Abnormal Sexual Psychology/Definition
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Abnormal Sexual Psychology
DSM-IV Clinical Paraphilias and Mental Health
| Table of Contents | Preface | Warning to Readers | Further Reading |
Contents |
[edit] Paraphilia
A paraphilia is being aroused by factors considered non-standard by mainstream society.
[edit] Clinical Meaning
 Paraphilias all have in common distressing and repetitive sexual fantasies, urges, or behaviors. These fantasies, urges, or behaviors must occur for a significant period of time and must interfere with either satisfactory sexual relations or everyday functioning if the diagnosis is to be made. There is also a sense of distress within these individuals. In other words, they typically recognize the symptoms as negatively impacting their life but feel as if they are unable to control them. |
The DSM-IV classifies paraphilias as an Axis II disorder.[1]. This means they are viewed as clinical syndromes or symptomatic personality functions that are evidenced in long lasting symptoms. Typically, all Axis II conditions are believed to affect all parts of the individual's way of interacting with the world, and are called pervasive. [The DSM-TR-IV identifies paraphilias as Axis I disorders. The only disorders recorded on Axis II are Personality Disorders and Mental Retardation. Please check DSM-IV-TR, pg. 28 for clarification.]
Clinically speaking, paraphilias are put in the same category as paranoia, antisocial disorders, and personality disorders.
[edit] Paraphilia as disorder
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Personality Disorders are mental illnesses that share several unique qualities. They contain symptoms that are enduring and play a major role in most, if not all, aspects of the person's life. While many disorders vacillate in terms of symptom presence and intensity, personality disorders typically remain relatively constant. |
In short, paraphilias are considered to be a component of the person's entire psychological makeup. They cannot be "fixed", but their effects can be suppressed. They should not be looked at as mere preferences. They are seen as being pervasive, as mentioned above, affecting all components of a person's lifestyle, thinking, and emotional states.
A person can like looking at naked members of the opposite sex, and get aroused by this. This is natural behavior. But such a person could also get aroused by risque talk, or while the person touches them in an erotic manner, or in anticipation of sexual contact in absence of any other arousing factors.
A person with a paraphilia, on the other hand, has varying levels of difficulty in becoming aroused when their specific trigger is not present. A "standard" pedophile might be able to become aroused by normal members of the opposite sex. An "exclusive" pedophile is unable to become aroused at all except by a pre-adolescent member of the opposite sex.[2]
The reason this is a disorder is that paraphilias tend to skew a person's entire way of thinking. A person with exclusively masochistic tendencies will be unable to function in a relationship without such overtones. They will be incapable of keeping such desires hidden from their sexual partners, and in some cases, may need to engage in autoerotic satisfaction of such desires merely to get through the day. This takes it beyond a mere preference or something that is enjoyed.
The other reason this is classified as a disorder is that the person with a paraphilia has no ability to control their desires. Pyrophilia is extremely dangerous both for the risk of arson and to the person suffering it, but pyrophiliacs are unable to control themselves.
There is research indicateing that paraphiliacs have higher libidos than normal people, and are more likely to experience sexual addictions related to their paraphilia. [3]
 To be diagnosed with a disorder that falls under Axis II, a psychologist has to find the following:
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[edit] Levels of Exclusivity
Each type of paraphilia is subclassified (by individual) on the level of exclusivity the person demonstrates for it. Many psychologists try to find patterns of behavior to distinguish between "levels" of paraphilia, to measure how much the paraphilia affects the individual.
DSM-IV does not adopt such terminology, but most psychologists agree that there are three levels of paraphiliac exclusivity.
- Level One: Referred to as "standard", "optional", and "low level".
- Level Two: Referred to as "preferred" and "mid level".
- Level Three:Referred to as "focused", "exclusive", and "high level".
(For the purposes of this book, we will use the "standard-preferred-focused" line of terminology).
A person with a standard paraphilia is very strongly aroused by the subject of the paraphilia, but can still find at least some level of arousal through more conventional methods. A masochist may achieve a higher level of arousal through pain, but can still be aroused normally. This is the lowest functional level of paraphilia, and is the most common. However, indulging in the paraphilia results in the activity becoming more and more preferred. Most fantasies involve the paraphilia, but they are rarely acted on, or if acted on are kept hidden and quiet.
A person with a preferred paraphilia is extremely aroused by the subject of the paraphilia, and achieves primary arousal through that means. They can only achieve arousal through conventioal methods with great difficulty, and sexual relations may fail if conducted without referral the paraphilia. A masochist with this level of preferrence experinces most of their arousal through pain, and has difficulty without it. The person has a harder time not indulging in their preferences on a regular basis, even in a non-sexual way. All fantasies involve the paraphilia. The person may change their lifestyle to more closely fit their needs, and may act on their desires.
A person with focused paraphilia is uncontrollably aroused by the subject of the paraphilia. Their entire thought process begins to focus on their desires. They are incapable of arousal except through the subject of their paraphilia. Interpersonal relationships that are not founded on their desires will also fail. The person will usually begin becoming anti-social or uncommunicative. Sexual addictions and obsessive compulsive disorders are common at this high level of paraphilia.
A person with multiple focused paraphilias is usually incapable of functioning normally in society. In particular, persons who have the following combinations withdraw from society or are criminalized:
- sadistic/hybristophiliac (cause pain, commit crime)
- masochistic/blood fetishists
- masochistic with algolagnia
[edit] 7 Clinical Paraphilias
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The primary characteristic in this category is the impairment in normal sexual functioning due to uncommon distressing and repetitive sexual fantasies, urges, or behaviors. This can result in an inability to perform or reach an orgasm in the absence of these factors, a strong repulsion of sexual activity outside of the factors that attract, or an exaggerated sexual response cycle or sexual interest. A medical cause must be ruled out prior to making any sexual dysfunction diagnosis and the symptoms must be hindering the person's everyday functioning. The following seven paraphilias are set aside due to their unique and easily segregated effects |
There are seven clinically recognized paraphilias. These are considered to be the most common paraphilias, and each one is distinct. DSM-IV is close to recatagorizing everything according to a new system, in which paraphilia would be broken down into three classes: action, reaction, and object based paraphilas. [4]
- Pedophilia: sexual arousal by and strong sexual attraction to children and adolescents.
- Exhibitionism: sexual arousal by revealing one's body or peforming sexual acts in public.
- Frotteurism: sexual arousal by rubbing one's body against an unwilling person.
- Masochism: sexual arousal by having pain inflicted on one's self.
- Sadism: sexual arousal by inflicting pain on another.
- Transvestic Fetishism: sexual arousal by dressing and acting as the opposite sex.
- Voyeurism: sexual arousal by watching others engage in sex without their knowledge.
[edit] Fetishism
The DSM-IV is not precisely clear on fetishism. According to the DSM-IV, fetishism is the use of inanimate objects or parts of the human body as a stimulus to achieve sexual arousal and satisfaction. This means that some paraphilias are not clincal paraphilias but do not qualify as fetishes either, particularly "action" based paraphilias like biastophilia or lust murder.
For the purposes of this book, fetishism will include the so-called "Other paraphilias not otherwise specified", code 302.81.
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Fetishism the use of inanimate objects,actions with living or non-human beings, actions taken, or parts of the human body as a stimulus to achieve sexual arousal and satisfaction. |
[edit] Cultural Meaning
The word paraphilia, or fetish, is a loaded term in society. Most people fail to understand the differing criteria used to identify real paraphilias from "things that turn people on". For example, a male who is aroused by a woman's breasts does not have a breast fetish in the clinical sense of the word. The breast fetishist would be aroused by any breasts, and would have extreme difficulty in achieving arousal or orgasm without such stimulus.
Homosexuality and Bisexuality are important since in older version of the DSM they were considered mental illnesses or paraphilias. Some misinformed people today still term them as such. They are not paraphilias since they encompass a far larger perversion of the normal sexual instinct than what arouses. The term perversion is used non-judgmentally, to indicate deviations from the scientific norm of expected behavior. Unfortunately, this sort of language does not serve to segregate these actions from the stigma of being "unnatural" to most hetrosexuals.
Transgender individuals do not have a fetish, either. Transvestic Fetishism is arousal by dressing up as or pretending to be a member of the opposite sex. A transgender or transsexual person is someone who undergoes surgical, hormonal, and psychological proceedures to shift their sex to the opposite sex. Transgenderation is not a paraphilia. Culturally, of course, it's deemed non-standard and again, older versions of the DSM lumped it in with Transvestic Fetishism.
Pedophilia is perhaps the most problematic large-scale paraphilia and, since it involves children, the most reviled. Some versions of the DSM-IV would lump pedophilia in with the more arcane term of chronoastiphilia, or attraction to younger people. But pedophilia is specific. Throughout history, younger inviduals have engaged in sexual congress with older members of the community through marriage, etc. A 25 year old male engaging in sexual contact with a 15 year old female is not pedophilia. Pedophilia specifically refers to children (under 13 years of age) who are typically not sexually or mentally mature enough to have a developed sex drive or physically developed enough to safely engage in sex. Due to the large number of molestation cases from parents, priests, etc, this paraphilia has been shoved to the forefront of the cultural limelight.
Other paraphilias and fetishes, such as zoosadism, necrophilia, and crush fetishes, are so limited in their exposure that the mere existence of such things often shocks people who were unaware of them. Typically speaking, the more extreme the paraphilia, the less known it tends to be. Unfortunately, the most dangerous and criminal paraphilias are almost unknown outside of certain circles.
[edit] Sexuality and Paraphilia
Obviously, since paraphilia is a sexual disorder, it should come as no surprise that any discussion of it is tied up heavily with a discourse on sexuality itself. Paraphilia is , in the simplest terms, an attraction to things beyond the norm.
[edit] Interactions
One large issue with sexuality and paraphilia is that it rarely is mutual in nature. Some paraphilias go extremely well together. A masochistic raptophiliac who suffers from algolagnia (a person who enjoys pain, enjoys being raped, and derives sexual pleasure from physical pain beyond their control) is a natural match for a sadistic biastophiliac (person who enjoys raping and causing pain).
There are dangers in this, however. For one, paraphiliacs (especially focused ones) have extreme difficulty in self-control or stopping themselves, and (in the example above) one partner may end up badly injured or dead. Another problem is that even such mutual paraphiliac dependences still produce stress on relationships.
While some paraphilias are harmless enough to be worked into normal sexual relations, more bizzare attractions are almost impossible to achieve consenstually. Sometimes, this leads to sexual frustration, or even violence.
[edit] Criminal concerns
Other paraphilias are so outre and unacceptible, such as pedophilia, that there is no legal way for a person suffering from them to pursue them. A person with focused pedophilia will end up having sex with young children until he or she is caught and imprisoned.
Some paraphilias, such as pyrophilia, can cause property damage. Others, like necrophila, can wreak enormous psychological damage on a grieving person, who now has to deal with the fact that a loved one's corpse has been sexually violated. People who are aroused by the torture and slaying of pets is also a criminally problematic issue.
The law, as a rule, does not accept paraphilia as a debilitating mental illness that robs a person of the ability to tell right from wrong. The fact that it is increasingly compulsive is not seen as a legal excuse for such actions. Particularly in the case of pedophilia, where premeditation and clear intent are required, the law is unprepared to alter it's viewpoint on paraphilia being a valid mental illness.
[edit] Mental health issues
Aside from relationship issues, or criminal concerns, paraphilias can be crippling for other reasons. The more specific and focused a paraphilia, the more disruption it can cause to a person's life. A severely specific masochist may commit great bodily harm to themselves trying to control their urges.
When these urges cannot be satisfied, undue stress is often placed on the mind of the sufferer. Common effects of this sort of psychic stress can cause further psychological problems, including obsessive-compulsive disorders, sexual addictions, and depression.[5]
[edit] Paraphiliac addiction
One final problem that occurs often in paraphiliacs is sexual addiction.
 The DSM-IV does not currently recognize sexual addiction as a mental illness, although there is a good deal of evidence to indicate that it has a purely neurological and psychlogical basis. Dr. Richard Irons has proposed a DSM-IV-TR specific code, but it has not been accepted. |
Sexual addiction is a form of psychological addiction to sexual intercourse, compulsive repeatitive masturbation, viewing pornography, serial cheating, alternative sexual outlets (cybersex, phonesex), and objectification of self. Mild sexual addiction is thought to be fairly common. [6]
Strong sexual addiction combined with paraphilias can be devastating. Cited cases in one study involved a woman with focused masochistic tendencies, nyphomania, and OCD (obsessive compulsive disorder). Her addiction led to her being unable to go for a period longer than 48 hours without several hours of whipping and self-torture.[7]
Sexual addiction is usually the result of denial of paraphilias, particularly focused ones. Preferred or standard paraphilias are not usually strong enough to cause such reactions. Even so, paraphiliacs often engage in near-mindless or thoughtless indulging of their paraphilia if such is possible, as the image of the foot fetishist - as a shoe store clerk can attest[8]
There are also some symbiotic or synergistic factors to consider. Two of note stand out: algolagnia and hypersexuality.
Algolagnia is not a paraphilia (and is covered elsewhere), but is a psychological and phsyiological condition where the body responds sexually to pain. In most cases, this involves pain inflicted on erogenous zones of the body. Algolagnia is significant since the infliction of pain does not have to involve arousal or anything else -- a person suffering from algolagnia can be forced to repeatedly orgasm through application of phsyical pain alone. Algolagnia combined with masochism or other self-inflicted paraphilias can be lethal, since the person can be manipulated through pain alone.
Hypersexuality is an unnaturally high level of sexual desire. This amplifies the urges of any paraphilia already present.
All DSM-IV boxes denote source is from DSM-IV. |
