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Paraphilias

Paraphilias

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Paraphilias

  1. 1. Paraphilic Disorders MAP106 - Advanced Abnormal Psychology
  2. 2. What are Paraphilias? ● These are sexual stimuli or acts that are deviations from normal sexual behaviors, but are necessary for some to experience arousal and orgasm, to which the client’s sexuality appears to be restricted with ● It can range from nearly normal behavior to behavior that is destructive or hurtful only to oneself or to another. ● Paraphilia is clinically significant if the person has acted on these fantasies or if it has caused marked distress or interpersonal/job-related difficulties
  3. 3. What are Paraphilias? ● If the client has not acted out on their fantasies, we shall omit a diagnosis of a paraphilic disorder. ● The fantasies and their behavioral manifestations extend beyond the sexual sphere to pervade people’s lives. ● It ranges from mild (men wearing women’s underwear, consensual blindfolding, and role playing) to severe (sexually abusing children or sadistic beating/cutting), and clinicians must determine the level of distress of harm that warrants a diagnosis
  4. 4. DSM-5 Modifications The DSM now made a clear distinction between paraphilic interests and paraphilic disorders in order to avoid pathologizing sexual preferences that are not problematic. However, criticisms are due to perceived lack of clarity underlying the categorization of paraphilic disorders, unclear distinctions between paraphilias and paraphilic disorders, and the use of vague description of “recurrent and intense” in describing the symptoms
  5. 5. Paraphilic Disorders: Courtship Disorders (abnormal activities that are reminiscent of courtship) VOYEURISTIC DISORDER ➢ Recurrent and intense arousal from observing an unsuspected person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors EXHIBITIONISTIC DISORDER ➢ Recurrent and intense arousal from exposing one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors FROTTEURISTIC DISORDER ➢ Recurrent and intense arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges or behaviors
  6. 6. Paraphilic Disorders: Algolagnic Disorders (involves pain to oneself or others) SEXUAL MASOCHISM DISORDER ➢ Recurrent and intense arousal from the act of being humiliated, being made to suffer,, as manifested by fantasies, urges, or behaviors SEXUAL SADISM DISORDER ➢ Recurrent and intense arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors
  7. 7. Paraphilic Disorders: Anomalous Activity/Target Preferences PEDOPHILIC DISORDER ➢ Recurrent and intense arousal involving sexual activity with prepubescent children (13 or younger), as manifested by fantasies, urges, or behaviors ➢ The individual should be at least 16 years old and at least 5 years older than the child or children FETISHISTIC DISORDER ➢ Recurrent and intense arousal from the use of nonliving objects or a highly specific focus on nongenital body parts, as manifested by fantasies, urges, or behaviors ➢ These objects are not limited to articles of clothing in cross-dressing or devices that is designed for tactile genital stimulation TRANSVESTIC DISORDER ➢ Recurrent and intense arousal from cross-dressing, as manifested by fantasies, urges or behaviors
  8. 8. Epidemiology ● Paraphilias are practiced only by a small percentage of population, but the insistent, repetitive nature of the disorder results in a high frequency of such acts. ● It was suggested that the prevalence is significantly higher than the number of cases diagnosed. ● Peaks are at around ages 15 to 25
  9. 9. Epidemiology ● Legally identified cases: ○ Pedophilia is most common ○ Exhibitionists among children ○ Voyeurism may be apprehended, but the risk is not great ○ Sadism comes with rape, brutality, and lust murder ○ Excretory paraphilic disorders are scarcely reported due to their consensual nature ○ Fetishists rarely become entangled with the legal system ○ Transvestites are occassionally arrested ● Fetishism almost occur among men. ● Paraphilias seem to be largely male conditions ● DSM-5 suggests that diagnosis of paraphilias be reserved for ages 18 and above
  10. 10. Etiology (Biological) ● The monoamines are implicated in both paraphilic disorders and hypersexual behavior ● Prescription of dopamine agonists ● Multiple sclerosis, temporal lobe epilepsy, brain lesions and brain tumors. ● Elevated levels of androgens
  11. 11. Etiology (Environmental & Psychosocial) ● Classical conditioning due to the simultaneous arousal to the presence of an object ● Operant conditioning by means of evasion from punishment ● Psychosocial history and comorbid problems ● Substance-abuse problems ● Early sexual problems ● Psychological difficulties and dissatisfaction with life
  12. 12. Etiology (Environmental & Psychosocial) ● Classical conditioning due to the simultaneous arousal to the presence of an object ● Operant conditioning by means of evasion from punishment ● Psychosocial history and comorbid problems ● Substance-abuse problems ● Early sexual problems ● Psychological difficulties and dissatisfaction with life
  13. 13. Treatment ● Individuals are reluctant to seek treatment: ○ They do not believe it is problematic ○ Embarrassment about unusual sexual activities ○ Their sexual activities are illegal
  14. 14. Biological Treatments ● SSRIs influence the serotonergic pathway ● SSRIs may be used as a frontline treatment among juvenile offenders ● Antiandrogens (Androgen Deprivation Therapy) ○ Effective to those who commit cases among nonconsenting individuals. ● Gonadotropin-releasing hormone agonists and Luteinizing Hormone-Releasing Agonists ○ Paradoxically stimulates the hypothalamus to release hormones until the down-regulation of the receptors ● Surgical castration is still performed, but human rights consideration will lead to the discontinuation of the procedure
  15. 15. Psychosocial Treatments ● Cognitive-Behavioral & Socio-Cognitive Models ○ Assess the risk of reoffending ○ Identify and match criminogenic needs ● Good Lives Model emphasizes the personal goals and strengths and use these in motivating for positive change ● Psychoeducation can be used in making clients understand their problem such as an attempt to refute the sexual myths and schemas clients are holding on to

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