Paraphilias

1. Paraphilias Ece İBANOĞLU PSYC 441

2. OUTLINE • Definition of paraphilias • Types of Paraphilias • The Aetiology of Paraphilias • The risk factors for paraphilias • Pedophilia • Treatments (pedophilia) • Conclusion

3. Definition of paraphilias Problematic, high-frequency sexual behaviors or unusual sexual urges and activities that are often directed at inappropriate targets.

4. Types of paraphilias • Fetishism INANIMATE OBJECTS • Transvestic Fetishism Cross-dressing • Sexual Masochism BEING HUMALIATED • Sexual Sadism SUFFER • Exhibitionism EXPOSING THE PENIS TO STRANGER • Voyeurism WATCHING NAKED PERSON • Frotteurism TOUCH AND RUB UP IN CROWDED • Paedophilia AROUSED FROM AGED 13OR UNDER

5. Fetishism DSM-IV-TR diagnosing criteria for fetishism Over Period of at least 6 months, Sexually aroused and urges intensely by non-living objects Cause clinically important distress and problems in their environment Not limited by just women’s underwear or genital stimulation

6. Transvestic Fetishism DSM-IV-TR diagnosing criteria Over at least 6 moths, • Heterosexual males sexually aroused from cross-dressing Wearing women clothes, like this example

7. Sexual Masochism • Masochistic acts being physically calm through the use of handcuffs, cages, chains, and ropes DSM-IV-TR diagnosing criteria for sexual Masochism • Being sexually aroused from being humiliated, beaten, bound • Cause environmental impairment

8. Sexual Sadism • Feeling sexually satisfaction by physically or sexually suffering the others

9. Exhibitionism • Person who is immature of sexual relationship, • Strongly aroused by exposing penis to a strangers • Usually occurs before age of 18 physically harm, • Traumatic an psychological consequences

10. Voyeurism • By watching unsuspecting naked person • Situation of undressing or different sexual activities • A problem when violates other’s privacy. Begins in adolescence

11. Frotteurism • By touching or rubbing up in a disallowing places • e.g.: public places • Usually male’s activity • Begins in adolescence

12. Paedophilia • Sexual attraction towards children before puberty, under 13 years or younger • Girls = 3 boys • Low income = 18 high income • Differentiate differences between who is papedophiliaa and who sexually abused children because of availability

13. Unofficial sub-types of Papedophilia • Incest Paedophilia Sexual intercourse or any kinds of sexual activity between closely related person (immediate family) • Preference Molesters become aroused by sexually immature child • Child Rapists only get fully sexual gratification from harming and even murdering victims

14. The Risk Factors For Paraphilias • Effectiveness of Hypersexuality on anxiety, depression and paraphilias (Kafka, 1997) • DSM-IV-TR paraphilias are predominantly male activities (being a male risk factor) • Risk factors for paedophilia include: • Being a victim of childhood sexual abuse • Possessing an inadequate attachment style • Depression and psychosocial stress • Alcohol abuse • Psychiatric comorbidity

15. The Aetiology of Paraphilias • The Psychodynamic Perspective • Classical Conditioning • Childhood Abuse & Neglect • Dysfunctional Beliefs, Attitudes & Schemata

16. The Psychodynamic perspective • Defensive reactions attempting to protect the ego from repressed fears • Representing fixation at a pre-genital stage of development (e.g. the Oedipal stage) • Castration anxiety • Transvestic fetishism when there is denial of mother’s castration. • Dressing in a woman’s clothes but still having a penis underneath is seen as reassuring the transvestite that his mother has not been castrated and he should not therefore worry about himself being castrated. Successfull in the treatment of paraphilias Not effective in treating sexual offenders

17. Classical Conditioning Paraphilias are the result of early sexual experiences becoming associated with unusual stimuli or behaviour Masturbating to pictures of a woman dressed in tights tights fetish

18. Childhood Abuse & Neglect • Physical and sexual abuse feature in the history of many paraphilias (e.g. mason, 1997) • Problematic child-parent relationships may develop low self-esteem which may lead individuals to seek sexual gratification in unusual ways

19. Dysfunctional Beliefs, Attitudes & Schemata • Cognitive distortions, dysfunctional beliefs and information processing biases play an important role in facilitating paraphilias involving sexual offending (Abel et al., 1989; Ward et al., 1997)

20. Cognitive Distortions in Sexual Offenders • Cognitive Distortions that justify sexual offending include: • “Children want sex with adults” – Incest offenders • “Sex is not harmful for the child” – Paedophiles • “Women are sex objects and will enjoy sex when it is forced on them” - Rapists

21. Cognitive Distortions

22. The Treatment of Paraphilias • BEHAVIORAL TECHNIQUES - Aversion Therapy attempts to break the link by pairing these stimuli with aversive (rather than enjoyable) consequences Short-term access Ex: olfactory (ammonia) aversion Person will inhale ammonia to pair its noxious odor with antecedents that are likely to lead to a sexual offense Ammonia: amonyak

23. Antecedents for person with pedophilia • I ask him casually when he and his dad play ball (knowing pretty well that he is going to say something about his dad not being available). I am right and he says that his mom and dad are divorced, his dad doesn’t spend any time with him, and his mom has a new boyfriend so he rarely plays at all. I invite him to go for a hamburger. He is enthusiastic.” • “I am breaking capsule. I am sniffing the ammonia. I am coughing. My head is beginning to throb. I can barely breathe. It hurts to breathe. My head is throbbing because I invited a boy to come to a restaurant with me.”

24. Cont. • “After going to eat, I invite the boy to come over to the house to watch some movies and he agrees.” • “I am breaking another capsule. I sniff and I am coughing and my eyes are hurting and my eyes are watering and I have a sharp pain in the back of my head and I’m getting a terrible headache. My eyes are watering and hurting because I invited a boy to my house.”

25. Cont. • Covert Conditioning / sensitization Using the client’s ability to imagine events to condition acceptable associations between events • Aversion therapy can also be used in covert conditioning form

26. Example of covert conditioning “I am at work, I am surrounded by my fellow engineers, and we are talking about an important project that I am heading up. My boss walks in with his face ashen, behind him are two police officers. They ask me my name, which I confirm. They tell me I am under arrest for molesting a 14-year-old boy named Andy. Of course I start to protest, saying I don’t know what they’re talking about, that surely this is a mistake. They escort me out of the boardroom in handcuffs in front of everyone. I hear gasps and murmurs and “What is going on?” following behind me as I walk down the hall. The police tell my workmates I am a child molester, and they are shocked. We ride the elevator down with several of my well-known clients looking puzzled and confused. We walk out into the bright sunlight where a squad car is waiting. I am being taken away by the police because I volunteered to help kids out, thinking that I could become sexual with one of them.”

27. Cont. • Masturbatory Satiation the client is asked to masturbate in the presence of arousing stimuli until those stimuli are no longer arousing

28. Example • patients first to masturbate to nondeviant sexual fantasies (I am with my wife, I am looking at her beautiful hair and beautiful skin, and I am thinking about how sexy she looks to me. We are in the Jacuzzi; we dry each other off and walk over to our bed)until they reach orgasm, and then, promptly following orgasm, to continue to masturbate while focusing on one of their highly erotic pedophiliac fantasies (I watch as he chews his food and laughs and smiles about watching a movie at my house. I think about how easy it will be to get him to sit on the couch next to me and let me rub his shoulders and legs.)The pedophiliac fantasies are used during the refractory or resolution phase when the patient cannot, or is not likely to, achieve erection or orgasm. (Abel et al. 1984)

29. Cont. • Orgasmic Reorientation Replacing inappropriate or distressing sexual activities which aims to make the client sexually aroused by more conventional or acceptable stimuli. Example when they are about to orgasm, they change those thoughts from children, to a woman.

30. COGNITIVE TREATMENTS • CBT is used to challenge the cognitive distortions held by many paraphilics Challenging distorted beliefs includes: • Showing that distorted beliefs are based on deviant behaviour • Showing clients that they misinterpret information to be consistent with these beliefs • Showing that the client’s beliefs are not shared by most other members of society

31. HORMONAL & DRUG TREATMENTS - Anti-Androgen Drugs (testosterone-lowering drugs) - Antidepressants (e.g. SSRIs) • No long-term follow-up studies

32. Problems In Treating Paraphilias • Many paraphilias are criminal offences so clients are less likely to be truthful about their activities • involve things people enjoy doing and are reluctant to give up • are associated with rigid beliefs that justify the behaviour • is highly co morbid with other psychopathologies

33. Conclusion • Defining all types of paraphilias • The Aetiology of paraphilias • The risk factors of paraphilias • Focused on pedophilia • Behavioral Techniques to treat are explained (pedophilia)

34. REFERENCES • John Tennison (2012),Valuable Sources Describing Peer-Reviewed and Accepted Methodology for Evaluations Under “Sexually Violent Predator” Statutes. •  Michael B., and R. L. Halon, (2008),Use of DSM Paraphilia Diagnoses in Sexually Violent Predator Commitment Cases,"., Journal of the American Academy of Psychiatry and the Law, Volume 36, pages 443-454. • Davey, G. (2008). Psychopathology. Research, assessment and treatment in clinical psychology. West Sussex: British Psychological Society & Blackwell Publishing Ltd • http://whyfiles.org/154pedophile/2.html • http://www.health.am/sex/more/pedophilia/ • http://texaspsychiatry.com/Valuable%20Methodological%20Sources.htm • http://www.health.am/sex/more/pedophilia_covert_sensitization/