1. Paraphilic Disorders, Sexual Dysfunctions, and Gender Dysphoria
Chapter 11
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2. 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
When evaluating the normality of a given sexual behavior, customs and mores which change over time are to be considered.
Sexual perversity - Linked sexual fantasy and the compulsion to kill.
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3. 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.
Para = abnormal; philia = attraction
Deviation involving the object of a person’s sexual attraction.
Paraphilic disorder: Diagnosis in which a paraphilia causes distress and impairment.
The essential feature is that people with one of these disorders are so psychologically dependent on the target of desire that they are unable to experience sexual arousal unless this target is present in some form.
Cause intense personal distress or impairment in social, work, and other areas of life functioning.
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4. TABLE 11.1 Paraphilic Disorders
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5. 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
Individual experiences sexual arousal when with children that may be equal to, if not greater than, that which he or she experiences with individuals who are physically mature.
Internet offenders fall into two groups:
“Contact driven”
“Fantasy driven”
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6. Exhibitionistic Disorder
A person has intense sexual urges and arousing fantasies involving the exposure of genitals to a stranger
Exhibitionistic disorder begins early in adulthood and persists throughout life.
The existence of comorbid conditions such as major depressive disorder and substance abuse, along with the reluctance of people with the disorder to come forward.
Present numerous challenges both for developing an understanding of the causes of the disorder and for planning its treatment.
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7. 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
Voyeurism, the most frequent paraphilia, is related to exhibitionism, and people with either of these disorders are likely to engage in sado-masochistic behaviors and cross-dressing.
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8. 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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9. Fetishistic Disorder
Partialism: The person is interested solely in sexual gratification from a specific body part:
Feet
Nearly half of all fetishes involves the feet and toes, and of all preferred objects, the most frequent involved objects worn on the legs or feet.
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10. 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
Men with frotteuristic disorder seek out crowded places in which they can safely rub up against their unsuspecting victims.
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11. Sexual Masochism
Attraction to achieving sexual gratification by having painful stimulation applied to one's own body
The term “masochism” refers to seeking pleasure from being in pain.
People with sexual masochism disorder are sexually aroused by being beaten, bound, or otherwise made to suffer.
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12. Sexual Sadism
Deriving sexual gratification from activities that harm, or from urges to harm, another person
People with sexual sadism disorder become sexually aroused from the physical or psychological suffering of another person.
People with these disorders tend not to seek treatment because they feel no need to change.
They tend to carry out these behaviors in a great deal of secrecy because they often involve consensual behavior.
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13. 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
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14. 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.

15. 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.

16. 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.

17. Transvestic Disorder Transvestic fetishism- Transvestic disorder-
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
Transvestism(cross-dressing) - Behavior of dressing in the clothing of the other sex.
Clinicians consider an individual who engaged in frequent cross-dressing for the purposes of sexual arousal a “transvestite”.
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18. Theories and Treatment of Paraphilic Disorders
Biological perspectives
Castration
Psychotherapeutic medications
Psychological perspectives
Lovemaps
Group therapy
The cognitive behavioral perspective
Relapse prevention
Biological perspectives
Paraphilic disorders involve a combination of influences including genetic, hormonal, and sensory factors in interaction with cognitive, cultural, and contextual influences.
Theory of pedophilic disorders is that it results from early neurodevelopmental disorders which researchers believe is involved in altered sexual arousal.
Castration as a treatment for men with paraphilic disorder is intended to destroy the body’s production of testosterone through surgical castration.
Chemical castration - Individual receives medications that suppress the production of testosterone.
Psychotherapeutic medications alter the individual’s neurotransmitter levels.
Psychological perspectives
Lovemap: Representations of an individual’s sexual fantasies and preferred practices.
Paraphilia is due to a lovemap gone awry.
Treatments within the psychological perspective seem most effective when combining individual with group therapy.
Cognitive behavioral perspective is useful in helping clients recognize their distortions and denial.
Empathy training
Relapse prevention
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19. Sexual Dysfunctions
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20. Sexual Dysfunctions
Abnormality in an individual’s sexual responsiveness and reactions
Feelings of significant distress or impairment
Lifelong or acquired
Generalized or situational
Masters & Johnson identified three phases of the sexual response cycle—desire, excitement, and orgasm—with the last stage consisting of resolution (post-orgasm).
Physiological factors and chronic health conditions are strongly related to risk of developing sexual disorders.
Risk factors
Diabetes, cardiovascular disease, other genitourinary diseases, psychological disorders, other chronic diseases, and smoking.
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21. 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.
Hypoactive sexual desire disorder: Individual has an abnormally low level of interest in sexual activity.
Female sexual arousal disorder: Persistent or recurrent inability to attain or maintain the normal physiological and psychological arousal responses during sexual activity.
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22. 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
Sexual aversion disorder: An active dislike of intercourse or related sexual activities.
Male erectile disorder: A man cannot attain or maintain an erection during sexual activity that is sufficient to allow him to initiate or maintain sexual activity.
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23. Disorders Involving Orgasm
Female orgasmic disorder
Male orgasmic disorder
Female orgasmic disorder: A woman experiences problems having an orgasm during sexual activity.
Factors relating to female orgasmic disorder:
Stress
Anxiety
Depression
Relationship satisfaction
Age-related changes in the genital area that can lead to pain, discomfort, irritation, or bleeding.
Male orgasmic disorder: A man experiences problems having an orgasm during sexual activity.
Also known as:
Inhibited male orgasm
Delayed ejaculation
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24. 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.
Clinicians prefer to apply a psychiatric diagnosis only when the individual is distressed about the condition.
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25. 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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26. 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
Masters and Johnson claimed that all men with erectile dysfunction had psychological problems.
Anxiety and job stress.
Boredom with long-term sexual partners.
Other relationship difficulties.
Medications to treat erectile dysfunction are all in the category of phosphodiesterase (PDE) inhibitors, which work by increasing blood flow to the penis during sexual stimulation.
The treatment of sexual arousal and desire disorders in women that follows from the biological perspective incorporates hormonal replacement therapy.
Sexual pain disorders - Treatment can include application of corticosteroids and physical therapy to promote muscle relaxation and improved blood circulation.
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27. Sexual Dysfunctions: Theories and Treatment
Psychological perspectives
Macho myth
Sensate focus
Erectile dysfunction - A predisposing factor is a man’s belief in the “macho myth.”
Belief in this myth makes them more prone to developing dysfunctional thoughts when they have an unsuccessful sexual experience.
Quality of the relationship contributes to sexual dysfunction.
Sensate focus: Method of treating sexual dysfunction in which the interaction is not intended to lead to orgasm, but to experience pleasurable sensations during the phases prior to orgasm.
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28. Gender Dysphoria
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29. Gender dysphoria Gender Dysphoria Gender identity: Biological sex
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.
Biological sex: Sex determined by a person’s chromosomes.
Transsexualism: Gender identity disorder, specifically pertaining to individuals choosing to undergo sex reassignment surgery.
Gender dysphoria: Distress associated with feeling that a person has the wrong gender.
Reason for using the term gender dysphoria instead of gender identity disorder:
An individual’s identification with a sex other than the biologically assigned one need not be a disorder.
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30. 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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31. 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 self-identification 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.
Transphobia - The negative stereotyping and fear of people who are transgendered.
Whereas in the past, the profession equated transgenderism with a “disorder,” the new terminology is reflecting a theoretical perspective that does not focus specifically on what is “wrong” with people whose self-identification differs from their biological characteristics or social roles. Clinicians who work with transgendered individuals experiencing gender dysphoria take a three-pronged approach to psychotherapy including psychological, hormonal, and potentially sex reassignment surgery. Ideally, according to the World Professional Association for Transgender Health (WPATH), clinicians would provide an assessment of a client’s well-being without regard to diagnostic criteria.
Clinicians who work with transgendered individuals experiencing gender dysphoria take a three-pronged approach to psychotherapy including psychological, hormonal, and potentially sex reassignment surgery
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32. 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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