Atypical Sexual VariationsChapter 17

Learning Objectives

• Normal versus Deviant Sexual Behavior• The Paraphilias• Theoretical Perspectives• Treatment of Paraphilias

Normal vs. Deviant Behavior

Defining Normal Sexual Behavior

• Statistical norms• Cultural considerations• Persistent preference for non-genital

sexual outlets• Atypical variations• Unusual patterns of arousal or

behavior that individuals or society view as problematic

Critical Thinking

Why is statistical rarity an inadequate standard for considering a sexual practice to be normal

or abnormal?

The Paraphilias

Fetishism• Inanimate object elicits sexual arousal• Common objects are articles of clothing and

materials made of rubber, leather, silk, or fur• Partialism• Related to fetishism • Sexual arousal is exaggeratedly associated with a

particular body part, such as feet, breasts, or buttocks

• Most fetishes and partialisms are harmless

The Paraphilias

Transvestism• Person repeatedly cross-dresses to achieve sexual arousal or

gratification, or is troubled by persistent, recurring urges to cross-dress

• Almost all transvestites are men• Both gay and heterosexual males report transvestism

• It is not the same as transsexualism.• Transsexuals cross-dress because of discomfort with their

anatomic sex and desire to be the other sex• However, some transvestites and some transsexuals may be

motivated by autogynephilia • A fetish in which men are sexually stimulated by fantasies

that their own bodies are female

The Paraphilias

Exhibitionism• Urges and fantasies involving exposing one’s genitals to

unsuspecting strangers• Provides sexual arousal or gratification• Urges are either acted upon or are disturbing

• Exposure to exhibitionism is common• A sample of college women found that one-third had been

approached by a “flasher”• Victims may experience negative psychological consequences

• Exhibitionists usually are not physically threatening• Often lonely and sexually repressed• Some progress to more serious crimes of sexual aggression

Critical Thinking

Critical thinkers pay closer

attention to definitions.

Why are (most) strippers and

nude sunbathers not

exhibitionists?

The Paraphilias

Obscene Telephone Calling

• Sexual arousal results from shocking victims

• Telephone scatologia• A DSM label for a

paraphilia characterized by the making of obscene telephone calls

• Usually socially inadequate heterosexual men

Voyeurism

• Characterized by observing unsuspecting strangers who are naked, disrobing, or engaged in sexual relations

• Most, but not all, voyeurs are nonviolent

• Often feel inadequate and lack social & sexual skills

The Paraphilias

• Characterized by the desire or need for pain or humiliation to enhance sexual arousal

• Bondage• Ritual restraint, as by shackles

• Hypoxyphilia• Person seeks to enhance sexual arousal, usually during

masturbation, by becoming deprived of oxygen• Although some masochists are women, it is much more

common among men• Masochists may form relationships with sexual sadists,

people who become sexually aroused by inflicting pain or humiliation

Sexual Masochism

The Paraphilias

• Characterized by the desire or need to inflict pain or humiliation on others to enhance sexual arousal

• Sadomasochism (S&M)• A mutually gratifying sexual interaction between consenting sex partners

• Sexual arousal is associated with the infliction and receipt of pain or humiliation

• Occasional, mild S&M is common among the general population

• S&M subculture exists in the US• S&M fantasies likely begin in childhood

Sexual Sadism

The Paraphilias

• Characterized by rubbing against or touching a non-consenting person• Often takes place in crowded places such as

buses, subways, or elevators• Also known as “mashing” or “groping”

• Reported exclusively among males• Toucherism

• Related to frotteurism and characterized by the persistent urge to fondle non-consenting strangers

Frotteurism

The Paraphilias

• Characterized by urges and fantasies involving sexual contact with animals

• Bestiality • Involves actual sexual contact with an animal

Zoophilia

• Characterized by desire for sexual activity with corpses• 3 types

• Regular – sex with a dead person• Necrophilic homicide – commit murder to obtain corpse for

sexual purposes• Necrophilic fantasy – fantasizes about sex with corpse

• Rare paraphilia & necrophiles are seriously disturbed

Necrophilia

The ParaphiliasLess common paraphilias

Klismaphilia• Sexual arousal is

derived from the use of enemas

Coprophilia• Sexual arousal is

attained in connection with feces

Urophilia• Sexual arousal is

associated with urine

These paraphilias may have

childhood origins

Theoretical Perspectives

Biological Perspectives

Examines factors such as the endocrine system and the nervous system• Some studies show that many paraphiliacs have

higher sex drive• Electroencephalograph (EEG) data show that

paraphilic men’s brains respond differently to sexual stimuli and paraphilic stimuli compared to control subjects

Theoretical Perspectives

Psychoanalytic Perspectives

Paraphilias are psychological defenses• Usually against unresolved castration

anxiety due to the Oedipus complex• Suppressed or repressed feelings of

sexual guilt and shame

Critical Thinking

If people with paraphilias have powerful urges to engage in “deviant” behavior due to

biological forces or unconscious fears, can they be expected to

control their behavior?

Theoretical Perspectives

Cognitive-Behavioral Perspectives

Paraphilias are learned behaviors acquired through experience• An object or situation may be associated with sexual arousal,

fantasies, or orgasm

Modeling or observational learning also may play a role

Theoretical Perspectives

Sociological Perspectives

Focus on • Social context• Effects of the group• Society in general

Theoretical Perspectives

An Integrated Perspective: The “Lovemap”

Acknowledges the multiple origins of paraphilias

Money (2000) proposes that childhood experiences create a lovemap• A mental representation of the idealized lover and the idealized erotic

activity with the lover• Lovemaps can become distorted by early traumas

Treatment of Paraphilias

Issues in treatment

• Many people with paraphilias don’t want treatment & don’t seek it voluntarily

• Ethical issues arise when providers are asked to contribute to judicial processes

• Providers realize they are likely to not be successful with resistant clients

• Perceived responsibility

Critical Thinking

Is it ethical for mental-health professionals to work with clients who do not want treatment?

Treatment of Paraphilias

Psychoanalytic Psychotherapy

• Focuses on resolving unconscious conflicts

Cognitive-Behavioral Therapy

• Focuses directly on changing behavior

Cognitive-Behavioral Treatment of Paraphilias

Systematic desensitization

• A method for terminating the connection between a stimulus and an inappropriate response

• Relaxation replaces sexual arousal

Aversion therapy

• A method for terminating undesirable sexual behavior in which the behavior is paired repeatedly with an aversive stimulus such as electric shock so that a conditioned aversion develops

Covert sensitization

• A form of aversion therapy in which thoughts of engaging in undesirable behavior are paired repeatedly with imagined aversive stimuli• Used with

pedophiles, a paraphilia involving sexual interest in children

Cognitive-Behavioral Treatment of Paraphilias

Social skills training

• Behavior therapy methods for building social skills that rely on a therapist’s coaching and practice• Used to help

individuals relate to the other gender

Orgasmic reconditioning

• A method for strengthening the connection between sexual arousal and appropriate sexual stimuli by repeatedly pairing the desired stimuli with orgasm

Medical Treatment of Paraphilias

Selective serotonin reuptake inhibitors (SSRIs)

• Used to treat exhibitionism, voyeurism, and fetishism• May treat the obsessive-

compulsive quality of paraphilias

Anti-androgen drug

• A chemical substance that reduces the sex drive by lowering the level of testosterone in the bloodstream• Depo-Provera is used in the

treatment of sex offenders• Suppresses, but does not

eliminate, sexual desire in men

• Unlike surgical castration (removal of the testes), the effects of this treatment can be reversed