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Major Mental Illness > Paraphilic Disorders > Flashcards

Paraphilic Disorders Flashcards

1
Q

Paraphilias

A
  • recurrent atypical arousal /practice to objects with sexual fantasies, behaviors, urges for at least 6 months.
  • if a paraphilia causes distress or impairment to the individual or if its satisfaction entails personal harm (or the risk of such harm) to others, it is considered a paraphilic disorder.
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2
Q

DSM IV versus DSM V

A

DSM V diagnoses individuals with paraphilia ONLY if they are in distress or cause personal harm to self or others.

DSM V also has remission specifiers:

   - in a controlled environment (incarcerated) 
  - in full remission (urges have not been acting on for at least 5 years)
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3
Q

Paraphilia- to meet criteria for these disorders must meet….

A
  • Criteria A: intense sexual arousal
  • Criteria B: distress or impairment of functioning
  • DSM IV had a distinction that they needed to be in distress, but the DSM V argues this because individuals can have a paraphilia and NOT be in distress.
  • you can engage in a paraphilia..without having a mental disorder if you have a consenting adult.
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4
Q

Adolescence & Paraphilias

A

we don’t typically dx an adolescent with paraphilia due to not wanting to stigmatized them.

They also dont want to dx early because during this time sexuality is still fluid.

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5
Q

Paraphilia: Fetishism

A
  • Recurrent and intense sexual arousal (fantasies/urges) from either the use of nonliving objects (inanimated) or a highly specific focus on nongenital body parts
  • Female clothing, vibrators
  • Arousal may be in the form of smelling, licking, sucking, cutting, burning, stealing, or seeing someone else dressed in the fetish objects
  • Fetish objects may include footwear, diapers, gloves, certain fabrics
  • Present for at least 6 months
  • Mostly in men
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6
Q

Paraphilia: Transvestic Disorder

A

•Recurrent, intense sexual arousal from cross-dressing, manifested by fantasies, urge, or behaviors for at least 6 months
•Significant distress, impairment
•Specifiers:
- Fetishism- aroused by fabrics, materials, or garments
- Autogynephilia – sexual arousal from thoughts or images of self as female
•Majority is men – most identify as heterosexual, but some homosexual men have reported arousal to cross-dressing, to a lesser extent than heterosexuals
•Can be associated to gender dysphoria and desire to change to the female gender role, especially when paired with autogynephilia

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7
Q

Paraphilia: Exhibitionistic Disorder

A

•Recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person for at least 6 months (one of the most comm)
- May consist of showing genitals or masturbating in front of, a stranger
- Victim’s shock is sexually arousing
•Must act on sexual urges/fantasies and there must be marked distress due to their sexual interest
•Majority of exhibitioners are married or in common-law relationships and enjoy sexual activity with their partners
•Compared to other paraphilias, they see their behavior less likely to be harmful to the victim
•Mostly in men

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8
Q

Paraphilia : Voyeurism

A
  • Recurrent, intense sexual arousal from observing an unsuspecting person who is naked, unrobing, or engaging in sexual activity
  • Distress, interpersonal difficulties, or present in actual voyeuristic behaviors
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9
Q

Paraphilia: Frotteuristic Disorder

A

•Recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person – at least 6 months
•Clinically significant distress or impairment is not required if acted on the urges
•Toucherism – has been coined to describe those who use hands to touch instead
•Public areas are best for these people (crowded trains)
•Mostly men
**in Japan it was more tolerated bc of the view that “ men were just being men” but now its being cracked down on

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10
Q

Paraphilia: Sexual Masochism Disorder

A

•Recurrent, intense sexual arousal from the (actual…not simulated) act of being humiliated, beaten, bound, or otherwise made to suffer for at least 6 months
•Consequent distress or impairment in at least one area of functioning
-Specifier – Asphyxiophilia: practice of achieving sexual arousal related to restriction of breathing

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11
Q

Paraphilia: Sexual Sadism Disorder

A
  • In some ways, complementary opposite of sexual masochism disorder
  • Recurrent, intense arousal from the phys/psych suffering of another person for at least 6 months
  • Urges/fantasies must have been carried out, been distressing, or caused interpersonal difficulties
  • It’s been suggested the sexual interest of power, rather than inflicting pain, is at the core of SSD
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12
Q

Profile of individuals who may be meet criteria for Sexual Sadism Disorder

A

•Most in men

  • many serial killers are sadists….and choose individuals who are easy targets
  • May be very dangerous if co-morbid with antisocial PD
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13
Q

Rapists (NOT CONSIDERED PARAPHILIA)

A
  • Rapists tend to be sexually aggressive and may have been abused as boys
  • There is no relationship to sexual arousal
  • Are considered to hold callous attitudes towards women
    • blaming the woman for provoking the act
    • “you enjoyed that! Its your fault!”
    • respond highly to depictions of rape scenes and enjoy watching
  • are not premeditated …more opportunistic
  • ## tend to be individuals who are acquaintances and/or date rapers
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14
Q

Paraphilia: Pedophilic Disorder

A

•Recurrent, intense sexually arousing fantasies, sexual urges, or behavior involving sexual activity with a prepubescent child or children – at least 6 months
•Must experience distress or interpersonal difficulty or have acted on urges
•The individual must be at least 16 years old and at least 5 years older than the
prepubescent child
- not to be diagnosed before the age of 16
•Pedophilia is a psych disorder, while child molester is reserved for those who act on it
- the child molester is not out to hurt the child, they aren’t overly aggressive (even though they are hurting the child)
- they take advantage of the child’s trust and try to convince them that its OK
•May be sexually aroused by girls, boys, or both, or may be specific to certain ages
- Incestual pedophilia- victim and perpetrator are related and they have special status and have power over the child (father, family relationship)

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15
Q

Prevalence of Pedophilic Disorders

A

-prevalence cannot really be known, but a study in 2010 of 18-60 years of age (M &F) said that about 3.1% have exposed their genitals to gain arousal

  • 7.7% being sexually aroused by spying on somebody
  • 4% report having sexual contact with a child
  • 9% report having sexual fantasies with a child
  • 6% report having masturbated to fantasies of children

telephone survey = 2% of male responder and 1.4% engaged in sadistic or masochistic activity

1-3% of men have engaged in paraphilia

1/3 of women have experienced sexual abuse (13 years old and below)
- others say that this may be too high because its retrospective memories

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16
Q

Overall similarities among paraphilias

A
  • current and intense arousal for over 6 months
  • adolescents are not dx with paraphilias under age of 16
  • only dx if there is an unwilling participant or if the individual is distressed or impaired in functioning.
  • do not dx if there are two adult consenting individuals. (then its not a paraphilia)
  • tend to be due to hypersexuality
  • more likely to be found in sex therapy or forensic settings
17
Q

Briken & Kafka (2007) - Medication for paraphilia?

A
  • Medroxyprogesterone Acetate (MPA) indicated to reduce risk of repeated sexual offenders
    - Those who received it did not commit sexual offense and fewer overall nonsexual offense and probation violations than other 2 groups (those recommended to get it but didn’t, and those deemed not to have needed it)
    - LHRH agonists have been prescribed for treatment of pedophiles
    - Lithium also implicated in treatment for sex offenders
  • SRI antidepressants showed significant decrease in masturbation with paraphilic fantasies, impulsivity, and paraphilic acting-out, as well as depressive symptoms after 22 months
  • Mood, anxiety, substance, and neuro-disorders may occur more frequently than expected in sexually impulsive men
18
Q

Lawrence (2006)

A

Desire for healthy limb regarded as a paraphilia (apotemnophilia) but may be disorder of identity

     - Profound dissatisfaction with embodiment 
     - Desire for limb amputation may reflect an erotic target location error (ETLE), occurring in combination with an unusual erotic target preference for amputees - Individuals not psychotic - Desire for amputation usually accompanied by:
        - Attraction to amputees as romantic/sexual partners (acrotomophilia/amelotatism)
        - Experiencing sexual arousal/pleasure from pretending to be an amputee

**perhaps this may be an identity disorder, much like how cross dressing and arousal from the self as the opposite sex may be indicative of gender dysphoria

19
Q

Self-report assessments used in Paraphilia (5)

A
  • Multidimensional inventory of development sex and aggression
    • used with adults with sexual disorders
  • Multiphasic Sex history (MSI)
    • used with sexual offenders
  • Clark sex history questionnaire
    • variety of scales (child/adolescent fantasies, porno…etc)
  • Bradford Sexual history inventory (BSI)
  • Screening scales for paraphilic interest (SSPI)
20
Q

Assessing for Paraphilia

A

individuals do not want to report on their paraphilias

require comprehensive, multimodal, mental status examination for any co-occuring psychiatric disorders

need to review sexual history

physiological tests (arousal)

look at hormonal levels (some can predict paraphilia )

Measuring of erection using circumference looking at photos

collaborative information from others (parents, spouse)

self- report measures may work if individual is nonjudgmental and able to ask questions in a warm manner.

*rapist are aroused by violent pictures

21
Q

Paraphilia and comorbidity with other disorders

A
  • Overlap with personality disorders
    • 78% have mood, anxiety, eating disorders
    • substance abuse
    • 42% ADHD
    • impulse control disorders
    • 11% are voyeurs
    • 2/3 frotteurs show voyeurism behavior

Major Mental Illness (8 decks)

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