A: over a period of at least 6 months: recurrent and intense sexual arousal from cross-dressing as manifested by fantasies, urges and behaviors
B: the individual has acted on these sexual urges with a consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational or other important areas of function
C: specify if: with fetishism, if sexually aroused by fabrics, materials or garments. With autogynephilia: if sexually aroused by thoughts or images of self as female
Pedophilic Disorder
A: over a period of at least 6 months, recurrent and intense sexually arousing fantasies, urges or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger)
B: the individual has acted on these sexual urges or the sexual urges or fantasies cause marked distress or interpersonal difficulty
C: the individual is at least age 16 years and at least 5 years older than the child or children in Criterion A
Note: do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12 or 13 year old
Specify if:
-exclusive type (attracted to only children)
-nonexclusive type
Specify if:
-sexually attracted to males
-sexually attracted to females
-sexually attracted to both
Specify if:
-limited to incest
Paraphilia Assessment
- lots of details
- conventional vs. unconventional (helps you feel what realm they’re in. As opposed to DSM help)
- legal issues/safety issues
- TSO (number of organisms per week), other sex history details including time spent, injury, etc.
- Past treatments
- impairment? Consent?
- OCD type: symptoms/compulsions?
Paraphilias: Treatment
options vary and must take into account the specific needs of each individual case. The following options are available:
- psychotherapy
- pharm
- surgical interventions (not widely used)
- CBT
- Orgasmic reconditioning (controversial)
- social skills training
- 12 step programs
- group therapy
- individual expressive-supportive psychotherapy
Pharmacologic Treatments
-antidepressants (e.g. SSRIs)
Used to treat depression and anxiety. High doses can cause decreased lovito, difficulty completing an orgasm, hard to get an erection
-long-acting gonadotropin-releasing hormones
-antiandrogens (used a lot in treatment of prostate cancer)
-phenothiazines
-mood stabilizers
-ethical issues with some of these treatments in some settings
Surgical Treatments
- psychosurgery using stereotaxic tractotomy and limbic leucotomy
- bilateral orchidectomy (surgical castration)
- considerable ethical issues here as well
