"What is the total number of behaviors in a week that culminate in orgasm?" (Maxmen & Ward, 1995, p. 325), Kinsey referred to this as the individual's "total sexual outlet"; Maxmen and Ward note that only 5% of men have an outlet of 7 or greater, while the majority of men with paraphilic disorder have persistent hypersexual desire and tie or exceed this number.
"What are the different ways that you become aroused to the point of orgasm?" (Maxmen & Ward, 1995, p. 325), eliciting an honest answer to this question will reveal paraphilias and related behavior (promiscuity, dependence on pornography, and compulsive masturbation). Morrison (1995) discusses interviewing on sensitive topics, including a client's sexual life.
Paraphilia [para: "beyond" or "along side of"; philia: "love"]: sexual deviations
Ford, C.S. & Beach, F.A. (1951). Patterns of Sexual Behavior. New York: Harper.
"sexual disorders characterized by persistent and intense fantasies or desires, usually for nonhuman objects; for sexual activities involving pain, domination or submission; or for nonconsenting partners, such as young children." (Weiner & Rosen, 1999, p. 421)
"a paraphilia is the involuntary and repeated need for unusual or bizarre imagery, acts, or objects to induce sexual excitement." (Maxmen & Ward, 1995, p. 324)
Weiner and Rosen suggest that it is: "the repetitive and persistent character of the sexual fantasies or urges" which uniquely define paraphilias (p. 421); they note that these disturbances are sometimes referred to as disorders of sexual compulsivity or impulsivity.
Paraphilias usually interfere with interpersonal relationships "or normal pair bonding" to some degree (Weiner & Rosen, 1999, p. 421); "The essential disorder is in the lack of capacity for mature and participating affectionate sexual behavior with adult partners." (Meyer & Seitsch, 1996, p. 154)
A distinction may be made between "victimless" paraphilias and those involving victimization of a nonconsenting partner; this validity of distinction has been questioned
legally paraphilias are usually prosecuted as "sex crimes", adjudicated offenders are referred to as "sex offenders", and there may be reporting requirements for both clients and therapists significantly different than those which usually exist for mental health cases
Although DSM-IV bases subclassification of paraphilia on the stimulus/activities found to be sexually arousing, some research suggests many paraphilic individuals engage in multiple forms of deviant sexual behavior: Abel, Becker, Cunningham-Rathner, Mittelman, & Rouleau (1988) reported that less than 10% of their patients had a single paraphilia, approximately 20% had two paraphilic diagnoses, 32% had three or four diagnoses, and 38% had engaged in five or more concomitant paraphilic behaviors; other investigators have reported high rates of multiple paraphilias (see Weiner & Rosen, 1999)
Individuals with paraphilias do not usually seek treatment or disclose information voluntarily; the reported prevalence data is viewed by everyone as a small fraction of the actual level of behavior
Most paraphilias are predominantly male disorders, the age of onset is often prior to age 18, and individuals often report high frequencies of behavior over time
as with all paraphilias, prevalence figures are highly suspect; but appears to be a common sexual offense
not all cases are harmless
prevalence may decline past 40 years of age, possibly associated with the general reduction of impulsiveness reported with advancing age
almost exclusively male clinical population, onset usually prior to age 18, approximately 1/3 never married and high reported rates of unsatisfactory interpersonal relationships in samples
"scopophilia" or "scoptophilia"
"An essential feature is the lack of awareness in the victim being observed, in contrast to consensual forms of voyeurism, such as occurs in sex clubs and X-rated movies." (Weiner & Rosen, 1999, p. 425)
"partial fetishism" refers to using the fetish object for stimulating arousal
"complete fetishism" requires use of the fetish object to achieve orgasm
"Partialism" is a fetish behavior involving intense erotic attraction to specific parts of the body, to the exclusion of sexual interest in the partner or the partner's body as a whole [Paraphilia NOS in DSM-IV]
usually begins in adolescence and may decline after age 25 (Abel & Osborn, 1992)
Sexual Sadism & Masochism
28% of subscribers to sadomasochistic magazines found to be female (Breslow, Evans, Langley, 1985)
cross dressing for sexual arousal, may be associated with either masturbatory or heterosexual activity
not diagnosed when cross dressing occurs exclusively during a gender identity disorder
not diagnosed when motivation for cross dressing is not sexual in nature
heterosexual males may cross dress without arousal
homosexual males may cross dress for entertainment purposes
homosexual males may cross dress to attract heterosexual clients
coprophilia: smearing feces
klismaphilia: self-administering enemas
mysophilia: lying in filth
partialism: exclusive focus on parts of the body
zoophilis: sexual activity with animals
necrophilia: having sex with a corpse
telephone scatologia: making lewd telephone calls
urophilia: urinating on others or being urinated on
a focus of erotic attraction or interest upon prepubescent children
Pedophilia does not follow a single pattern (Finkelhor & Arraign, 1986; see also Weiner & Rosen, 1999)
sadistic physical harm/incidental physical harm
some cases of sexual abuse of children by adult females have been reported
Course is often chronic
Child Sexual Abuse (not exactly the mirror image of pedophilia)
The prevalence of child sexual abuse is unknown, in 2000 child sexual abuse comprised approximately 10% of the officially reported child abuse cases and approximately 88,000 substantiated or indicated cases were found (Putman, 2003). Only about half of victims found in community surveys had disclosed to anyone (Putman, 2003).
Females are at higher risk for child sexual abuse (2.5 to 3 times greater risk than boys); males account for 22-29% of victims (Putman, 2003); risk rises with age, physical disabilities, absence of a parent. A step-father in the home doubles the risk for girls. Socioeconomic status, race, and ethnicity have not been found to be significant risk factors (but may relate to likelihood of reporting and symptom expression). Intergenerational transmission of child sexual abuse appears less than that seen for physical abuse. (Putman, 2003)
A number of child and adult psychiatric disorder have been associated with childhood sexual abuse, including depression, sexualized behavior, neurobiological sequelae (Putman, 2003)
"As a group, individuals with histories of CSA, irrespective of their psychiatric diagnosis, manifest significant problems with affect regulation, impulse control, somatization, sense of self, cognitive distortions, and problems with socialization. Many of these processes are believed to have developmentally sensitive neuronal and behavioral periods related to brain maturation and early caretaker interactions" (Putman, 2003, p. 273)
Pelcovitz et al. (1997) recommended a proposed diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS)
"(1) altered affect regulation such as persistent dysphoria, chronic suicidal preoccupation, and explosive or inhibited anger; (2) transient alterations of consciousness, such as flashbacks and dissociative episodes; (3) altered self-perceptions including helplessness, shame, guilt, and self-blame; (4) altered relationships with others, such as persistent distrust, withdrawal, failures of self-protection, and rescuer fantasies; (5) altered systems of meanings, including loss of sustaining faith, hopelessness, and despair; and (6) somatization (Herman, 1992)."
Not all sexually abused children have emotional and behavioral sequelae, up to 40% present with no symptoms (Putman, 2003), 10% to 20% of these may deteriorate over the next 12 to 18 months. Long term deterioration ("sleeper effect") is poorly understood and not well predicted by family-environmental and abuse-related variables (Putman, 2003)
Adolescent Sex Offenders