Paraphilic Disorder

Paraphilia
greek; para - "beside", philia- "love"

condition in which which a person’s sexual arousal and gratification depend on fantasizing about engaging in sexual behavior that is atypical and extreme.

distinguised by a preoccupation with the object or behavior to the point of being dependent on that object or behavior for sexual gratification.

Characteristics of Paraphilia (DSM-V)

• feel personal distress about their interest, not merely distress resulting from society's disapproval; or
• have a sexual desire that involves another person's psychological distress, death, injury, or desire for sexual behaviors involving unwilling persons or persons unable to give legal consent.

Causes and risk factors

• the paraphilic behaviors defending the person's psyche against anxiety (defense mechanisms)
• result of the sufferer associating something with sexual arousal or by having unusual early life sexual experiences
• Some view these disorders as another form of obsessive compulsive disorder.

Other theories of risk factors

• Temperament: a tendency to be overly inhibited
• Early relationship formation: a lack of stable self-awareness, trouble managing emotions
• Trauma repetition: People who are abused, especially during childhood.
• Disrupted development of sexuality

Diagnosis

• extensive medical interview
• physical examination
• routine laboratory tests
• asked series of questions from a standardized questionnairehelp assess presence symptoms
• exploration for any history

DSM-V

Paraphilia to Paraphilic Disorder

• Paraphilia was divided to 2 criterions (A for sexual interests, B for involved victims) to avoid "invisible symptoms"
• Proposed diagnosis for paraphilias who are under B criteria will only be considered if the victim no. required was met.

Paraphilic Disorders

voyeuristic disorder

symptoms

• experiencing intense sexual fantasies and urges
• getting sexual gratification from watching a person naked with or without the consent
• proven if the behavior, fantasies and the intense sexual urges cause distress or hindrance to social, occupational areas of normal functioning.

diagnosis

• recurrent and intense sexual gratification from observing unsuspecting targets
• exhibiting stress, has sought sexual gratification from observing at least three or more unsuspecting targets on separate occasions

treatment

• psychotherapy, marital therapy, group therapy, family therapy, cognitive therapy, psychoanalysis and pharmacotherapy
• prescribed medications incd. medicines that are aimed at inhibiting the levels of their sexual hormones

exhibitionistic disorder

symptoms

• of six months, intense sexual arousal from the exposure of one’s genitals to a stranger
• uncontrollable sexual urge
• significant clinical distress and impairs social, occupational and/or other normal functions

diagnosis

• complete patient history; assessment of mental status; physical as well as neurologic examinations
• battery of tests: behavioral analysis, risk assessment, physiologic measurements and neuropsychological tests
• genital measures, self-reporting

treatment

• experimental psychotherapy treatment formats: shame aversion
• individual and/or group therapy, and marital and/or family therapy.
• Pharmacotherapy: SSRIs (selective serotonin reuptake inhibitors)

frotteuristic disorder

symptoms

• intense sexual arousal resulting from touching or rubbing against individuals
• fantasies of touching
• occurs in public settings
• at least 6 months and the patient must experience significant distress or negative impact on functioning

diagnosis

• recurrent touching or rubbing of one or more nonconsenting individuals
• clinically significant distress
• freely disclose their fantasies and frotteuristic behaviors
• deny either their urges, the resulting behaviors, or both, despite compelling evidence

treatment

• reduction of sexual urges and behaviors through behavioral therapy
• psychopharmaceutical intervention (antiandrogens)

pedophilic disorder

symptoms

• arousing fantasies about, behaviors with a prepubescent child
• significant distress or difficulty as a result of these desires
• 16 years of age, and at least five years older than the child

specifiers (sysmptoms)

• sexual attraction to children
• sexual attraction to adults and children
• Incestuous only

diagnosis

• patient history: molested as children, early clinical distress
• sexual trauma
• Freud's Repetition Compulsion

treatment

• Physical castration of sex offenders (1975)
• chemical castration through the use of synthetic estrogen
• long term incarceration

fetishistic disorder

symptoms

• 6 mos. period: sexual urges focused on a non-genital body part
• urges, behaviors cause distress, or impairment in functioning
• Fetishistic object is not an article of clothing

specifiers

• type of stimulus which is the focus of attention
• Body part, not the person. - Partialism preoccupation
• Other- situations or activities
• Non-living Object

diagnosis

• sexual dysfunction, inability to achieve or maintain an erection without the object of desire.
• Criminal behavior may be involved with Fetishistic Disorder
• unable to contain their desires = experience guilt, shame, and humiliation

treatment

• DSM-5 does not specify treatment options
• if learned behavior, CBT by systematic desensitization- gradual exposure to the fetishistic object show neutral response, rather than a sexual response may work to lower or eliminate sexual arousal

Transvestic disorder

symptoms

• 6 months: recurring sexual arousal brought on by the act of cross-dressing
• sexual fantasies, behaviors, or urges
• distress or impairment in important areas of function

diagnosis

• extensive items like full clothing, makeup, and wigs or hair styling
• masturbation sessions in younger individuals

treatment

• psychotherapy with a focus on negative self-perception
• antidepressants, particularly serotonergic drugs
• psychopharmacological strategies, anti-androgens

sexual masochism disorder

individuals who openly acknowledge and freely admit fantasy and urges to be beaten, bound or humiliated during sex (American Psychiatric Association, 2013)

patient experience distress, such as shame, guilt to anxiety related to sexual fantasy, urges, behavior.

symptoms

• pattern of sexual arousal for being made to suffer through physical violence or humiliation
• being beaten, bound, or verbally abused
• asphyxiation - choking
• must cause impairment or distress.

diagnosis

• experiencing anxiety, guilt, shame or other negative feelings related to masochistic sexual desires
• patient must admit to having these fantasies and urges

treatment

• medication alone cannot resolve sexual masochism disorder
• Depot antiandrogen injections
• keep a diary of sexual fantasy, arousal and masturbation
• Insight-focused therapy, Behavior Therapy

sexual sadism disorder

Algolagnic disorders are a class of paraphilic disorders wherein sexual arousal is dependent on pain and suffering.

Sexual sadism disorder is a specific algolagnic disorder

sexual arousal occurs from the physical or psychological suffering of another individual (The American Psychiatric Association, 2013).

symptoms

• intense feelings of sexual excitement when fantasizing about or witnessing an individual hurt, agonizing.
• may happen with a consenting partner, or as assault on a nonconsenting individual

diagnosis

• recurrent and intense sexual arousal from fantasies of physical or psychological harm of others
• acted upon these urges with a nonconsenting person
• more than normal human adult interaction (scratching, slapping, cutting)

treatment

• reduce sexual urges and behaviors via behavioral therapy
• psychopharmaceuticals: serotonin reuptake inhibitors, antipsychotics

Paraphilic Disorder

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