Introductory Notes

Wednesday, 1 March 2023 7:37 am

• Paraphilic Disorders
○ Intense and persistent sexual interest other than sexual interest in genital
stimulation or preparatory fondling with mature consenting humans

• The last chapter of the section 2 of the DSM 5

• DSM
○ DSM I and II
▪ Personality Disturbance
○ DSM III
▪ Psychosexual Disorders
○ DSM IV
▪ Sexual Dysfunctions, Paraphilic Disorders and Gender Identity
Disorder
○ DSM 5
▪ Paraphilic Disorders

• Paraphilia vs Paraphilic Disorders

○ In the past, these were used interchangeably
○ Paraphilia becomes a disorder if there is distress or impairment to the
individual and poses harm to self or others
▪ This is when we intervene

○ Paraphilia
▪ Experience of intense sexual arousal to atypical objects, situations,
fantasies, behaviors, or individuals
▪ Necessary but not sufficient condition for a diagnosis
□ Some people find sexual arousal in objects, not really in individuals
all the time
▪ May or may not require clinical intervention
○ Paraphilic Disorders
▪ Paraphilia
□ A symptom
▪ Causes distress or impairment to the individual
▪ Poses harm to self or others

• Diagnostic Criteria for Paraphilic Disorders

○ Just like sexual dysfunctions

○ Criterion A
▪ Qualitative nature of the paraphilia
□ Ex. Cross-dressing
○ Criterion B
▪ Negative consequences of the paraphilia
□ Significant distress or impairment in important areas of
functioning

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• Specifiers for Paraphilic Disorders

○ Controlled environment
▪ The person is restricted as to their behavior
○ Full remission
▪ Somehow healed

• Paraphilic Disorders
○ Anomalous Activity Preferences
▪ Courtship Disorders
□ Voyeuristic, exhibitionistic, and frotteuristic disorders
▪ Algolagnic Disorders
□ Sexual masochism and sexual sadism disorders
○ Anomalous Target Preferences
▪ Directed at other humans
□ Pedophilic disorder
▪ Directed elsewhere
□ Fetishistic disorder and Transvestic disorder

• Pedophilia
○ Is very clear that it victimizes children so the treatment is focused on
pedophilia

• Summary
○ Voyeuristic Disorder
▪ Paraphilic interest or sexual arousal from observing an unsuspecting
person who is naked and disrobing or engaged in sexual activity
○ Exhibitionistic Disorder
▪ Exposing their genitals to unsuspecting individuals
○ Frotteuristic Disorder
▪ Sexual attraction from touching and rubbing against a non-consenting
individual
○ Sexual Masochism Disorder
▪ Sexual arousal from the act of being humiliated, beaten, bound
○ Sexual Sadism Disorder
▪ Sexual arousal in the physical/psychological difficulties or suffering of
another individual
○ Pedophilic Disorder
▪ Sexually arousing fantasies, sexual urges with children under 13
□ 5 year difference between victim and perpetrator
○ Fetishistic Disorder
▪ Use of non-living objects or non-genital body parts that causes sexual
arousal

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 arousal
○ Transvestic Disorder
▪ Cross-dressing
□ Source of sexual arousal

• Etiology:
○ Biological
▪ Brain activity during sexual arousal
▪ General brain structure
□ Frontal lobes and diencephalic structures
○ Psychological
▪ Temperament
□ A tendency to be overly inhibited or uncontrolled with emotions
and behaviors
▪ Early relationship formation
□ A lack of stable self-awareness, trouble managing emotions, and in
seeking help and comfort from others
▪ Trauma repetition
□ People who are the victim of sexual or other form of abuse,
especially if it occurs during childhood, may identify with the
abuser such that they act out what was inflicted on them by
victimizing others in some way
□ They may also act out the trauma by somehow harming themselves
▪ Disrupted development of sexuality
□ The patterns of what brings one sexual pleasure tend to form by
adolescence
□ People raised in a household that is either excessively sexually
permissive or inhibited are at higher risk for developing a
paraphilia
○ Social
▪ High conflict between parents
▪ Low supervision by parents
▪ Lack of affection from the mother, and generally not feeling treated
well by their parents

▪ People with paraphilia tend to have trouble making and keeping friends
and other relationships

• Treatment
○ CBT
▪ Recognize and combat rationalizations about his or her behavior
□ If they recognize and justify their behavior, they do not accept
that this is maladaptive and is therefore needed to be treated
▪ Develop empathy for the victim and in techniques
□ For pedophilia
 We help them have empathy for the child
▪ Control their sexual impulses
▪ Anticipate situations that increase their risk of sexually acting out and
finding ways to avoid or more productively respond to those triggers
□ Avoid triggers and situations that cause the disorder to manifest
Social skills training to help them develop age-appropriate, reciprocal

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○ Social skills training to help them develop age-appropriate, reciprocal
relationships
○ For pedophilia:
▪ Medications to suppress production of Testosterone and SSRI
□ Testosterone makes males sexually active and aggressive
□ SSRI helpful in cases to treat pedophilia and other disorders

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Paraphilic Disorders
Saturday, 4 March 2023 2:21 pm

Voyeuristic Disorder

Exhibitionistic Disorder

○ Specify whether:
▪ We need to know the triggers behind the behavior

Frotteuristic Disorder

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 •

Sexual Masochism Disorder

Sexual Sadism Disorder

Pedophilic Disorder

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 •

○ Nonexclusive type
▪ Children and adults

Fetishistic Disorder

○ If the "fetish" is cross-dressing, it is transvestic disorder

Transvestic Disorder

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•

○ Fetishism
▪ A standalone disorder and specifier

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