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Sexual Disorders
This Sexual Disorders topic center contains information
about paraphillias (more commonly known as sexual
perversions or deviancies), they involve recurrent
fantasies, urges or behaviors of a sexual nature that
center around children, non-humans (animals, objects,
materials), or harming others or one's self. Because they
are so often associated with abusive sexual practices
that generate real victims, many people tend to regard
persons who display sexual deviancies as monsters.
While they are ultimately responsible for their choices (including
those that harm other people), and should be punished and
thereafter closely monitored to prevent further abusive practices,
even predator child-molesting pedophiliac are legitimately suffering
from mental, emotional and spiritual disturbance and should be able
to participate in mandated treatment. Whereas pedophilia (child
molestation) is a particularly awful sexual deviancy, there are other
forms of sexual deviancy such as transvestism and many forms of
fetishism that harm no one and that do not deserve to be thought of
in the same breath as child molestation.
A list of the paraphillias follows, each with a short description:
Exhibitionism involves a compulsion to display one's private parts to strangers. Like
gamblers, pyromaniacs and other impulse-junkies, exhibitionists cycle through
periods of increasing tension that are only relieved by the ‘rush' of exposing
themselves to strangers (occasionally accompanied by masturbation).
Symptoms
There are many different symptoms that come with Exhibitionism and these
symptoms can be categorized in four different groups which include:
Mild- A person has recurrent fantasies of exposing themselves but has never acted on
these fantasies.
Moderate- A person has occasionally exposed himself or herself and has difficulty
controlling the urge to keep doing so.
Severe- A person has exposed themselves to three or more people and has a serious
problem controlling the urges.
Catastrophic- This would be very severe and would probably not exist in someone who
doesn’t suffer from other paraphilias. This level of severity denotes the presence of
sadistic tendencies.
Treatment of Exhibitionism
The most common form of treatment for
this disorder is psychotherapy and
medication. Some different types
of psychotherapy used in treatment are
cognitive-behavioral therapy, group
therapy or couples therapy (this therapy
is most useful to exhibitionists who are
married).
Fetishism involves having ones sexual energies fixated on to a manufactured
object, rather than onto another human being. Frequently, fetish objects are
garments such as shoes, underwear, panties or bras. They may be made of
particular materials such as leather or rubber. It is common for a person with a
fetish to not be able to achieve orgasm without involving their fetish object in the
sexual act (e.g., by getting their partner to wear the fetish object).
Symptoms
Over a period of at least 6 months, recurrent, intense sexually arousing fantasies,
sexual urges, or behaviors involving the use of nonliving objects (e.g., female
undergarments).
The fantasies, sexual urges, or behaviors cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
The fetish objects are not limited to articles of female clothing used in crossdressing (as in Transvestic Fetishism) or devices designed for the purpose of
tactile genital stimulation (e.g., a vibrator).
Treatment
Medication-based options for the treatment of
fetishistic disorder and other paraphilic disorders
include anti-anxiety/antidepressant drugs called
SSRIs and a number of different hormone therapies
that achieve their effects by lowering the potential
for sexual arousal, or the potential for sexual
performance in response to sexual arousal. Examples
of available hormonal treatments include estrogen
and testosterone-lowering drugs called
antiandrogens.
Frotteurism involves a compulsion to
rub ones self against strangers others
in a sexual manner. Like exhibitionism
and other impulse control disorders,
frotteurism tends to involve a cycle of
tension buildup that is relieved by
acting out in ‘exciting' ways.
Symptoms
Over a period of at least 6 months, recurrent, intense sexually arousing
fantasies, sexual urges, or behaviors involving touching and rubbing
against a nonconsenting person.
The fantasies, sexual urges, or behaviors cause clinically significant
distress or impairment in social, occupational, or other important areas of
functioning.
Treatments
Behavior therapy is often used to treat paraphilias. This can include
management and conditioning of arousal patterns and masturbation.
Therapies involving cognitive restructuring and social skills training are
also utilized.
Medication is also used to reduce fantasies and behavior relating to
paraphilias. This is especially true of people who exhibit severely
dangerous masochistic behaviors.
Treatment can also be complicated by health problems relating to sexual
behavior. Sexually transmitted diseases and other medical problems,
especially when the sadomasochistic behavior involves the release of
blood, can be present. Also, people participating in hypoxyphilia and other
dangerous behaviors can suffer extreme pain and even death.
Transvestism (Transvestic Fetishism) occurs when an
otherwise ‘normal' heterosexual male has fantasies
about and/or acts out dressing up in woman's clothing.
Such cross dressing is commonly experienced as sexually
stimulating.
Symptoms
Over a period of at least 6 months, in a heterosexual
male, recurrent, intense sexually arousing fantasies,
sexual urges, or behaviors involving cross-dressing.
The fantasies, sexual urges, or behaviors cause clinically
significant distress or impairment in social,
occupational, or other important areas of functioning.
Treatment
In the earliest period of behavior therapy, transvestic fetishes were
narrowly viewed as inappropriate behavior that was confined to a
limited range of situations, and were sometimes treated
with aversion therapy , usually with electric shocks. This approach
was largely unsuccessful. Persons with fetishes have also been
treated by using a form of behavioral therapy known as orgasmic
reorientation, which attempts to help people learn to respond
sexually to culturally appropriate stimuli. This treatment also has had
limited success.
Most persons who have a transvestic fetish never seek treatment
from professionals. Most are capable of achieving sexual gratification
in culturally appropriate situations. Their preoccupation with crossdressing is viewed as essentially harmless to other persons, since
transvestism is not associated with criminal activities or forcing one's
sexual preferences on others. As of 2002, American society has
developed tolerance for transvestites, thus further reducing the
demand for professional treatment.
Voyeurism or ‘peeping tom' behavior involves compulsive fantasizing
about and/or acting out engaging in spying on someone (who does not
know they are being observed) in the act of disrobing. This sort of
behavior is very common amongst the general population; it is not
diagnosable as a disorder unless it becomes a compulsive part of a
person's sexual routine.
Symptoms
Over a period of at least 6 months, recurrent, intense sexually arousing
fantasies, sexual urges, or behaviors involving the act of observing an
unsuspecting person who is naked, in the process of disrobing, or
engaging in sexual activity.
The fantasies, sexual urges, or behaviors cause clinically significant
distress or impairment in social, occupational, or other important areas
of functioning.
Treatment
For treatment to be successful, a voyeur must want to modify existing patterns
of behavior. This initial step is difficult for most voyeurs to admit and then
take. Most must be compelled to accept treatment. This may often be the
result of a court order.
Behavioral therapy is commonly used to try to treat voyeurism. The voyeur
must learn to control the impulse to watch non-consenting victims, and just as
importanly to acquire more acceptable means of sexual gratification. Outcomes
of behavioral therapy are not known. There are no direct drug treatments for
voyeurism.
Voyeurism is a criminal act in many jurisdictions. It is usually classified as a
misdemeanor. As a result, legal penalties are often minor. The possibility of
exposure and embarrassment may deter some voyeurs. It is also not easy to
prosecute voyeurs as intent to watch is difficult to prove. In their defense
statements, they usually claim that the observation was accidental.
Pedophilia is considered a paraphilia, an "abnormal or
unnatural attraction." Pedophilia is defined as the fantasy or
act of sexual activity with prepubescent children. Pedophiles
are usually men, and can be attracted to either or both sexes.
How well they relate to adults of the opposite sex varies.
Perpetrators often delude themselves into viewing their
actions as helpful to children. They might tell themselves they
are contributing to a child's development or that the child is
enjoying the act; however, they do tell their victims not to
alert their parents or authorities.
An estimated 20 percent of American children have been
sexually molested, making pedophilia the most common
paraphilia. Offenders are usually family friends or relatives.
Types of activities vary and may include just looking at a child
or undressing and touching a child. However, acts often do
involve oral sex or touching of genitals of the child or
offender. Studies suggest that children who feel uncared for or
lonely may be at higher risk.
What are the symptoms?
People with this disorder may pretend that they are not doing anything wrong. They may tell
themselves that they are "teaching" the child or that the child "wants to" have sex. Most
pedophiles are attracted to one gender and age group.
The symptoms of pedophilia are:
For at least 6 months, having sexual fantasies, urges, or behaviors with a child age 13 years or
younger. This happens over and over.
Preferring children who go along with requests. Pedophiles may look at naked children,
expose themselves, or masturbate without touching the child. They may also force sexual acts
on the child.
The fantasies, sexual urges, or behaviors cause pain, depression, anxiety, shame, or guilt. This
may cause the pedophile to be more aggressive, or to do poorly at work or school.
Pedophiles must be at least 16 years old, and at least 5 years older than the child.
Sexual abuse of a child does not always mean that someone is a pedophile. People who have
antisocial personality disorder or sadism may abuse children. These disorders may be more
about power and control than sex. Pedophiles are sexually drawn to children.
How is it treated?
Pedophilia may be treated with psychotherapy, such as:
Cognitive-behavior therapy: The therapist helps you identify views you have of yourself, your
relationships, the world, and the future. This therapy helps you recognize unhealthy ways of
thinking and behaving. You learn ways to think and behave that lead to healthier choices.
Dynamic psychotherapy: The therapist helps you connect current behaviors and past
experiences. He or she can help you sort out your feelings. This helps you identify problems and
changes you want to make.
Medicines such as female hormones or testosterone-lowering medicines may be used to reduce
sex drive in men. Selective serotonin reuptake inhibitors (SSRIs) may reduce sex drive and
lessen obsessive thoughts and compulsive behaviors. Mood stabilizers or antipsychotic medicines
may also be helpful.
Even with treatment, this disorder is usually lifelong. However, both the fantasies and the
behaviors often lessen with ongoing treatment and as you get older.
Gender Identity Disorder
Gender identity disorder is a conflict between a person's physical gender and the gender he or she
identifies as. For example, a person identified as a boy may actually feel and act like a girl. The
person is very uncomfortable with the gender they were born.
Symptoms
A strong and persistent cross-gender identification (not merely a desire for any perceived cultural
advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the
following:
repeatedly stated desire to be, or insistence that he or she is, the other sex
in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only
stereotypical masculine clothing
strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of
being the other sex
intense desire to participate in the stereotypical games and pastimes of the other sex
strong preference for playmates of the other sex
In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the
other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the
conviction that he or she has the typical feelings and reactions of the other sex.
Treatment
Individual and family therapy is recommended
for children to create a supportive environment
at home and in school. Individual and, if
appropriate, couples therapy is recommended
for adults. Sex reassignment through surgery
and hormonal therapy is an option, but identity
problems may continue after this treatment.
On a final note, we should point out one
mode of sexuality which is
definitively not listed here; namely
Homosexuality. Although historically listed
as a sexual deviancy, homosexuality has
been recognized as acompletely normal
variant of human sexuality for many years
now. But just because being gay isn't a
sexual deviency or disorder, doesn't mean
that it doesn't come with its own set of
stressful issues.