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PARAPHILIC DISORDERS,
SEXUAL DYSFUNCTIONS,
AND GENDER DYSPHORIA
CHAPTER 11
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written consent of McGraw-Hill Education.
WHAT IS ABNORMAL
SEXUAL BEHAVIOR?
• When evaluating the “normality” of a given sexual
behavior, the context is extremely important.
• Attitudes and behaviors related to sexuality are continually
evolving over time.
• Contemporary human sexuality researchers:
• Alfred Kinsey
• William Masters
• Virginia Johnson
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written consent of McGraw-Hill Education.
PARAPHILIC DISORDERS
• Behaviors in which an individual has recurrent, intense
sexually arousing fantasies, sexual urges, or behaviors
involving:
• (1) nonhuman objects
• (2) children or other non-consenting persons
• (3) the suffering or humiliation of self or partner
• Psychological dependence on the target of desire that
results in inability to experience sexual arousal without
target.
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written consent of McGraw-Hill Education.
TABLE 11.1 PARAPHILIC DISORDERS
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written consent of McGraw-Hill Education.
PEDOPHILIC DISORDER
• A paraphilic disorder in which an adult is sexually
aroused by children or adolescents.
•
•
•
•
2/3 of all sexual assault victims are children & adolescents
Nearly 2/3 of victims are female
Vast majority of perpetrators are male
About 1/3 of offenders are relatives of the victimized
children
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written consent of McGraw-Hill Education.
EXHIBITIONISTIC DISORDER
• A person has intense sexual urges and arousing
fantasies involving the exposure of genitals to a
stranger
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VOYEURISTIC DISORDER
• From French voir (“to see”)
• The individual has a compulsion to derive sexual
gratification from observing the nudity or sexual
activity of others
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FETISHISTIC DISORDER
• The individual is preoccupied with an object
• Depends on the object rather than sexual intimacy
with a partner for achieving sexual gratification
• Behavior is not fetishistic when involving an object
specifically designed for sexual excitation
• Vibrator
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FETISHISTIC DISORDER
• Partialism: The person is interested solely in sexual
gratification from a specific body part:
• Feet
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FROTTEURISTIC DISORDER
• From French frotter (“to rub”)
• The individual has intense sexual urges and sexually
arousing fantasies of rubbing against or fondling an
unsuspecting stranger
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SEXUAL MASOCHISM
• Attraction to achieving sexual gratification by
having painful stimulation applied to one's own
body
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SEXUAL SADISM
• Deriving sexual gratification from activities that
harm, or from urges to harm, another person
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ATYPICAL AND ABNORMAL SEXUAL
BEHAVIOR (CONT.)
• Sexual sadism:
- practice of receiving sexual
pleasure from inflicting pain on
others
• Sexual masochism:
- obtaining sexual pleasure from
receiving pain
BDSM
•
•
•
•
•
•
Bondage and Discipline
Bondage: the practice of restraining for pleasure. Bondage is usually, but not always, a sexual
practice.
• Bondage means binding the partner by tying their appendages together; for example, by the
use of handcuffs or by lashing their arms to an object.
Discipline: describes the use of rules and punishment to control overt behavior in BDSM.
• Punishment can be pain caused physically (such as caning), humiliation caused
psychologically (such as a public flagellation) or loss of freedom caused physically (ex.
chaining the Bottom to the foot of a bed).
Sadism and Masochism
Sadism: Deriving of sexual gratification, or the tendency to derive sexual gratification, from
inflicting cruelty, pain or emotional abuse on others.
• The word is derived from the Marquis de Sade, an 18th century French nobleman who got off
on the sexual torment and humiliation of others.
Masochism: Deriving of sexual gratification, or the tendency to derive sexual gratification, from
being physically or emotionally abused, humiliated or mistreated.
• It is named after Leopold von Sacher-Masoch, a 19th century Austrian novelist who delighted
in being tortured and humiliated by his lovers.
• Many people consider BDSM perverted, dehumanizing, or worse. But aficionados
call it the most loving, nurturing, intimate form of human contact and play.
CAUSES OF BDSM
• Psychoanalytic theory: BDSM is the result of childhood trauma or significant childhood
experiences that manifest itself in exhibitionistic behavior (Noyes, 1998).
• BDSM is simply a sexual interest or subculture attractive to a minority, and for most
participants not a pathological symptom of past abuse or difficulty with "normal" sex
(Richters et al., 2008).
• Psychobiological theory: BDSM is the result of hormonal influence on the central nervous
system.
• BDSM is associated with abnormally high levels of endorphins reinforcing an initial
experimental or accidental experience with BDSM.
• Learning theory: BDSM represents a form of conditioning; specifically, when a young boy
becomes aroused while being spanked over his mother's lap. The pain is associated with
arousal resulting in patterned masochism.
• Behavioral theory: suggests the practice is acquired through early exposure to BDSM
(through experience and/or observation) that is imitated and reinforced.
• Safe, Sane and Consensual (Brennan, 2010)
• SAFE: To start it must be said that nothing is 100% safe, including BDSM. Safety involves
many things. It means knowing your limitations, Dom and Sub alike. It means taking
precautions like having safety scissors (EMT shears are good for this, they will cut
through almost anything) and having more then one key to anything that locks (as
well as having locks that use a common key). It means keeping things clean and
using condoms or other barrier protection when needed. It means having some
simple first aid items handy.
• SANE: It means understanding what's possible and what should remain fantasy.
Knowing the difference between what must remain a fantasy and what you can
actually do is an important step to being a responsible member of our scene
community, even if you only play privately. It also means taking the time to learn
about that newest thing you want to try, by reading, observing, talking to others, and
practicing if needed. Finally, it also means not incorporating drugs/alcohol and/or
anger.
• CONSENSUAL: This may be the most important concept of all. It's what separates us
from the abusers. Everything we do is based on consent. Consenting to play and
then negotiating what will happen. Consenting to enter into a Dom/sub relationship.
The ability to do that can be modified by negotiated agreements, but, if, and when
consent is withdrawn, that withdrawal must be honored.
TRANSVESTIC DISORDER
• Transvestic fetishism• A man has an uncontrollable craving to dress in women's
clothing in order to derive sexual gratification.
• Transvestic disorder• Diagnosis applied to individuals who engage in transvestic
behavior and have the symptoms of a paraphilic disorder
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THEORIES AND TREATMENT OF
PARAPHILIC DISORDERS
• Biological perspectives
• Castration
• Psychotherapeutic medications
• Psychological perspectives
•
•
•
•
Lovemaps
Group therapy
The cognitive behavioral perspective
Relapse prevention
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written consent of McGraw-Hill Education.
SEXUAL DYSFUNCTIONS
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written consent of McGraw-Hill Education.
SEXUAL DYSFUNCTIONS
• Abnormality in an individual’s sexual responsiveness
and reactions
• Feelings of significant distress or impairment
• Lifelong or acquired
• Generalized or situational
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SEXUAL AROUSAL DISORDERS
• Male hypoactive sexual desire disorder• Low level of interest in sexual activity.
• Female sexual interest/ arousal disorder• Persistent or recurrent inability to attain or maintain normal
physiological and psychological arousal responses during
sexual activity.
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SEXUAL AROUSAL DISORDERS
• Erectile disorder
• Male cannot attain or maintain an erection during sexual
activity that is sufficient to allow them to initiate or maintain
sexual activity
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DISORDERS INVOLVING ORGASM
• Female orgasmic disorder
• Male orgasmic disorder
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DISORDERS INVOLVING ORGASM
• Delayed ejaculation
• A sexual dysfunction in which a man experiences problems
having an orgasm during sexual activity.
• also known as inhibited male orgasm.
• Premature ejaculation
• A sexual dysfunction in which a man reaches orgasm well
before he wishes to, perhaps even prior to penetration.
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DISORDERS INVOLVING PAIN
• Genito-pelvic pain/penetration disorder
• The individual experiences recurrent or persistent genital
pain before, during, or after sexual intercourse.
• Can affect both males and females.
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SEXUAL DYSFUNCTIONS:
THEORIES AND TREATMENT
• Biological perspective
• Erectile dysfunction - Medications to treat include the
prescription drugs Viagra, Levitra, and Cialis
• Hormonal replacement therapy
• Application of corticosteroids and physical therapy
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written consent of McGraw-Hill Education.
SEXUAL DYSFUNCTIONS:
THEORIES AND TREATMENT
• Psychological perspectives
• Macho myth
• Sensate focus
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written consent of McGraw-Hill Education.
GENDER DYSPHORIA
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GENDER DYSPHORIA
• Gender Dysphoria
• Distress that may accompany the incongruence between a
person’s experienced or expressed gender and that
person’s assigned gender.
• Gender identity:
• A person’s inner sense of maleness or femaleness
• Biological sex
• The sex determined by a person’s chromosomes.
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• Transsexualism,
• The phenomenon in which a person has an inner feeling of
belonging to the other sex.
• Some people with gender dysphoria disorders wish to live as
members of the other sex, and they act and dress accordingly.
• Unlike individuals with transvestic disorder, these people
do not derive sexual gratification from cross-dressing.
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GENDER DYSPHORIA:
THEORIES AND TREATMENT
• New approaches are used that emphasize a more fluid view of
gender than the binary male-female dichotomy.
• New DSM 5 terminology reflects a theoretical perspective that does
not focus specifically on what is “wrong” with people whose selfidentification differs from their biological characteristics or social
roles.
• Clients will still likely struggle with Transphobia
• New therapeutic approaches encourage clients to create their
own gender identities, which can result in an improved sense of
well-being.
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THE BIOPSYCHOSOCIAL PERSPECTIVE
• Clinicians are increasingly developing models that
incorporate integrated treatment
• DSM-5’s sweeping changes reflects:
• Expansion of the empirical approaches to sexual disorders
• Adoption of a broader, more inclusive, and socioculturally
sensitive approach to their understanding and treatment
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