Various behaviors and activities are used to express sexuality, some more common than others. Many less common behaviors are negatively labeled, often implying the behaviors are unnatural or perverted. This lecture will address the topics of sexual variations and paraphilic behavior, domination and submission, non-coercive versus coercive paraphilic disorders, and the origins and treatments of paraphilic disorders.
Let's first define sexual variations. Sexual variations refer to those behaviors that are not statistically typical of American sexual behaviors. These behaviors also may occur in addition to the "mainstream" expression of sexuality.
"Sexual variation" is the most common term used, although terms like atypical sexual behavior or kinky sex are often used. It is important to note, however, that atypical does not necessarily mean abnormal; it simply means that the majority of people do not engage in that particular behavior or that it occurs outside of the culturally sanctioned sexual behaviors. Most sexual variations are also not identified as mental disorders.
Some sexual variations are considered to be so extreme by the American Psychiatric Association, or APA, that they are classified as mental disorders, or paraphilias. Paraphilic behaviors tend to be compulsive, longstanding, and distressing to the individual.
So what Is Paraphilia?
A paraphilia is a mental disorder characterized by recurrent, intense sexually arousing fantasies, sexual urges, or sexual behaviors lasting at least 6 months and involving:
nonhuman objects
the suffering or humiliation of oneself or one's partner -or-
children or other nonconsenting people
For people with paraphilic disorder, the paraphilic behavior is the predominant sexual behavior, although they may engage in other sexual activities as well. The distinction between sexual variation and a paraphilic disorder is sometimes a difference of degree and not kind. For example, many men find that certain objects, such as black lingerie, intensify their sexual arousal; and for other men, these objects are necessary for arousal. In the first case, there is nothing particularly unusual. But if a man is unable to become sexually aroused without the lingerie and the purpose of sex is to bring him in contact with it, the behavior is considered fetishistic disorder by the American Psychiatric Association.
The majority of paraphilic disorder diagnoses involve males. Paraphilic disorder tends to be compulsive, long-standing, and distressing to the individual. They may lead to legal and interpersonal difficulties, but it may seem irresistible and rewarding for that person who continues the activity.
The Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, is published by the American Psychiatric Association. The DSM is the standard worldwide resource for defining mental illness, and for determining which behaviors and desires are healthy and unhealthy.
In your text, the fourth-edition of the DSM is referenced. In May of 2013, the fifth edition of the DSM, known as the DSM-5, was printed. Regarding diagnoses and classifications for paraphilic disorder, there are no major revisions from the fourth edition to the fifth, just a few changes you should be aware of:
Most people with atypical sexual interests do not have a mental disorder. To be diagnosed with a paraphilic disorder, DSM-5 requires that people with these interests:
• feel personal distress about their interest, 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 persons unable to give legal
consent.
This is not very different from the criteria listed in the DSM-IV, just the addition of the personal distress not caused by societal views and the clarification of non-consensual partners and the interest to cause harm. <br /><br />To differentiate between the behavior itself and the disorder stemming from that behavior, the name now includes the word ‘disorder' in it. For example, Sexual Masochism in DSM-IV will be titled Sexual Masochism Disorder in DSM-5. Furthermore, the category was simply referred to as ‘paraphilias', as indicated in your text, but in the new DSM-5, the category is referred to as paraphilic disorders. This small, but significant change in the nomenclature is what we will use in this course.
It is also important to recognize that seemingly scientific or clinical terms may not be scientific at all. Instead, they may be pseudoscientific terms hiding moral judgments. What is considered abnormal or excessive is often defined moralistically rather than scientifically. For example, nymphomaniacs is not currently recognized as a clinical condition by the American Psychiatric Association, but it dates back to the 17th century. It was popularized in the 19th century by Richard von Krafft-Ebing and refers to abnormal or excessive sexual desire in women. Physicians and psychologists use the term to pathologize women's sexual behavior if it deviated from the 19th century moral standards. Even today, "nymphomania," "nymphomaniac," and "nympho" are still used and retain pathological connotations. Another term, satyriasis, referred to abnormal or uncontrollable sexual desire in men. This was less commonly used than nympho because men were expected to be more sexual than women. Satyriasis is also not recognized as a clinical condition by the APA. It is important to remember to distinguish clearly between the clinical, judgmental, or casual connotations of the various terms.
Variations in sexual behavior are not rare. One of the more widespread forms of sexual variation is domination and submission. It entails the consensual sexual role-playing in which one person dominates and the other submits. The term sadomasochism (S&M) is also used by the general public to describe domination and submission, but it is no longer used as a clinical term in psychiatry and psychology to describe consensual domination and submission. Power is a central element, and it is consensual usually without pain. If pain is present, the amount or degree of pain is usually faint or slight. The submissive partner is usually controlled by subtle, nonverbal signals, and the majority of individuals that engage in it do it as a form of sexual enhancement. As such, domination and submission are not a paraphilic disorder since the behavior is consensual and without pain. To be considered paraphilic, such behavior requires that the suffering or humiliation of oneself or one's partner be real, not merely simulated. Image: http://nymag.com/thecut/2011/02/rihannas_sm_video_banned.html
Bondage and discipline is the most widely known form of domination and submission. It is when a person is bound with scarves, leather straps, underwear, handcuffs, or chains while another simulates or engages in light to moderate discipline activities such as spanking or whipping. The bound person may also be blindfolded or gagged. This may take place in a special setting known as dungeons, furnished with restraints, body suspension devices, racks, whips, as well as chains.
Another form of domination and submission is humiliation, in which a person is degraded. Humiliation can occur in many forms. Klismaphilia, is the sexual pleasure derived from receiving enemas or water treatments in the anus. There is also urophilia, AKA golden showers, which is the sexual pleasure from contact with urine. Coprophilia is the sexual pleasure from contact with feces and is also known as scat. There are other humiliation activities such as servilism, infantilism, kennilism, or tongue lashing. Servilism is when a person desires to be treated as a servant or slave. Infantilism or AKA babyism is when a person acts in a babyish manner using baby talk, wearing diapers, being pampered, scolded, or spanked by his or her "mommy" or "daddy."
Kennilism is being treated like a dog. The individual may wear a studded dog collar and like being tied to a leash. Or the individual could be ridden like a horse while the dominant partner applies whips or spurs. And then there is tongue lashing. This is the verbal abuse by a dominant partner who uses languages that humiliate and degrade the other person.
Domination and submission are engaged in private or as part of an organized subculture complete with clubs and business catering to the acting out of domination and submission.
Image from McGraw-Hill
An important aspect of paraphilic disorders is whether they involve coercion. Noncoercive paraphilic disorders are regarded as relatively benign or harmless because they are victimless. Noncoercive paraphilic disorders include fetishistic disorder and transvestic disorder.
Image: http://corsetsonfilm.wordpress.com/2010/06/14/dr-frank-n-furter/
Fetishism is the sexual attraction to an object which is required or preferred for sexual arousal. To meet APA definition of fetishism as a disorder, one must not be able to have satisfactory sex without the fetish. Instead of relating to another person, one can gain sexual gratification from kissing a shoe, caressing a glove, drawing a lock of hair against his or her cheek, or masturbating with a piece of underwear.
A form of Fetishism is partialism. This is the exclusive attraction to particular body parts. For example, a woman's feet, ears, breasts, legs, elbows, or any other part of her body. As a reaction, the heartbeat increases, muscles can tense, and toes can curl.
Using objects for sexual stimulation, such as vibrators, or using female clothing for cross-dressing is not a sign of fetishistic disorder. Fetishistic behavior can be viewed on a continuum. The object is a substitute for sexual partners and can vary from a slight preference to a strong preference to a necessity for sexual arousal. Most people have slight fetishes, and most fetishes and partialisms rarely cause harm.
Image from McGraw-Hill
Transvestic disorder is another noncoercive paraphilic disorder. It is the wearing of clothing associated with the other sex for sexual arousal. Trans means cross and vest means dress. It forms in a broad range of behaviors in which one can wear only an article of clothing like a bra or panties of the other sex in the privacy of their own home, or an entire outfit. The difference between transvestistic disorder and fetishistic disorder is the viewing or fondling of the item of clothing versus the wearing of it.
The majority of these individuals have no desire to undergo a sex change operation. And transvestism should not be confused with transsexualism. Most transvestites have no desire to change their anatomical sex, where transsexuals do. However, they believe they have both masculine and feminine personalities within and value transvestism as an important part of their life. Most men who engage in this practice are heterosexual and masculine in their gender role.
The DSM-IV limits transvestic disorder to heterosexual males. However, the DSM-5 has no such restriction, opening the diagnosis to women or gay men who have this sexual interest. While
the change could increase the number of people diagnosed with transvestic disorder, the requirement
remains that individuals must experience significant distress or impairment because of their behavior.
Few noncoercive paraphilic disorders are brought to public attention because of their private, victimless nature. But coercive paraphilic disorders, which involve victimization, are a source of concern for society because of the harm they cause others. All of these paraphilic disorders involve some kind of coercive or nonconsensual relationship with another person or with an animal.
Zoophilic disorder, sometimes referred to as "bestiality," involves deriving sexual pleasure from animals. True zoophilic disorder occurs only when animals are the preferred sexual contact regardless of what other sexual outlets are available. Zoophilic disorder is classified as a coercive paraphilic disorder based on the assumption that the animal is an unwilling participant.
There is also voyeuristic disorder. This is the recurring, intense sexual urges and fantasies related to nonconsensual observation of others for the purpose of sexual arousal. The individual being watched could be nude, disrobing, or engaging in sexual activity. The observing individual must hide and remain unseen and a person or couple being watched must be unaware of their presence. The excitement of these individuals is intensified by the possibility of being discovered. The person viewing may masturbate or imagine having sex with the observed person.
The majority of those with voyeuristic disorder are young men who seek out females they find sexually attractive. These men are primarily heterosexual, lack social and sexual skills, and fear rejection. Unfortunately, due to technology, we now have video voyeurism. This is the use video cameras to take pictures or video of a person in private places as they change clothes, shower, or engage in sexual activities. Health clubs, gyms, and cell phones have made video voyeurism easier, and women are usually the target, but it also happens to men. Technology not only makes video voyeurism easier to record but also to distribute as well. Images and videos are often uploaded to the internet as a means of mass distribution. Severe psychological harm of the victim can occur upon discovery. States are now beginning to enact laws against video voyeurism. In 2008, Erin Andrews, an ESPN reporter, was secretly videotaped in her hotel room after getting out of the shower. The tape posted online and went viral. The man that filmed the video was charged and served jail time for creating and distributing the video. Andrews spent years trying to get the video removed from the Internet. When a video like this surfaces, many view it not thinking of the personal distress and humiliation of the victim in the video. In our seemingly accessible and viral world, think how you would feel in the victim's situation and make sure that you do not contribute to someone else's invasion of privacy.
Image: http://www.mediabistro.com/tvspy/erin-andrews-to-appear-in-court-with-accused-stalker_b4128
Exhibitionistic disorder is the exposure of the genitals to a nonconsenting stranger for sexual arousal. Exposure is an escape from intimacy and the individuals expose to only strangers, not willing women. The individual obtains sexual gratification after exposure when fantasying about shock and horror experienced by the victim.
Exhibitionistic disorder is a common paraphilia in which one-third of all males arrested for sexual offenses are exhibitionist acts. The characteristics of these individuals include being introverted, insecure, are sexually inadequate, feeling powerlessness as men, and having sexual relationships with wives or their partners that are usually poor. However, they are rarely violent. If you are confronted by someone with exhibitionistic disorder it is best to ignore and distance yourself from the person and immediately report it to the police.
Frotteuristic disorder is the touching or rubbing against a nonconsenting person for the purpose of sexual arousal. The offender is often male, and it is carried out in crowded subways or buses, as well as large sporting events or concerts. The offender rubs against the buttocks or thighs with an erect penis inside his pants and may use his hands to rub the women's buttocks, pubic region, thighs, or breasts. The act takes approximately 60 to 90 seconds, and if the individual ejaculates, they will stop. If not, they will move on to another victim. During the act, the individual may fantasize about having consensual sex or recall the episode during masturbation. Frotteuristic disorder can occur with other paraphilic disorders and it is also associated with rape.
Necrophilic disorder is also a coercive paraphilic disorder. It is the sexual contact with a corpse. The corpse is obviously unable to provide consent. There are relatively few instances of necrophilia, yet it retains a fascination in horror literature, especially vampire stories and legends in gothic novels. Instead, the most common motive for someone with necrophilic disorder is the possession of a partner who neither able to resist or reject. Clearly, many people with this disorder are severely mentally disturbed.
Image: http://www.demotivationalposters.org/facebookview.php?id=36681
Pedophilic disorder is a widely known coercive paraphilic disorder. It is the recurrent intense sexual urges and sexually arousing fantasies involving sexual activity with a prepubescent child. Pedophilic disorder is different from "child sexual abuse," "child molestation," and "incest," which all denotes sex with minors. Pedophilic disorder, as defined by the APA, is a psychiatric disorder. Not all of those who sexually abuse minors would be considered people with pedophilic disorder unless the APA criteria are met. Sexual contact with a minor is not, in itself, a determination of pedophilia. It is, however, illegal. The child must be 13 years of age or younger. Female victims are usually 8 to 10 years old and male victims are slightly older. The person offending must be at least 16 years old and at least 5 years older than the child. The offenders are mostly male and some are aroused by only children and some by both children and adults. Also, some offenders prefer only one sex and others are aroused by both.
With pedophilias the vulnerability of the child is very important. The majority of pedophiles know their victims and their family. Victims may be their own children, stepchildren, relatives or children of close friends. Pedophiles will use their relationships to gain the child's trust. The individual uses seduction and enticement to manipulate children. Pedophilic behavior rarely involves sexual intercourse and often includes fondling or touching a child, usually on the genitals, legs, and buttocks. Or the exposing of one's self and having the child touch the penis, as well as masturbation in the presence of the child and occasionally oral or anal stimulation by the child. Half of pedophiles are or have been married. A well-known case of child molestation is that of a Penn State football coach, Jerry Sandusky. In 2011, following a two-year grand jury investigation, Sandusky was arrested and charged with 52 counts of sexual abuse of young boys over a 15-year period. He met his molestation victims through a charitable organization he created to help at risk youth. During his trial, a psychologist stated the Sandusky was diagnosed with pedophilic disorder. Regardless of the mental disorder, his acts were against the law and he was sentenced to 30 to 60 years in prison which is where he will most likely live out the rest of his life. Image: http://thelibertyblog.org/wp-content/uploads/2012/06/SanduskyAttoneyGeneralChildAbuse.jpg
Sexual sadism and masochism are separate but sometimes related. The pain and harm are real, not simulated. Therefore, there are risks involved including physical injury. It is important for participants of sadism and masochism to communicate their preferences and limits before activities. The acts are indistinguishable from D/S if they are consensual, but coercion distinguishes sadism. If it is consensual, a good rule of thumb that differentiates the two is that sexual sadism and masochism disorders are often extreme, compulsive and dangerous. Let's define the different forms.
Image from McGraw-Hill
Sexual sadism disorder is characterized by urges or fantasies of intentionally inflicting real physical or psychological pain or suffering on a partner. Characteristic symptoms include violent sexual thoughts and fantasies involving a desire for power and control, centering on a victim's physical suffering, which is sexually arousing. The victim may also be a consenting person with sexual masochism disorder or someone abducted by a person with sadism. The victim may be tortured, raped, or killed, and the victim is physically restrained and blindfolded or gagged. However, most rapes are not committed by those with sexual sadism disorder.
Sexual masochism disorder is the recurring sexual urge or fantasy of being humiliated or cause to suffer through real acts, not simulated ones. The fantasies, sexual urges, or behaviors must result in significant distress or social impairment. Masochism can occur alone or with partners. With partners the acts can include restraining, blindfolding, paddling, spanking, whipping, beating, shocking, cutting, pinning, piercing, and humiliating. It is the only paraphilic disorder that is diagnosed with some frequency in women.
Autoerotic asphyxia is a form of sexual masochism disorder linking strangulation with masturbatory activities. Individuals seek to heighten their masturbatory arousal and orgasm by cutting off oxygen supplies to the brain. It is done alone or with a partner, and if death occurs it is usually accidental. There are a variety of techniques used for this act. Interference with the blood supply to the brain causes cerebral anoxia, or a lack of oxygen, and the individual experiences giddiness, lightheadedness, and exhilaration. The use of rope, cords, and chains with padding prevents bruising, and bags or blankets are used over heads. Sometimes corpses are found naked or partially clothed if individuals die during the act. Those who engage in such sexual practices rarely realize the potential consequences of their behavior. The key signs of individuals participating in these behaviors include unusual neck bruises, bloodshot eyes, disoriented behavior, and unexplained possession of or fascination with ropes or chains.
More than 1,000 deaths are attributed to autoerotic asphyxia in the United States each year with ages of victims ranging from 9 to 77 years. One of the most notable deaths due to this practice was the death of actor David Carradine. He was found in his hotel room in 2009 hanging by a rope naked in the closet. It was determined that he died of accidental asphyxiation. He was most known for playing martial arts roles. His last well-known movie was Quentin Tarantino's Kill Bill. Until there is education regarding the risks of engaging in autoerotic asphyxia, we will continue to see deaths due to this practice.
Image: http://en.wikipedia.org/wiki/David_Carradine#Death
What is the cause of paraphilic disorders? They are likely the result of the social and environmental, psychological, and biological factors, thus a combination of all. Therapists have found paraphilic disorder to be difficult to treat. Most people who are treated are convicted sex offenders, who have the most severe paraphilias, while those with milder paraphilic disorders go untreated. Multi-faceted approaches that are used include enhancing social and sexual skills to assist recovery. But prevention has been shown to be the best approach.
Our examination of the variations in sexual behaviors revealed that there are a variety and a complexity of sexual behaviors. But what also underlie are limits of tolerance. As long as the behavior is done in private, between two consenting adults, it should not be of concern. Behaviors that cause physical and psychological harm to oneself or others should be addressed and treated. We must be aware that some activities can result in serious injury and even death.