1. Sexual Compulsions and Gambling Eating Disorders

2. Compulsive Sexual Behaviors 2 General Types: - paraphilic CSBs - nonparaphilic CSBs

3. An Overview Para –“Beyond” or “Amiss” Philia –“Love” Para –“Beyond” or “Amiss” Philia –“Love” Sexual Stimulation Requiring Bizarre or Unusual Acts, Imagery, or Objects

4. Fetishism Sexual Attraction to: –Inanimate Objects –Tactile Stimulation –Parts of the Body Sexual Attraction to: –Inanimate Objects –Tactile Stimulation –Parts of the Body

5. “The Flasher” –Expose Genitals to Unsuspecting Strangers –Element of Risk is Important –May Not Be “Harmless” (Many Rape / Molest) “The Flasher” –Expose Genitals to Unsuspecting Strangers –Element of Risk is Important –May Not Be “Harmless” (Many Rape / Molest) Exhibitionism

6. “The Peeping Tom” –Watching Unsuspecting Strangers Naked or Undressing “The Peeping Tom” –Watching Unsuspecting Strangers Naked or Undressing Voyeurism

7. “Cross Dresser” –Sexual Arousal by Dressing in Clothes of the Opposite Sex –Most are Male Heterosexuals –Most are Married “Cross Dresser” –Sexual Arousal by Dressing in Clothes of the Opposite Sex –Most are Male Heterosexuals –Most are Married Transvestic Fetishism

8. Sexual Sadism and Masochism The “Sadist” –Sexual Arousal by Inflicting Pain / Humiliation Domination, Beatings The “Masochist” –Suffers the Pain / Humiliation –Helps the Sadist The “Sadist” –Sexual Arousal by Inflicting Pain / Humiliation Domination, Beatings The “Masochist” –Suffers the Pain / Humiliation –Helps the Sadist

9. Pedophilia –Sexual Attraction to Children –More Aroused to Young Children Pedophilia –Sexual Attraction to Children –More Aroused to Young Children Pedophilia and Incest Incest –Children Related to Perpetrator Incest –Children Related to Perpetrator

10. Other Forms of Paraphilia Frotteurism -- Rubbing Necrophilia -- Corpses Klismaphilia -- Enemas Coprophilia -- Feces Zoophilia -- Animals Scatologia -- Obscene Calls Frotteurism -- Rubbing Necrophilia -- Corpses Klismaphilia -- Enemas Coprophilia -- Feces Zoophilia -- Animals Scatologia -- Obscene Calls

11. Psychosocial Contributions Inability to Develop Adequate Relationships Early “Unusual” Sexual Experiences Person’s Early Sexual Fantasies Excessive Sex Drive & Suppression Specific Causes are Still Unclear Inability to Develop Adequate Relationships Early “Unusual” Sexual Experiences Person’s Early Sexual Fantasies Excessive Sex Drive & Suppression Specific Causes are Still Unclear

12. Anxiety/S-E Management Strategies are Commonalities

13. Psychosocial Treatments Suppression –Paradoxically Backfires Covert Sensitization Orgasmic Reconditioning Relapse Prevention Treatment Can Work But… follow-up issues are a concern Suppression –Paradoxically Backfires Covert Sensitization Orgasmic Reconditioning Relapse Prevention Treatment Can Work But… follow-up issues are a concern

14. Drug Treatments Anti-Androgen –Cyproterone Acetate; Depo-Provera –Reduces Testosterone Levels Eliminates Sexual Desire / Fantasy Use for Sex Offenders Only a Temporary Solution Anti-Androgen –Cyproterone Acetate; Depo-Provera –Reduces Testosterone Levels Eliminates Sexual Desire / Fantasy Use for Sex Offenders Only a Temporary Solution

15. Nonparaphilic Compulsive Sexual Behaviors: Compulsive Cruising & Multiple Partners Fixation on Unattainable Partner Compulsive Autoeroticism Multiple Love Relationships (obsessed with finding intense feeling of a new relationship) Compulsive sexuality in relationship (unending needs for sex, expressions of love, attention etc – possessiveness, jealousy, anger…) Nonparaphilic Compulsive Sexual Behaviors: Compulsive Cruising & Multiple Partners Fixation on Unattainable Partner Compulsive Autoeroticism Multiple Love Relationships (obsessed with finding intense feeling of a new relationship) Compulsive sexuality in relationship (unending needs for sex, expressions of love, attention etc – possessiveness, jealousy, anger…)

16. Compulsive Overeating: A Unique Type of Eating Disorder? Eating Disorders

17. Research Criteria for Binge-eating disorder n Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: –eating, in a discrete period of time (e.g. 2 hr period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances –a sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating)

18. Research Criteria for Binge-eating disorder n The binge-eating episodes are associated with 3 or more of the following: –eating much more rapidly than normal –eating until feeling uncomfortably full –eating large amounts of food when not feeling physically hungry –eating alone because of being embarrassed by how much one is eating –feeling disgusted with oneself, depressed, or very guilty after overeating

19. Research Criteria for Binge-eating disorder n Marked distress regarding binge eating is present. n The binge eating occurs, on average, at least 2 days a week for 6 months. n The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g. purging, fasting, excessive exercise) and does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.

20. Binge-eating disorder n Affects about 2% of general population, and about 8% of those who are obese n Health effects n Treatment strategies –behavioral weight control methods –nutritional consultation –relapse prevention / cognitive therapies –medications –self-help groups

21. GAMBLING

22. Diagnostic Criteria for Pathological Gambling n Persistent and recurrent maladaptive gambling behavior as indicated by 5 or more of the following: –is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble). –needs to gamble with increasing amounts of money in order to achieve the desired excitement.

23. Diagnostic Criteria for Pathological Gambling (cont..) –Has repeated unsuccessful efforts to control, cut back, or stop gambling –is restless or irritable when attempting to cut down or stop gambling –gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression.) –after losing money gambling, often returns another day to get even (“chasing” one’s losses.)

24. –Lies to family members, therapist, or others to conceal the extent of involvement with gambling –has committed illegal acts as forgery, fraud, theft, or embezzlement to finance gambling –has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling –relies on others to provide money to relieve a desperate financial situation caused by gambling n The gambling behavior is not better accounted for by a Manic Episode