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Sexual Disorders Dysfunction & Paraphilias Dysfunction & Paraphilias Professor Craig A. Jackson Head of Psychology

Overview Understanding sexual disordersParaphilias The role of Fantasy PrevalenceSpaces COS model PaedophiliaCausesTreatments Other Paraphilias

Two types of Sexual Disorders Sexual Dysfunction Problem of sexual response Desire Aversion Drive Orgasm

Sexual Disorders Paraphilias Abnormal sexual activity Illegal & legal Not necessarily distressing No desire to change At extreme of sexual spectrum rather than disordered

Paraphilias caveat DSM-IV Must result in distress Or not considered disorder

Paraphilias Fetishism Intense sexual urges Sexually arousing fantasies Behaviours Living or inanimate objects

Paraphilias Exhibitionism Urges to expose genitalia Sometimes to others Concomitant with sexual fantasies

Paraphilias Sadomasochism / Sadism / Masochism Sexual stimulation Through acts of humiliation Beating / being beaten Binding / constriction / airway reduction / unconsciousness Suffering

Colin Ireland UnemployedGay men Peter Sutcliffe DriverSex workers (mostly) Peter Manuel UnemployedYoung women Steve Wright DriverSex workers Stephen Griffiths StudentSex workers Wests Builder / ProstituteRunaways / strays Brady & Hindley UnemployedChildren Dennis Nilsen Civil ServantGay men Harold Shipman GPOlder people Robert Black DriverChildren Beverley Allit NurseChildren Bible John ?Young women Peter Tobin HandymanWomen / immigrants Colin Norriss NurseOlde people David Copeland UnemployedGay men / immigrants Donald Neilson UnemployedOlder people /child UK Serial Murderers and their Paraphilias

The Crimes of the BTK Serial killer in Kansas active from 1974 to 2005 Murdered 10 people from 1974 – 1991 (caught in 2005) Victims 1974 Mr Joe Otero, Mrs Julie Otero, and children Jo jr & Josephine 1974Kathryn Bright and wounded her brother Kevin 1977 Killed Shirley Vian 1977Killed Nancy Fox 1985Marine Hedge, was murdered 1986Vicki Wegerle was killed 1991The last confirmed victim of BTK was Dolores Davis

Shirley Vian murder scene

Kathryn Bright murder scene

Who was BTK? Dennis Lyn Rader Married father of two Heterosexual ADT home security installer (1980s) Scout Leader Church Minister City dog warden (1990s)

Who was BTK? BondageBDSM Violent sexual fantasist

Who was BTK?

Paraphilias Paedophilia Intense sexual urges Sexually arousing fantasies Involving children

DSM IV & Paedophilia Recurrent sexual urges and sexually arousing fantasies involving sexual activity (nt necessarily) with a pubescent child or children Offender must be 16yrs or older AND at least 5 yrs older than victim Genital touching, oral sex, or undressing Pedophiliac relationships rely on persuasion, guilt and friendship (Murray 2000)

Exploring Erotic Fantasies Represent our own world Psychological realm Thinking, dreaming, imagining occurs Without fear of reprimand Without social constraints

Exploring Erotic Fantasies Serve to sexually arouse Mental images Over long periods or Fleeting moments Hicks & Leitenberg 2001 Not culturally constrained or limited by age and gender

Erotic Fantasy Prevalence Males fantasise about sex 7 times per day Females: about sex 4 times per day Doskoch 1995 Fantasies important - enable to be free to indulge primitive lusts and brutish impulses that are unacceptable in reality Wilson 1997 Do fantasies remain in the fantasy realm?

Fantasy Spaces Fantasies don't always stay in fantasy realm Facilitated by: Socially acceptable physical environments (retail) Acceptable virtual environments (online) Consenting adults - fear of reprimand possible (Green 2001) Fantasies not static Cog rehearsal, transformation, maintenance, abandonment, reinforcement

The Virtual Space Pseudo reality space Hybrid twixt psychological & physical space Fantasy blended with reality Pornography - virtual space Voyeurs rather than active participants A gateway to sexual offending? No (Taylor & Quayle 2002) Porn may reinforce, update & strengthen erotic fantasy

Ready-Made Fantasies. Vanilla

Three Fantasy Spaces Fantasies co-exist between Psychological, Physical, and Virtual spaces Each space provides unique opportunity for Motivation Access Opportunity Fantasy & Reality inextricably linked "Doing" is dangerous when fantasy is non-consensual, unwanted, violent & illegal

Aetiology of Paedophilia Offenders frequently report disruptive early parent-child relationships, or childhood sex abuse (Hanson& Slater 1988) 60% offenders report childhood abuse (Cohen et al 2000) Many offenders try to justify / rationalise their abuse Cycle of abuse misappropriated Some offenders highly skilled and use their victimology

Behavioural Theories of Paedophilia Offenders develop sexual attraction to children Follows pairing of sexual arousal and child images Pairings often occur in adolescence Reinforced by masturbation (Barbaree 1990) Many offenders report isolation & loneliness Arising from inadequate childhood attachments (Ward 1996) Children as alternatives to adult connections

Preconditions Theory of Offending Finkelhor 1984 Sex with children emotionally & sexually satisfying Unable to meet sex needs / fantasies in appropriate ways Disinhibited behaviour at times of stress Paedophilia triggered by periods of low mood / depression as result of stress / distress / conflict (Pithers 1990) Offenders enter high risk behaviours to decrease negative feelings. Feelings return once rush has passed Self-loathing --> More offences --> Self-loathing

Combined Offending Space Model Wilson & Jones 2007 Important role of Internet in supporting, nurturing and normalising sexual fantasies Even extreme violent & illegal Assess if thinking leads to doing When does thinking lead to doing? Understand why offenders use children

Combined Offending Space Model OffendingSpace Psychological Fantasy Space Motivation Physical Real-world Space Access Virtual Pseudo-reality Space Opportunity Norms

Conversations with Sexual Offenders I guess fantasy is where I want it to go, what I can do for getting aroused to this thought As my fantasies grew my offending grew The Internet is designed purely for sexual thoughts I think your fantasies stay with what you've done and you re- visit A male may be abusing the hell out of a child... It's almost the very best of the actual fantasy on screen I think it (the internet) made me fantasise more. I don't think it made me offend more, but I suppose it made me do different things in the offences

Conversations with Sexual Offenders

Paedophilia Treatments Secure forensic units or prison Rehab programme Not compulsory. 25% uptake in prison Chemical castration for high testosterone offenders 15% of offenders on androgen programmes re-offend (Meinecke 1981) Poor compliance with medication in offenders (Barbaree & Seto 1997)

Behavioural Paedophilia Treatments Aversion Therapy Child sexual stimulus paired with aversive event Masturbatory Reconditioning Initiates sexual response to child material / thoughts. Once aroused, switch to appropriate image, continue until orgasm Really thinking of appropriate image??? Fewer ethical issues than version therapy

Relapse Prevention Offender taught a behavioural modification programme ID situations at high risk of offending Get out of high risk situation Learn from lapses ID factors that lead to relapses 2% success rate against relapse (Marques et al 2000)

Additional Paraphilias Exhibitionism Fetishism Frotteurism Paedophilia Sexual masochism Sexual sadism Transvestic fetishism Voyeurism Paraphilia NOS (not otherwise specified) e.g copraphilia, necrophilia, acrotomophilia, Gender identity disorder