Perspectives on Sexual Variations and Paraphilic Disorders

pdf

School

University of Guelph *

*We aren’t endorsed by this school

Course

2100

Subject

Sociology

Date

Nov 24, 2024

Type

pdf

Pages

Uploaded by DeanWaterBuffaloMaster2369

441 Chapter 16 Sexual Variations Learning Objectives Normal Versus Deviant Sexual Behaviour LO 16.1 List and discuss different approaches to defining normal versus deviant sexual behaviour. The Paraphilias LO 16.2 List and define the paraphilias. Theoretical Perspectives LO 16.3 Discuss biological perspectives on paraphilias. LO 16.4 Discuss psychoanalytic perspectives on paraphilias. LO 16.5 Discuss cognitive-behavioural perspectives on paraphilias. LO 16.6 Discuss sociological perspectives on paraphilias. LO 16.7 Discuss the “lovemap.” Treatment of Paraphilic Disorders LO 16.8 Discuss the psychoanalytic treatment of paraphilic disorders. LO 16.9 Discuss the cognitive-behavioural treatment of paraphilic disorders. LO 16.10 Discuss medical treatment of paraphilic disorders. Sarah Ashun/Dorling Kindersley Ltd.

442 Chapter 16 Sexual Addiction, Compulsive Sexual Behaviour, and Hypersexuality LO 16.11 Discuss the concepts of sexual addiction, compulsive sexual behaviour, and hypersexuality. TRUTH OR FICTION? Which of the following statements are the truth, and which are fiction? Look for the Truth-or-Fiction items throughout this chapter to find the answers. 1 Strippers are exhibitionists. T / F ? 2 People who enjoy watching their mates undress are voyeurs. T / F ? 3 Exhibitionists and voyeurs are never violent. T / F ? 4 Some people cannot become sexually aroused unless they are bound, flogged, or humiliated by their sex partners. T / F ? 5 There is a subculture in various parts of the world in which sexual sadists and sexual masochists form liaisons to inflict and receive pain and humiliation during sexual activity. T / F ? 6 It is normal to enjoy some mild forms of pain during sexual activity. T / F ? 7 Painful stimuli may activate the reward regions of the brain. T / F ? By the time he came to the clinic, 55-year-old Arron had been cross-dressing for decades. There was a time when he would go out in public as a woman, but as his prominence in the community grew, he and his wife, Maya, who knew of his “peccadillo,” decided he must limit his cross-dressing to home. Maya had learned of his behaviour because he borrowed many of her clothes. In order to keep Arron at home, Maya offered to help him with his “weirdness.” But eventually Maya had had it, in part because a teenage daughter nearly walked into their bedroom while they were acting out Arron’s fantasies. Arron accompanied Maya to the clinic, under threat of divorce. Arron would wear her underwear and masturbate while she watched and told him how disgusting he was. (The couple also regu- larly had what Maya called “normal” sex, and Maya enjoyed it.) With Maya out of the consulting room, Arron confided that he grew up in a family with several older sisters. He described how underwear had been perpetually hanging out to dry in the house’s single bathroom. As an adolescent, Arron experimented with rubbing against articles of underwear, then with trying them on. On one occa- sion a sister walked in while he was modelling panties before the mirror. She told him he was a “dredge to society,” and he straightaway experienced unparalleled sexual excitement. He masturbated immediately when she left the room, and his orgasm was the most intense of his young life. Arron did not think that there was anything wrong with wearing women’s underwear and masturbating. He found the prospect of giving it up extraordinarily painful. But Maya at this point felt that she must separate from Arron’s “sickness.” She didn’t care what he did anymore, so long as he did it by himself. “Enough is enough,” she said. Actually, these feel- ings embodied the compromise that the couple worked out. Arron would engage in his fantasies by himself. He would do so when Maya was not at home, and she would not hear of his activities. He would also be careful to choose times when the children would not be around. Six months later the couple were together and content. Arron had replaced Maya’s input into his fantasies with transvestic- sadomasochistic magazines. Maya said, “I see no evil, hear no evil, smell no evil.” They continued to have sex. After a while, Maya forgot to check to see which underwear had been used. — The Authors’ Files

Sexual Variations 443 Arron is a transvestite. He seeks sexual satisfaction by dressing in women’s clothing. Some transvestites can be sexually aroused only by cross-dressing. Others, like Arron, are in long-term, committed relationships and also have sex with their regular partners in addition to enacting their cross-dressing desires. Arron’s wife, Maya, describes his sexual inclinations as “weird” and “sick” and even implies that his transvestism is “evil.” But, in using those terms, is she being unfairly judgmental? Is Arron’s transves- tism harmful to himself or others or necessarily problematic? In Western society, there’s been a tendency to classify behaviour as “normal” or “abnormal,” and if a sexual behaviour hasn’t fit conventional societal standards it’s often been labelled with a pathologizing or negative term. People often wonder, “Am I normal?” In this chapter, we’ll examine a number of sexual behaviours that deviate from the norm. First, however, it’s important to clarify what we mean when we say a sexual behaviour is abnormal, or deviant. Normal Versus Deviant Sexual Behaviour LO 16.1 List and discuss different approaches to defining normal versus devi- ant sexual behaviour. One approach to defining normality versus deviance is statistical. That is, something that falls outside a statistical norm can be considered abnormal. Put another way, some- thing can be considered deviant because it deviates from the norm. So, for example, only a small percentage of people have naturally red hair. In statistical terms, we can say that, with respect to hair colour, red-haired people are abnormal. A sexual behaviour that’s unusual is, by statistical definition, abnormal and deviant. But this statistical abnor- mality doesn’t necessarily make an unusual sexual behaviour problematic or harmful. A second approach to assessing whether a behaviour is normal is to determine how closely it adheres to the accepted norms of a society. For example, in Western culture, oral sex used to be thought of as immoral and “dirty.” It violated societal norms for acceptable behaviour. Oral sex was, in other words, considered abnormal and devi- ant. Today, oral sex is considered a typical sexual behaviour. This example is instruc- tive, because it demonstrates that societal standards for abnormality and deviance can change over time. Societal standards for sexuality can also vary considerably among cultures. A third approach to determining whether a sexual behaviour is normal focuses on harm—for the individual(s) involved, for others, and for society. In this approach, a sexual behaviour is considered abnormal if it causes stress, anxiety, or unhappiness for the individual who engages in it, or if it’s nonconsensual or it harms someone else. The discipline of abnormal psychology, for example, focuses less on how statistically rare a specific behaviour is and more on whether the behaviour causes problems in a person’s life or harms or disrupts the lives of others. These differences in how the terms “abnormal” and “deviant” are used are extremely important. Some of the behaviours we’ll discuss in this chapter may be unusual in a statistical sense, and may be contrary to the accepted norms of main- stream society, but they may also be quite harmless for the individuals in question. Other sexual variations can be quite destructive, both for the individuals who engage in them and for others. The Paraphilias LO 16.2 List and define the paraphilias. Because of the confusing array of meanings for “deviant” and “abnormal,” we prefer to speak about unusual patterns of sexual arousal or behaviour as atypical variations in sexual behaviour, rather than as sexual deviations. The psychiatric community uses

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

444 Chapter 16 the term paraphilia , which is defined in the American Psychiatric Association’s (2013a) Diagnostic and Statistical Manual of Mental Disorders , 5th ed. ( DSM-5 ) as “any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human part- ners” (American Psychiatric Association. (2013b) DSM-5: Diagnostic and Statistical Manual for Mental Disorders (5th ed.). Washington, DC: American Psychiatric Press. P. 685). In other words, paraphilias involve sexual arousal in response to unusual stimuli such as children or other nonconsenting persons (such as unsuspecting people who one watches or to whom one exposes one’s genitals), nonhuman objects (such as shoes, leather, rubber, or undergarments), or pain and humiliation (Fisher, Ceballos, Matthews, & Ficher, 2011). Paraphilic behaviours that involve mutually consenting adults or unharmful solitary sexual practices can be more simply described as “kinky sex.” In an important change from previous editions of the DSM, the DSM-5 makes a distinction between a paraphilia and a paraphilic disorder , which is defined as a para- philia that causes distress or impairment to the individual or causes harm to the indi- vidual or poses a risk of harm to others (American Psychiatric Association, 2013a). In other words, a paraphilic disorder involves atypical patterns of sexual arousal or behaviour that become problematic in the eyes of the individual and/or potentially cause harm to the self or other people. According to Ottawa psychiatrist Paul Fedoroff, a major factor in delineating paraphilic disorders is that they “involve sex without the possibility of a consensual, mutually reciprocal relationship” (Fedoroff, 2003, p. 336). It’s important to keep in mind that some paraphilias are generally harmless and vic- timless. Examples include fetishism and cross-dressing to achieve sexual arousal (trans- vestic fetishism). Indeed, because behaviours such as cross-dressing don’t harm others, some experts, including San Francisco physician Charles Moser and Ottawa psychologist Peggy Kleinplatz, believe that atypical sexual inclinations shouldn’t be used as the basis for a category of psychiatric disorders (Moser, 2016; Moser & Kleinplatz, 2005b). From this perspective, people who have a mental illness that involves sexuality in some way should be classified according to more generic classifications of psychiatric disorders. Moser and Kleinplatz have argued that because unusual sexual interests aren’t, in and of themselves, signs of pathology, paraphilias should be removed from the DSM. Moser and Kleinplatz (2005a) and Moser (2016) have also argued that the section of the DSM on paraphilia is based not on current scientific findings but on political values about what’s considered acceptable behaviour. A number of authors have pointed out that sexual preferences for particular types of people and activities are strongly influ- enced by cultural values (e.g., Bhugra, Popelyuk, & McMullen, 2010; Seto & Barbaree, 2001). For example, until relatively recently in Western culture, oral sex, anal sex, mas- turbation, and homosexuality were considered to be symptoms and even causes of mental disorders, but now these behaviours and orientations are considered part of the spectrum of healthy sexual expression (Federoff, Di Gioacchino, & Murphy, 2013). paraphilia Sexual interest and arousal in response to unusual stimuli such as children, other nonconsent- ing persons, nonhuman objects, or pain and humiliation. Mutu- ally consenting and unharmful paraphilic behaviours are often referred to as “kinky sex.” paraphilic disorder A diagnostic designation for a paraphilia that causes the person distress and/or is harmful to the self or other people. Real Students, Real Questions Q Is having sex underwater considered atypical? Can it cause infection? A It’s not a paraphilic disorder, and we hate to burst your bubble (pardon the pun), but it’s not really all that unusual. You’re unlikely to get anyone infected with salt water, although there can be some irritation. The same goes for the chlorine in a pool, but irritation is no fun, and the water is no lubricant. Remember to hold your breath or get scuba gear. In their more extreme forms, people with paraphilias usually feel that their urges are insistent, demanding, or compulsive (Fedoroff, 2003; Lehne, 2009). They may describe Corbis/SuperStock

Sexual Variations 445 themselves as overcome by them and tend to experience their urges as uncontrollable, just as drug addicts and compulsive gamblers feel helpless to avert their irresistible urges. Paraphilias vary in severity. In some cases, people can function sexually in the absence of the unusual stimuli, seldom (if ever) acting on their unusual urges. In other cases, people resort to paraphilic behaviour only in times of stress. In more extreme forms, individuals repeatedly engage in paraphilic behaviour and may become preoc- cupied with thoughts and fantasies about these experiences. People in this last category may be unable to become sexually aroused without either fantasizing about, or being in the presence of, the paraphilic stimuli. For them, paraphilic behaviour may be the only means of attaining sexual gratification (Lehne, 2009). The person with a paraphilia typically replays the paraphilic act in sexual fantasies to stimulate arousal during masturbation or sexual relations. It’s as though she or he men- tally replays a videotape of the paraphilic scene. The scene grows stale after a while, and the individual feels the urge to perform another paraphilic act, to make a new “video.” Canadian research has confirmed findings from other Western countries that, in general, most paraphilias are more common among men than women (Bouchard, Dawson, & Lalumière, 2017; Joyal & Carpentier, 2017). Because people are generally unwilling to talk about them, the exact prevalence of paraphilias in the general popula- tion remains unknown. Much of what we’ve learned about paraphilias derives from the reported experiences of people who’ve been apprehended for performing illegal acts (such as exposing themselves in public), and from the few who have voluntarily partici- pated in studies. The characteristics of people who haven’t been identified or studied remain virtually unknown. However, it should be noted that enjoyment of unharmful paraphilic behaviours or fantasies is increasingly considered socially acceptable. The success of Fifty Shades of Grey shows that, at the very least, depictions of kinky sex are of some interest to large numbers of people. The European-based social networking website Fetlife.com, which serves the fetish, kink, and BDSM communities, has over 6 million members (see Innovative Canadian Research: The Prevalence of Paraphilic Interests and Behaviours in the General Population). In this chapter, we’ll discuss all the major types of paraphilia except pedophilia, which we’ll discuss in Chapter 17. In pedophilia, children become the objects of sexual arousal. It often involves sexual coercion, including incest and sexual molestation (Seto, 2009). Fetishism In fetishism , an inanimate object elicits sexual arousal. Articles of clothing (e.g., women’s panties, bras, lingerie, stockings, gloves, shoes, or boots) and materials made of rubber, leather, silk, or fur are among the more common fetishistic objects (Kafka, 2010). Leather boots and high-heeled shoes are especially popular. The fetishist may act on the urges to engage in fetishistic behaviour, such as masturbating while stroking or fantasizing about an object, or he or she may be distressed about such urges or fantasies, and not act on them (Kafka, 2010). In a related paraphilia, partialism , people are excessively aroused by a particular body part, such as the feet, breasts, or buttocks. Most fetishes and partialisms are harmless. Fetishistic practices are nearly always private, involving masturbation, or are incorporated into sexual activity with willing partners (Darcangelo, 2008). Only rarely have fetishists coerced others into paraphilic activities. Yet some partialists have touched parts of women’s bodies in public. And some fetishists have committed burglaries to acquire fetishistic objects. Transvestism Fetishism appears to include transvestism . Although other fetishists become sexu- ally aroused by handling fetishistic objects while they masturbate, transvestites become excited by wearing articles of clothing—the fetishistic objects—of the other fetishism A paraphilia in which an inani- mate object, such as an article of clothing or items made of rubber, leather, or silk, elicits sexual arousal. partialism A fetishism-related paraphilia in which sexual arousal is primar- ily associated with a particular body part, such as feet, breasts, or buttocks. transvestism A paraphilia in which a person repeatedly cross-dresses to achieve sexual arousal or gratification, or is troubled by persistent, recurring urges to cross-dress. Fetishism. In fetishism, inanimate objects such as leather shoes or boots, or parts of the body such as feet, elicit sexual arousal. Many fetishists cannot achieve sexual arousal without contact with the desired objects or without fantasizing about them. Fuse/Corbis/Getty Images

446 Chapter 16 gender (Blanchard, 2010). A fetishist may find the object—or sex involving the object—erotically stimulating. The trans- vestite finds the object sexually alluring only by wearing it. Transvestites are mostly male (Långström & Zucker, 2005). Transvestism has been described among both heterosexual and gay males (Taylor & Rupp, 2004; Wheeler, Newring, & Draper, 2008). Many are in committed male–female relation- ships and are otherwise stereotypically masculine in behaviour. Transvestism differs markedly from transgenderism. It’s true that some transvestites and some trans people appear to be motived by autogynaephilia, a condition in which an individual is sexually stimulated by fantasies that his own body is female (Bailey, 2003a; Lawrence, 2004), but transvestites are usually sexually gratified by cross-dressing and masturbating, or by cross-dressing and having sex with others. They may also find it gratifying to masturbate while fantasizing about cross-dressing. Many transvestites have masculine gender identities and don’t seek to change their anatomic sex. Transgender peo- ple, on the other hand, usually cross-dress because they’re uncomfortable with the attire associated with their anatomic sex and truly wish to be members of the other gender. For this reason, some transgender people seek gender reassignment. Like fetishism in general, the origins of transvestism remain obscure. Evidence of hormonal and neurologi- cal abnormalities in transvestism is mixed (Bailey, 2003a). Långström and Zucker (2005) surveyed 2450 Swedes and found transvestism in about 2.8% of the men and 0.4% of the women. They found that transvestism was associated with separation from parents, same-sex sexual experiences, use of pornography, high rates of masturbation, and para- philias—namely, sexual masochism, exhibitionism, and voyeurism. Some men cross-dress for reasons other than sexual arousal, and so aren’t true transvestites. Some make their livings by impersonating women such as Marilyn Monroe and Madonna on stage and are not motivated by sexual arousal. Among some segments of the gay community, it’s fashionable to masquerade as a woman. Gay men don’t usually cross-dress to become sexually stimulated. Transvestic behaviours can range from wearing a single female garment when alone, to sporting a dress, wig, makeup, and feminine mannerisms at a transvestite club. Some transvestites become sexually aroused by masquerading as women and attracting the interest of unsuspecting males. The great majority of transvestites don’t engage in antisocial or illegal behaviour. Most practise their sexual predilections in private and would be horrified to be discovered by associates while dressed in female attire. Exhibitionism Exhibitionists (“flashers”) have persistent, powerful urges and sexual fantasies that involve exposing their genitals to unsuspecting strangers, to achieve sexual arousal or gratification (Långström, 2010). They either act on the urges or find them disturbing. Exhibitionists are almost always male, although there are some female exhibitionists (Hugh-Jones, Gough, & Littlewood, 2005). What we know of exhibitionists, like most people with paraphilias, is almost entirely derived from studies of men who’ve been apprehended or treated by mental health professionals (Langevin, 2006). Such knowledge may yield a biased picture exhibitionism A paraphilia characterized by persistent, powerful urges and sexual fantasies that involve exposing one’s genitals to unsus- pecting strangers. The exhibition- ist achieves sexual arousal or gratification from this behaviour. Transvestism. Transvestites cross-dress for sexual arousal and gratification. Ryan McVay/Stockbyte/Getty Images

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Sexual Variations 447 because relatively few incidents result in apprehension and conviction. The characteristics of most perpetrators may thus differ from those of people who are available for study. In a survey of Quebec adults, 7.8% of men and 2.7% of women indicated that they had, at least once in their life- times, become sexually aroused by showing their genitals to a stranger who was not expecting it (Joyal & Carpentier, 2017). A survey of women at U.S. universities found exposure to exhibitionism to be widespread. About 32% to 39% reported running into a “flasher” (Murphy & Page, 2008). A majority of the women had been approached for the first time (some had been approached more than once) by 16 years of age. Few of the women had reported these incidents to the police. The clinical definition of exhibitionism involves exposure to a stranger, but about one third (36%) of the incidents among the college women were committed by acquaintances, relatives, or “good friends.” Based on the available information, the typical exhibi- tionist is thought to be young, lonely, or in an unhappy male– female relationship, and sexually repressed. An exhibitionist may claim that sex with his regular partner is reasonably satis- factory, but that he also experiences the compulsion to expose himself to strangers. Many exhibitionists are single, however. They typically have difficulties relating to women and are unable to establish meaningful relationships (Leue, Borchard, & Hoyer, 2004; Murphy & Page, 2008). Exhibitionism usually begins before age 18 (American Psychiatric Association, 2013a). The urge to “flash,” if not the actual act, usually begins in early adolescence, generally between the ages of 13 and 16. The frequency of exhibitionism declines markedly after age 40 (American Psychiatric Associa- tion, 2013a). The typical exhibitionist doesn’t attempt further sexual contact with the victim. The police may sometimes trivialize exhibitionism as a “nuisance crime,” but the psychological consequences can be serious for victims, especially young children. Victims may feel violated and may be bothered by recurrent images or nightmares. They may also develop fears of venturing out on their own. Moreover, exhibitionists are highly likely to repeat their crimes, even if they spend time in prison for them (Kaser-Boyd, 2015; Langevin et al., 2004). An Ontario study of exhibitionists who were repeat offenders found that 12% were also convicted of other sexual offences, and 17% were convicted of violent crimes (Rabinowitz, Firestone, Bradford, & Greenberg, 2002). Another Ontario study ( Firestone, Firestone, & Catlett, 2006a) found that men who exhibit may be at high risk for engaging in more serious offences. About one third of the sample in the second study went on to commit sexual or violent offences. Some evidence has suggested that exhibitionists may attempt to assert their mas- culinity by evoking responses from their victims, or that they exhibit themselves to express hostility toward women (Murphy & Page, 2008). A number of exhibitionists have reported that they’ve hoped the women would enjoy the experiences and be impressed with the size of their penises (Langevin et al., 1979). Other studies have shown exhibitionists to be shy, dependent, passive, lacking in sexual and social skills, and even inhibited (Leue et al., 2004). Exhibitionists who are socially shy or inadequate may be using exhibitionism as a substitute for the intimate relationships they can’t develop. An Exhibitionist? How do the motives of an exotic dancer differ from that of a paraphilic exhibitionist? BlueSkyImages/Fotolia

448 Chapter 16 Exhibitionists and some other people with paraphilias may find the risk of being caught to heighten their erotic response because it causes a rush of stress hormones that are chemically similar to testosterone (Haake et al., 2003). The exhibitionist may even purposefully increase the risk, as by exposing himself in the same location in his own, easily identifiable car. The preferred victims are typically girls or young women. The typical exhibition- ist drives up to or walks in front of a stranger and exposes his penis. In one sample of 130 exhibitionists, about 50% reported that they always or nearly always had erec- tions when they exposed themselves (Langevin et al., 1979). After his victim registers fear, disgust, confusion, or surprise, an exhibitionist typically covers himself and flees. He usually masturbates, either while exposing himself or shortly afterward while think- ing about the act and the victim’s response (American Psychiatric Association, 2013a). In 2011, Washington, DC, was rocked with scandal when then Congressman Anthony Weiner was accused of sending pictures of his penis to women he had never met via his smartphone. Was this behaviour a form of exhibitionism aided by modern information technology? It’s unclear at what point sexting with unsuspecting or non- consenting individuals changes from an unsolicited attempt at flirting to a paraphilic behaviour like exhibitionism. There has been very little research investigating the extent to which smartphones and social networking sites are being used by exhibi- tionists to expose themselves to others. In one of the few studies conducted so far examining the impact of technology on exhibitionistic behaviour, Kaylor, Jeglic, and Collins (2016) found, in a survey of 959 women and men aged 18 to 30, that 5.6% had engaged in traditional exhibitionist behaviour (i.e., exposing one’s genitals to others in a public place). Of those who had engaged in this type of exhibitionism, 33.9% had also sent nude photos of themselves electronically. This suggests that some exhibition- ists may be going online to engage in their para- philic behaviour. Definitions of exhibitionism also bring into focus the boundaries between normal and abnormal behaviour (Hugh-Jones et al., 2005; O’Donohue, 2014). People in intimate relationships may enjoy and become sexually aroused by show- ing their bodies to their partners, especially if the displays also arouse the partners. The behaviour is exhibitionist in some respects—but is it appro- priate to label it as abnormal? If we assume both partners are consenting and the behaviour isn’t motivated by a person’s overwhelming, uncontrol- lable urge to expose his genitals, then we’re likely to see the behaviour as harmless fun, rather than abnormal. And we might ask whether exotic dancers (strippers) are exhibitionists. After all, aren’t they exposing themselves to strangers? Yes, they are, but they are not exhibitionist in the paraphilic sense. They’re more successful at their work if they sexu- ally excite their audiences, but their audiences are not unsuspecting victims. They pay for the privi- lege of watching. The main motivation of exotic dancers is earning a living rather than their own sexual gratification (Philaretou, 2006). Sexting. Former Congressman Anthony Weiner and Huma Abedin, assistant to Hillary Clinton, at the Metropolitan Museum of Art in June 2016. Two months later, Abedin separated from Weiner because he repeatedly sent pictures of his naked body to other women. Taylor Hill/FilmMagic/Getty Images

Sexual Variations 449 1 ❯ T / F Truth or Fiction Revisited Fiction. Strippers are not exhibitionists. They are more successful at their work if they sexually excite their audiences, but their audiences are not unsuspecting victims. They pay for the privilege of watching them. Strippers’ main motive is (usually) to earn a living. Obscene Phone Calling (Telephone Scatologia) Like exhibitionists, obscene phone callers (almost all of whom are male) seek to become sexually aroused by shocking their victims (Balon, 2015b). Whereas an exhibitionist exposes his genitals to produce the desired response, the obscene phone caller “exposes” himself verbally by uttering obscenities and sexual provocations to a nonconsenting person. The DSM-5 labels this type of paraphilia telephone scatologia (American Psychiatric Association, 2013a). People practising chat scatologia are sexually aroused by sending obscene emails, instant messages, and chat-room messages (Balon, 2015b). These behaviours are sometimes considered a form of exhibitionism. Relatively few obscene callers are women (Quayle, 2008). Women who are charged with such offences are generally motivated by rage for some actual or fantasized rejec- tion rather than the desire for sexual arousal. They use the phone to hurl sexual invec- tives against men who they feel have wronged them. By contrast, male obscene phone callers are generally motivated by a desire for sexual excitement and usually choose their victims randomly from the phone book or by chance dialing. They typically masturbate during or shortly after the phone calls. Most obscene telephone callers also engage in other paraphilic acts, especially voyeurism and exhibitionism (Heil & Simons, 2008). There are many patterns of obscene phone calling. Some callers limit themselves to obscenities. Others make sexual overtures. Some just breathe heavily into the receiver. Others describe their masturbatory activities to their victims. Some profess to have previously met the victims at social gatherings or through mutual acquaintances. Some even present themselves as “taking a sex survey,” and ask a series of personally reveal- ing questions. The typical obscene phone caller is a socially inadequate heterosexual male who has difficulty forming intimate relationships with women (Leue et al., 2004). The rela- tive safety and anonymity of the telephone may shield him from the risk of rejection (Leue et al., 2004). Reactions of shock or fright from his victims may fill him with the feelings of power and control that are lacking in his life, especially in his rela- tionships with women. The obscenities may vent rage that he holds against women who have rejected him. Obscene phone calls are illegal, but it’s been difficult for authorities to track down perpetrators. Call tracing can help police track offending phone callers. Call tracing works in different ways in different locales. Caller ID shows the caller’s telephone number on a display panel on the receiving party’s telephone. In some locales, people can program their telephone services, so callers from private or anonymous numbers (i.e., numbers that don’t provide caller ID) receive messages stating that the recipients only accept calls from people who provide their phone numbers or names. These services may deter some obscene callers, but others may use public phones instead of their home phones (see Applied Knowledge: Respond- ing to Exhibitionists and Obscene Phone Callers). Voyeurism Voyeurism involves strong, repetitive urges to watch unsuspecting strangers who are naked, disrobing, or engaged in sexual activity (American Psychiatric Asso- ciation, 2013). The voyeur becomes sexually aroused by the act of watching and typically doesn’t seek sexual relations with the person he observes. Like fetish- ism and exhibitionism, voyeurism is more common among males than females telephone scatologia A paraphilia characterized by the making of obscene telephone calls. voyeurism A paraphilia characterized by strong, repetitive urges and sexual fantasies related to observing unsuspecting strangers who are naked, disrobing, or engaged in sexual relations. Blurring Boundaries. How would you describe this scene? Is it voyeurism? Exhibitionism? Or normal behaviour? Nostalgia/Alamy Stock Photo

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

450 Chapter 16 (Långström, 2010). It usually begins before age 15. In Toronto, Kurt Freund and his colleagues found that 12% of university males and 23% of a sample of community males had masturbated while watching females who were unaware of their presence (Freund, Seto, & Kuban, 1997). The voyeur may masturbate while peeping, or afterward while replaying the inci- dent in his imagination or engaging in voyeuristic fantasies. The voyeur may fantasize about making love to the observed person but have no intention of actually doing so. Are people voyeurs if they become sexually aroused by the sight of their lovers undressing? What about people who enjoy watching pornographic films, or stripteases? No, no, and no. The people being observed are not unsuspecting strangers. The lover knows his or her partner is watching. Porn actors and strippers know others are viewing them. They wouldn’t be performing if they didn’t expect or have audiences. 2 ❯ T / F Truth or Fiction Revisited Fiction. People who enjoy watching their mates undress are not voyeurs. In such cases, the person who is disrobing is knowingly and willingly observed, and the observer’s enjoyment is normal. True voyeurs want to peep on unsuspecting strangers. Women who attend male strip clubs also enjoy “bonding” with their friends and other women at the clubs. It’s perfectly normal for men and women to be sexually stimulated by the sight of other people who are nude, undressing, or engaged in sexual activity. Voyeurism is characterized by urges to spy on unsuspecting strangers (see Innovative Canadian Research: Would You Engage in Voyeuristic Behaviour?). Research with voyeurs and exhibitionists has usually been conducted with people who’ve been charged with crimes or seeing therapists. We lack research on general populations. A national survey conducted in Sweden did reveal, however, that 11.5% of men and 4% of women had been sexually aroused by spying on others having sex, and that 4% of men and 2% of women had been sexually aroused by exposing their genitals to strangers (Långström & Seto, 2006). APPLIED KNOWLEDGE RESPONDING TO EXHIBITIONISTS AND OBSCENE PHONE CALLERS How to Respond to an Exhibitionist It’s understandable that if you’re an unsuspecting woman who’s confronted by an exhibitionist, you may react with shock, surprise, or fear. Unfortunately, your display of shock or fear may reinforce the flasher’s tendency to expose himself. You may fear that the flasher, who has already broken at least one social code, is likely to assault you physically, as well. Fortunately, most exhibitionists don’t seek actual sexual contact with their victims and run away before they can be apprehended by police or passersby. When possible, showing no reaction or simply continu- ing on your way may be the best response. If you do want to respond to the flasher, you might calmly say something like “You really need professional help. You should see a profes- sional to help you with this problem.” You should then promptly report the incident to police, so authorities can apprehend the offender. How to Respond to an Obscene Phone Caller What should you do if you receive an obscene phone call? Advice generally parallels that given to women who are victim- ized by exhibitionists. Above all, remain calm and don’t reveal shock or fright, because such reactions tend to reinforce the caller’s behaviour and increase the probability of repeat calls. You may be best advised to say nothing at all and gently hang up the phone. Or you might offer a brief response that alludes to the caller’s problems before hanging up. You might say in a calm but strong voice, “It’s unfortunate that you have this problem. I think you should seek professional help.” If you receive repeated calls, you might request an unlisted number or contact the police about tracing the calls. Many women list themselves only by their initials in the phone directory, to disguise their gender. This practice is so widespread, how- ever, that obscene callers may assume people listed by initials are women who live alone.

Sexual Variations 451 Although most voyeurs are nonviolent, some commit violent crimes such as assault and rape (Lalumière, Harris, Quinsey, & Rice, 2005b; Langevin, 2003). Voyeurs who break into and enter homes or buildings, or who tap on windows to gain the attention of victims, are among the more dangerous. 3 ❯ T / F Truth or Fiction Revisited Fiction. We cannot say that exhibitionists and voyeurs are never violent. Those with exhibitionistic disorder and voyeuristic disorder per se are not violent in themselves, but some exhibitionists and voyeurs have been known to be violent; moreover, if provoked or angered, they may react. Voyeurs who break into and enter homes or buildings, or who tap at windows to gain the attention of victims, are among the more dangerous. In 2005, the Canadian Parliament passed legislation that makes it a crime to secretly observe or record a person in situations where privacy is expected. This includes situ- ations where someone is nude or engaged in sexual activity. It also includes situations where a person is fully clothed and someone observes or records him or her for sexual purposes. In 2010, for example, an Ontario man was convicted of voyeurism for record- ing his friends and employees with a hidden camera in the bathroom of his house. Because of concerns over the misuse of camera phones, some fitness centres and other organizations have banned them, especially in change rooms. Sexual Masochism As long as it occurs with mutual consent, it’s considered normal to enjoy some mild forms of pain during sexual activity. Love bites, hair pulls, and minor scratches are examples that fall within normal limits (O’Donohue, 2014). But people who prefer or need to have pain or humiliation inflicted on them by their sex partners are sexual masochists . A sexual masochist may act on, or be dis- tressed by, persistent urges and sexual fantasies involving the desire to be bound, flogged, humiliated, or made to suffer in some way in order to achieve sexual excite- ment. In some cases, the sexual masochist can’t become aroused unless she or he is bound, flogged, or humiliated by a sex partner. Sexual masochism is the most common paraphilia among women (Hucker, 2008; Logan, 2008). 4 ❯ T / F Truth or Fiction Revisited True. In some cases, a sexual masochist cannot become sexually aroused unless they are bound, flogged, or humiliated by their sex partner. Sexual masochism is the only paraphilic disorder that is found among women with some frequency (Logan, 2008). The word “masochism” derives from the name of Austrian storyteller Leopold von Sacher-Masoch (1836–1895). He wrote tales of men who derived sexual satisfaction sexual masochist A person who becomes sexually aroused by experiencing pain or humiliation inflicted by a sexual partner. sexual masochism A paraphilia characterized by the desire or need for pain or humilia- tion to enhance sexual arousal and attain gratification. INNOVATIVE CANADIAN RESEARCH WOULD YOU ENGAGE IN VOYEURISTIC BEHAVIOUR? Waterloo researchers B. J. Rye and Glenn Meaney (2007) conducted a survey to determine whether university students would, hypothetically, watch an attractive person undressing or two attractive people having sex. Most (84% the males and 74% of the females) said they’d watch an attractive person undressing if they wouldn’t be caught doing so. However, far fewer females (40%) than males (70%) said they’d watch a couple having sex if they wouldn’t be caught. For both situations, fewer said they’d watch if there was a chance of being caught. The finding that fewer students would watch a couple having sex suggests that this voyeuristic behaviour is considered more invasive of people’s privacy. SOURCE: Fichner-Rathus, Human Sexuality in a World of Diversity, Sixth Canadian Edition, 9780134646558, Pearson education.

452 Chapter 16 from having female partners inflict pain on them, typically by flagellation (beating or whipping). Sexual masochists may derive pleasure from various types of punishing experi- ences, including being restrained (a practice known as bondage ), blindfolded (sensory bondage), spanked, whipped, or made to perform humiliating acts, such as walking around on all fours and licking the boots or shoes of the partner, or being subjected to vulgar insults. Some masochists have their partners urinate or defecate on them. Some masochists prefer particular sources of pain; others seek an assortment. But we shouldn’t think sexual masochists enjoy types of pain that don’t involve sex. Sexual masochists are no more likely than anyone else to derive pleasure from the pain they experience when they stub their toes or touch hot stoves. Pain must be part of an elaborate sexual ritual, to provide erotic gratification (Hucker, 2008). Sexual masochists and sexual sadists often form sexual relationships or join “kink” communities to meet one another’s needs (Yates, Hucker, & Kingston, 2008). Sexual sadism is a paraphilia characterized by the desire to inflict pain or humiliation on some- one else in order to enhance sexual arousal and achieve gratification. Some sexual mas- ochists enlist the services of prostitutes or their regular sexual partners to help them enact their masochistic fantasies. 5 ❯ T / F Truth or Fiction Revisited True. There is a subculture—the sado- masochism (S&M) subculture—in which sexual sadists and sexual masochists form liaisons to inflict and receive pain and humiliation during sexual activity. It is catered to by sex shops that sell S&M paraphernalia and magazines. Paraphernalia includes leather restraints and leather face masks that resemble the ancient masks of executioners. People in the subculture seek one another out through mutual contacts, S&M social organizations, or personal ads in S&M magazines. It may seem contradictory for pain to become connected with sexual pleasure. The association of sexual arousal with mildly painful stimuli, however, is actually quite common. Kinsey and his colleagues (1953) reported that perhaps one person in four has experienced erotic sensations from being bitten during lovemaking. The erotici- zation of mild forms of pain (love bites, hair pulls, minor scratches) may fall within the normal range of sexual variation. Pain from these sources increases overall bodily arousal, which may enhance sexual excitement. Some of us become sexually excited when our partners “talk dirty” to us or call us vulgar names. When the urge for pain for purposes of sexual arousal becomes so persistent or strong that it overshadows other sources of sexual stimulation, or when the masochistic experience causes physical or psychological harm, we may say the boundary between normality and abnormality has been breached. 6 ❯ T / F Truth or Fiction Revisited True. It is considered normal—or typical—to enjoy some mild forms of pain during sexual activity. Love bites, hair pulls, and minor pinches or scratches are examples of sources of pain that are considered to fall within normal limits. But if pain becomes a requirement for sexual gratification, or if the painful experiences endanger the health of the recipient, its purposes and uses need to be reconsidered. Some theorists have suggested that independent and responsible selfhood becomes burdensome or stressful at times (Knoll & Hazelwood, 2009). Sexual masochism provides a temporary reprieve from the responsibilities of independent selfhood. It is a blunting of one’s ordinary level of self-awareness by focusing on immediate painful and pleasant sensations, and on the experience of being a sexual object. bondage Ritual restraint (e.g., by shack- les) practised by many sexual masochists. sexual sadist A person who becomes sexu- ally aroused by inflicting pain or humiliation on a sexual partner. Fifty Shades of Grey. Dakota Johnson as Anastasia Steele in the 2015 film Fifty Shades of Grey , which is based on the best-selling novel of the same name. The movie depicts tycoon Christian Grey’s (played by Jamie Dornan) seduction of Anastasia into a sex life of bondage and discipline, dominance and submission. Pictorial Press Ltd/Alamy Stock Photo

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Sexual Variations 453 Sexual masochism can range from relatively benign to potentially lethal practices such as hypoxyphilia (also known as auto-erotic asphyxia). Hypoxyphiliacs put plastic bags over their heads, nooses around their necks, or pressure on their chests to tempo- rarily deprive themselves of oxygen while engaging in some form of sexual stimulation, usually masturbation. They often fantasize that they’re being strangled by a lover. They try to discontinue oxygen deprivation before they lose consciousness, but miscalcula- tions result in death by suffocation or strangulation (Behrendt, Buhl, & Seidl, 2002; Santtila, Sandnabba, Alison, & Nordling, 2002). Sexual Sadism Sexual sadism is named after the infamous Marquis de Sade (1740–1814), a Frenchman who wrote tales of becoming sexually aroused by inflicting pain or humiliation on others. The virtuous Justine, heroine of his novel of the same name, endures terrible suffering at the hands of fiendish men. hypoxyphilia A practice in which a person seeks to enhance sexual arousal, usually during masturbation, by depriving himself or herself of oxygen. sexual sadism A paraphilia characterized by the desire to inflict pain or humiliation on others in order to enhance sex- ual arousal and attain gratification. INNOVATIVE CANADIAN RESEARCH THE PREVALENCE OF PARAPHILIC INTERESTS AND BEHAVIOURS IN THE GENERAL POPULATION Paraphilic sexual interests and behaviours are generally thought to be unusual, but their occurrence in the general population has not been well studied. Christian Joyal and Julie Carpentier (2017) from the Université du Québec à Trois-Rivières examined the prevalence of paraphilic interests and behaviours in the general population of Quebec. Joyal and Carpentier (2017) made it clear that there is a distinction between sexual interests and sexual fantasies. For instance, someone might fantasize about watching an attrac- tive neighbour undress; however, that does not mean that they are necessarily interested in engaging in voyeurism. Engaging in particular behaviours in the past or expressing a specific desire to take part in those behaviours is regarded as being a better indicator of an individual’s level of interest compared to determin- ing if a person has simply fantasized about a behaviour. Thus, the purpose of their study was to measure the prevalence of the desire to engage in different paraphilic behaviours and the experience of these behaviours in the Quebec population. The sample for the study consisted of 1040 adults (475 men and 565 women) between the ages of 18 and 64 living in Quebec. Participants completed a questionnaire by telephone (n=500) or online (n=543) in either English or French. Overall, almost one half (45.6%) of the sample reported a desire for at least one of the paraphilic behaviours that were provided to them as options on the questionnaire. However, only about one third (33.9%) of participants had actually ever engaged in one of them. Voyeurism was rated as the most common desire (46.3%) and experience (34.5%). Fetishism was the second most common, with 44.5% of participants reporting a desire for it and 26.3% of participants reporting having engaged in it. This was followed by what the authors defined as “extended exhibitionism,” engaging in sexual activity either in front of others or in a place where it would be likely to be seen by others (30.6% and 30.9%, respectively), and frotteurism (26.7% and 26.1%, respectively). Lastly, 23.8% of participants reported a masochistic desire and 19.2% of partici- pants reporting having engaged in masochism. The other paraphilic behaviours, such as transvestism and sadism, were less popular. When broken down by gender, men were more likely to report a desire to engage in a paraphilic behaviour than women overall, but some specific paraphilic interests were more com- mon in women. In order of overall prevalence, 60% of men com- pared to 34.7% of women reported voyeuristic desires. This was followed by fetishism (40.4% of men versus 47.9% of women), extended exhibitionism (35% of men versus 26.9% of women), frotteurism (34.2% of men versus 20.7% of women), and mas- ochism (19.2% of men versus 27.8% of women). A similar pattern was found for actual experience, with men being more likely to report paraphilic behaviours: voyeurism (50.3% of men compared to 21.2% of women), fetishism (30.1% of men and 23.2% of women), extended exhibitionism (32.6% of men and 29.4% of women), frotteurism (32.4% of men and 20.5% of women), and masochism (13.9% of men and 23.7% of women). Importantly, when the authors measured the intensity of peo- ple’s paraphilic interests, they found that, for all the paraphilic catego- ries, less than 10% of the study participants experienced an “intense and persistent” desire to engage in the behaviour. As noted in the introduction to this chapter, according to the DSM-5 , a paraphilia is defined as having an intense and persistent interest in unusual sexual stimuli. Thus, based on the findings of their study, Joyal and Car- pentier (2017) concluded that while some level of desire to engage in paraphilic behaviours is quite common in the general population, the intensity and persistence of these desires within individuals rarely reaches a level that qualifies as a paraphilia or a paraphilic disorder. SOURCE: Fichner-Rathus, Human Sexuality in a World of Diversity, Sixth Canadian Edition, 9780134646558, Pearson education.

454 Chapter 16 Sexual sadism is characterized by persistent, powerful urges and sexual fantasies involving the inflicting of pain and suffering on others in order to achieve sexual excitement or gratification (Yates et al., 2008). The sexual sadist acts on his or her urges or finds them distressing. Some sexual sadists cannot become sexually aroused unless they make their sex partners suffer. Others can become sexually excited without such acts. Some sadists hurt or humiliate willing partners, such as sexual masochists. Others—a small minority—stalk and attack nonconsenting victims (Yates et al., 2008). SADO-MASOCHISM Sado-masochism (S&M) is a mutually gratifying sexual interaction involving power exchange between consenting partners. A variation is bondage and discipline (B&D), which involves restraining and punishing a submissive partner physically or verbally. Today the term “BDSM” is often used instead of “S&M.” Occasional S&M is quite common among the general population. Couples may incorporate light forms of S&M into their lovemaking now and then, in the form of mild dominance-and-submission games or gentle physical restraint. It’s not uncommon for lovers to scratch or bite their partners, to heighten their mutual arousal during sex. They generally don’t inflict severe pain or damage. Most S&M encounters are time-limited. They’re often built around particular themes involving role play, such as a schoolteacher and a naughty schoolboy. Both the dominant person and the submissive person agree ahead of time on the rules, and usu- ally choose a safe word that the submissive person will say to stop a particular action if it exceeds his or her limits. Once the scene is over, the participants assume their regular relationship (Dancer, Kleinplatz, & Moser, 2006). In a small minority of relationships, referred to as “24/7 S&M slavery,” the participants attempt to live full time in owner–slave relationships. In one study, the participants were almost evenly divided between female and male, and ranged in age from 18 to 72. Of the 66 men, 51 were involved with other men, and 15 were involved with women. Of the 80 women, 74 were involved with men, and 6 were involved with other women. Accord- ing to the study respondents, the majority of these relationships were long-lasting and satisfying. The individuals who adopted the slave roles did have the right to exercise their free will, and could therefore leave the relationships at any time (Dancer et al., 2006). Although some forms of sado-masochism may fall within the boundaries of normal sexual variation, sado-masochism becomes pathological when the fantasies are acted on in ways that become destructive, dangerous, or distressing to either partner. How would you categorize the following example? A 25-year-old female graduate student described a range of masochistic experiences. She reported feelings of sexual excitement during arguments with her husband, when he’d scream at her or hit her in a rage. She would sometimes taunt him to make love to her in a brutal fashion, as though she were being raped. She found the brutal- ity and the sense of being punished sexually stimulating. She had also begun having sex with strange men, and enjoyed being physically punished by them during sex more than any other type of sexual stimulus. Being beaten or whipped produced the most intense sexual experiences she’d ever had. Although she recognized the dangers posed by her sexual behavior, and felt somewhat ashamed about it, she wasn’t sure she wanted treatment for it, because of the pleasure it provided her. (Spitzer, R. L., et al. (1989). DSM-III-R casebook: a learning companion to the Diagnostic and statistical manual of mental disorders Washington, DC: American Psychiatric Press. , pp. 87–88) There’s a subculture in which sexual sadists and sexual masochists form liaisons to inflict and receive pain and humiliation during sexual activity. The S&M subculture is catered to by sex shops that sell S&M magazines and paraphernalia, including leather restraints and leather face masks that resemble the ancient masks of executioners. sado-masochism (S&M) A mutually gratifying sexual interaction between consenting partners, in which sexual arousal is associated with inflicting and receiving pain or humiliation. It’s commonly known as S&M. S&M. An S&M club patron pays money for the services of a dominatrix. PBNJ Productions/Blend Images/Alamy Stock Photo

Sexual Variations 455 People in the subculture seek one another out through mutual contacts, S&M social organizations, and personal ads in S&M magazines. Participants in sado-masochism often engage in highly elaborate rituals involv- ing dominance and submission. They stage rituals as though they’re scenes in a play (B. Gross, 2006). In the master-and-slave game, the sadist leads the masochist around by a leash, and the masochist performs degrading or menial acts. In bondage and discipline (B&D), the dominant partner restrains and flagellates (spanks or whips) or sexually stimulates the submissive partner. The erotic appeal of bondage seems to be connected with controlling or being controlled. However, more than half had engaged in sado-masochistic activities such as spanking (96%), slapping breasts or but- tocks, applying clothespins to the breasts or genitals, pinch- ing, whipping, and caning. Yet they generally avoided practising these activities in ways that were dangerous or likely to lead to medical problems. Bondage was highly preferred, with 85% of participants reporting use of bondage toys and being immobi- lized. Most of the women (83%) created or watched kink-related pornography, live performances, and the like. The most popular role-play scenario involved master and slave fantasies (84%). Also popular were playing out danger, job (boss/underling), animal, and medical examination fantasies. The study did not attempt to address the prevalence of kinky behaviour in the general population. Nor did it try to inves- tigate the causes of the women’s sexual desires. It did describe the behaviour of many women involved in these activities. When you come across sexual sadomasochistic magazines or websites, photos may seem to be as likely to show women as men cracking whips, being tied up, being blindfolded, wear- ing leather, and the like. Although the majority of people with paraphilias and paraphilic disorders are male, an exception is sexual masochism, in which women may be as likely as men to participate. A recent study of women in the kink community recruited 1580 women via online kink forums and kink community events (Rehor, 2015). The study defined kink behaviour as including BDSM kinds of behaviour (bondage, discipline, dominance, submission, sadistic and masochistic behaviour), exhibitionism, voyeurism, fetishism, and some others. A majority of the women enjoyed activities such as caressing and cuddling, kissing, sucking (all more than 99%), applying body paint or oil or food, playing with wax candles, and using feathers or fur. Many did not require pain to become sexually aroused. A CLOSER LOOK WOMEN FROM THE “KINK” COMMUNITY Various types of stimulation may be used to administer pain during S&M encoun- ters, but pain isn’t always used. When it is, it’s usually mild or moderate. Psychological pain, or humiliation, is perhaps as common as physical pain. Pain may also be symbolic, Real Students, Real Questions Q Do people get genital piercings for sexual pleasure? A Some do, but the results are iffy at best, and body piercings can carry dangers. Please check with your doctor before undergoing any piercings. You will be surprised to hear that some are probably fine, but others are not fine. In any event, the kinds of piercings usually recommended for women who are looking to enhance their sexual pleasure are clitoral hood piercings, clitoral piercings, and labial piercings. Of these, clito- ral piercings are the most dangerous because they pass through the most nerves and blood vessels. Piercings of nipples, male sex organs, and navels are usually more for aesthetic purposes and have a subcultural message or appeal, rather than an aphrodisiacal effect. The really frightening thing here is how some people will allow anyone with a storefront to pierce their bodies—anywhere. Don’t be one of them. If you decide to go in this direction, use a reputable piercing studio that employs only trained and licensed employees. Hola Images/Getty Images

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

456 Chapter 16 such as when a sadist uses a harmless, soft rubber paddle to spank the masochist. The erotic appeal of pain for some S&M participants may therefore derive from the ritual of control, rather than from the pain itself (B. Gross, 2006). Extreme forms of pain, involving torture and severe beatings, are rarely reported by sado-masochists. Masochists may seek pain, but they usually avoid serious injury and dangerous partners (B. Gross, 2006). S&M participants may be heterosexual, gay, lesbian, or bisexual (Heil & Simons, 2008). They may assume just the masochistic or just the sadistic role, or they may alter- nate roles, depending on the sexual script. People who seek sexual excitement by enact- ing both roles are known as sado-masochists. In heterosexual relationships, the partners may reverse traditional gender roles. The men may assume submissive or masochistic roles, and the women may take dominant or sadistic roles (B. Gross, 2006). The majority of S&M participants are male, but a sizable minority are female (American Psychiatric Association, 2012). Most are in committed relationships (see A Closer Look: Women From the “Kink” Community and Innovative Canadian Research: The Personality Char- acteristics of Dominant and Submissive BDSM Practitioners). The causes of sexual masochism and sadism, like other paraphilias, are unclear, but pain has some direct biological links to pleasure (Berridge & Kringelbach, 2015; Elling- sen et al., 2013). Natural chemicals called endorphins, similar to opiates, are released in the brain in response to pain, producing feelings of euphoria and general well-being. Perhaps pleasure is derived from pain because of endorphin release or augmentation. 7 ❯ T / F Truth or Fiction Revisited True. Painful stimuli may activate the reward regions of the brain. This research finding may, in part, explain the development of sexual masochism. Whatever their causes, the roots of sexual masochism and sadism apparently date to childhood (Barbaree & Blanchard, 2008). Sado-masochistic behaviour commonly begins in early adulthood, but sado-masochistic fantasies are often present in child- hood (American Psychiatric Association, 2012). Despite the popularity of S&M-themed entertainment, such as the erotic novel Fifty Shades of Grey , in Canadian society, there’s the negative stereotype that people who engage in S&M behaviours are mentally disturbed. Research doesn’t support this view (Moser & Kleinplatz, 2005b). There’s no evidence that people involved in S&M have greater difficulty than other people in establishing intimate relationships. There’s also no evidence that engaging in S&M is distressing or dysfunctional. Moser and Kleinplatz (2005b) therefore conclude that S&M is not pathological. INNOVATIVE CANADIAN RESEARCH THE PERSONALITY CHARACTERISTICS OF DOMINANT AND SUBMISSIVE BDSM PRACTITIONERS Much of the existing research on BDSM lumps dominants (desire to take control) and submissives (desire to be controlled) together. Ali Hébert and Angela Weaver (2014) at St. Francis Xavier University in Nova Scotia used an online survey to compare 80 self-identified dominants and 190 self-identified submissives on a range of personality characteristics. Dominants scored significantly higher than submissives on measures of desire for control, extraversion, self-esteem, and life satisfaction. Submissives scored significantly higher than domi- nants on a measure of emotionality. Dominants and submissives did not differ on empathy, honesty-humility, conscientiousness, openness to experience, altruism, or agreeableness. Hébert and Weaver (2014) noted that both the dominants and the submissives scored in the normal range for all the person- ality characteristics measured except for altruism. This suggests, based on the data from the wide range of personality measures used in the study, that BDSM practitioners are not very different from people who do not practise BDSM. SOURCE: Fichner-Rathus, Human Sexuality in a World of Diversity, Sixth Canadian Edition, 9780134646558, Pearson education.

Sexual Variations 457 Frotteurism Frotteurism , also known as mashing or groping, is a paraphilia characterized by the desire to rub against or touch a nonconsenting person in order to become sexually aroused. Like other paraphilias, a diagnosis of frotteurism requires that the person act on or be distressed by these urges. Mashing has been reported exclusively among males (American Psychiatric Association, 2012). Unfortunately, this paraphilia is quite com- mon. In a survey of undergraduate women attending a university in New York City, 24% reported that they had been a victim of frotteurism at least once in their lifetimes (Clark, Jeglic, Calkins, & Tatar, 2016). Most mashing takes place in crowded places, such as buses, subway cars and plat- forms, and elevators. The man is sexually stimulated by the rubbing or touching, not by the coercive nature of the act. While rubbing against a woman, he may fantasize a consensual, affectionate sexual relationship with her. Typically, he incorporates images of mashing within his masturbation fantasies (Lussier & Piché, 2008). Mashing also incorporates a related practice, toucherism , the fondling of nonconsenting strangers. Mashing may be so fleeting and furtive that the woman may not realize what’s happened. Mashers therefore stand little chance of being caught. Many mashers have difficulty forming relationships with women and are handi- capped by fears of rejection. Mashing provides sexual contact in a relatively non- threatening context. Other Paraphilias Let’s consider some less common paraphilias. ZOOPHILIA One of the less common paraphilias, zoophilia is often associated with other disorders (Dittert, Seidl, & Soyka, 2005). A person with zoophilia experiences repeated, intense urges and fantasies involving sexual contact with animals. Someone with zoophilia may act on or be distressed by these urges. Actual sexual contact with an animal is referred to as bestiality. frotteurism A paraphilia characterized by recurrent, powerful sexual urges and fantasies that involve rubbing against or touching a nonconsent- ing person. toucherism A practice related to frotteurism, characterized by the persistent urge to fondle nonconsenting strangers. zoophilia A paraphilia involving persis- tent or repeated sexual urges and fantasies that involve sexual contact with animals. Real Students, Real Questions Q Are there cultures that allow sex with animals/pets? A No modern cultures do, but ancient cave paintings and other artefacts suggest that sex with animals might have been allowed and sometimes incorporated into magical rituals before the advent of the so-called Abra- hamic religions of Judaism, Christianity, and Islam. Many Egyptian gods were depicted as part animal, suggesting that sex with animals might have been included in some rituals. Goats and baboons might have been occasional sex partners in ancient Egypt. Although the exact prevalence of zoophilia in the general population is unknown, it’s estimated that 4.9% to 8.3% of men and 1.9% to 3.6% of women have had sexual con- tacts with animals (Singg, 2017). Men more often had sexual contact with farm animals, such as calves and sheep. Women more often reported sexual contacts with household pets. Men were more likely to masturbate or copulate with the animals. Women more often reported general body contact. People of both genders reported encouraging the animals to lick their genitals. A few women reported that they’d trained dogs to engage in intercourse with them. Urban–rural differences also emerged. Kinsey found rates of bestiality higher among boys reared on farms. Compared with only a few city boys, 17% of farm boys had Ingram Publishing/SuperStock

458 Chapter 16 reached orgasm at some time through sexual contact with dogs, cows, and goats. These contacts were generally restricted to adolescence, when human outlets were unavailable. Still, adults sometimes engaged in sexual contact with animals. In Canada, it’s a criminal offence to have penetrative sex (e.g., intercourse) with an animal, but other forms of sexual contact with animals do not fall within the legal definition of bestiality (Canadian Press, 2016). NECROPHILIA In necrophilia , a rare paraphilia, a person desires sex with corpses. Three types of necrophilia have been identified (Holmes & Holmes, 2002). In regular necrophilia, the person has sex with a deceased person. In necro- philic homicide, the person commits murder to obtain a corpse for sexual purposes. In necrophilic fantasy, the person fantasizes about sex with a corpse but doesn’t actually carry out necrophilic acts. Necrophiliacs often get jobs that provide access to corpses, working in cemeteries, morgues, or funeral homes. The primary motivation for necro- philia appears to be the desire to sexually possess a completely unresisting and nonrejecting partner (Holmes & Holmes, 2002). Many necrophiliacs have other serious psychological disorders. OTHER LESS COMMON PARAPHILIAS In klismaphilia , sexual arousal is derived from the use of enemas. Klismaphiliacs generally prefer the receiving role to the giving role. They may have derived sexual pleasure in childhood from the anal stimulation provided when their parents gave them enemas. In coprophilia , sexual arousal is connected with feces. The person may feel an urge to be defecated on or to defecate on a sex partner. The association of feces with sexual arousal may also be a throwback to childhood. In urophilia , sexual arousal is associated with urine. Again, the person may feel an urge to be urinated on or to urinate on a sexual partner. Urophilia may also have child- hood origins. Theoretical Perspectives The paraphilias are among the most fascinating and perplexing variations in sexual behaviour. People without paraphilic desires may find it difficult to understand why some people have sexual desires so different from their own. Let’s consider explana- tions that have been advanced from the major theoretical perspectives. Biological Perspectives LO 16.3 Discuss biological perspectives on paraphilias. Researchers are investigating whether there are biological factors in the paraphilias. The biological perspective looks at the involvement of factors such as the endocrine (hormonal) and nervous systems in paraphilic behaviour. The tendency of paraphilias to cluster within some families also raises the question as to whether genetic factors may be involved (Labelle, Bourget, Bradford, Alda, & Tessier, 2012). Studies appear to confirm that many paraphiliacs have higher-than-normal sex drives (Jordan, Fromberger, Stolpmann, & Muller, 2011). A German study, for example, found that men with paraphilias had shorter refractory periods after orgasm by mastur- bation than most men and experienced more frequent sexual fantasies and urges (Haake et al., 2003). Canadian research has found a link between high sex drive and paraphilic behaviours, suggesting that one reason paraphilias tend to be more common among men than women is that men have, on average, higher levels of sex drive than women (Bouchard, Dawson, & Lalumière, 2017). necrophilia A paraphilia characterized by a desire for sexual activity with corpses. klismaphilia A paraphilia in which sexual arousal is derived from the use of enemas. coprophilia A paraphilia in which sexual arousal is attained in connection with feces. urophilia A paraphilia in which sexual arousal is associated with urine. Frotteurism. Mashing or groping occurs most often in crowded places, such as subways. It’s been reported exclusively among males. Digital Vision/Photodisc/Getty Images

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Sexual Variations 459 But these studies have addressed the strength of the sex drive, not the direction it takes. Recent studies have used the electroencephalograph (EEG) to investigate elec- trical responses in the brain among paraphiliacs and others who engage in impulsive behaviour (e.g., Fisher et al., 2011). Researchers measured what’s called “evoked electrical potentials” to erotic stimuli in a sample of 62 right-handed men, half of whom were considered normal in terms of sexual fantasies and behaviours (the control subjects), and half of whom had been diagnosed as paraphilic (fetishistic and sado-masochistic) (Waismann, Fenwick, Wilson, Hewett, & Lumsden, 2003). The men were shown three sets of 57 slides in random order—57 para- philic slides that portrayed fetishistic and sado-masochistic themes; 57 “normal” sexual slides that depicted nude women, intercourse, and oral sex; and 57 neutral slides of land- scapes, street scenes, and the like. An electrical response labelled “P600” was determined as the best indicator of sexual arousal in men. The researchers found that the main site for evoking the P600 response to “normal” sexual stimuli was in the right side of the brain. The main site for paraphilic stimuli was in the left frontal part of the brain. The para- philic men showed significantly greater P600 response in the left frontal part of the brain than the control subjects did. Moreover, control subjects were more likely to differentiate between paraphilic and normal stimuli in the right side of the brain. Another neurological study may offer some insight into masochism. A research team at Massachusetts General Hospital found that the same neural circuits in the brain are often activated by painful and by pleasurable stimuli (Becerra, Breiter, Wise, Gonzalez, & Borsook, 2001). The researchers discovered that a painfully hot (46°C) stimulus to the hand activated areas of the brain believed to involve “reward” cir- cuitry. The researchers had set out to find ways to help chronic pain patients, not to investigate sexual masochism, but their findings certainly have implications for masochism. Other studies have confirmed that people who regularly engage in sexual masochistic behaviour are less sensitive to pain than other people (Defrin, Arad, Ben- Sasson, & Ginzburg, 2015). It is unclear whether their lower sensitivity reflects habitu- ation to painful experiences or a predisposition toward higher tolerance of pain. As time goes on, we may learn more about potential biological foundations of para- philic behaviour. A better understanding of these atypical patterns of sexual behaviour may lead to development of more effective treatments for paraphilic disorders. Psychoanalytic Perspectives LO 16.4 Discuss psychoanalytic perspectives on paraphilias. Psychoanalytic theory suggests that paraphilias are psychological defences, usually against unresolved castration anxieties dating to the Oedipus complex (Friedman & Downey, 2008). Perhaps the sight of a woman’s vagina threatens to arouse castration anxiety in the transvestite, reminding him that women don’t have penises and that he might suffer the same fate. Sequestering his penis beneath women’s clothing symbolically asserts that women do have penises, providing unconscious reassurance against his own fears of castration. By exposing his genitals, perhaps the exhibitionist unconsciously seeks reassurance that his penis is secure. It’s as if he’s asserting “Look! I have a penis!” Shock or surprise on the victim’s face confirms that his penis exists, temporarily relieving castration anxiety. Perhaps masturbation with an object such as a shoe allows the fetishist to gratify his sexual desires while keeping a safe distance from the dangers he unconsciously associates with female sexual contact. Or he may unconsciously see the fetishistic object as a symbol of his penis. Is a sadist attempting to defend him- or herself against unconscious feelings of impotence by inflicting pain on others?

460 Chapter 16 One psychoanalyst associated a type of male sexual masochism with a history of repressed feelings of sexual guilt and shame (Schrut, 2005). As an adult, the man wants to be punished for feelings of wrongdoing at the same time as he experiences sexual arousal. The pain or humiliation makes the experience okay. The paraphilias have provided a fertile ground for psychoanalytic theo- ries. Whatever evidence there is, however, consists of case studies and anec- dotes, which are open to interpretation. Cognitive-Behavioural Perspectives LO 16.5 Discuss cognitive-behavioural perspectives on paraphilias. Cognitive-behavioural theorists generally believe fetishes and other paraphil- ias are learned. An object may acquire sexually arousing properties through association with sexual arousal or orgasm. Alfred Kinsey and his colleagues (1953) wrote: Even some of the most extremely variant types of human sexual behavior may need no more explanation than is provided by our understanding of the processes of learning and conditioning. Behavior which may appear bizarre, perverse, or unthinkably unacceptable to some persons, and even to most persons, may have significance for other individuals because of the way in which they have been conditioned. (Kinsey, A. C., Pomeroy, W. B., Martin, C. E., & Gebhard, P. H. (1953). Sexual behavior in the human female. Philadelphia: W. B. Saunders. pp. 645–646.) For example, a boy who glimpses his mother’s stockings hanging on the towel rack while he’s masturbating may develop a fetish for stockings. Orgasm in the presence of the object reinforces the erotic connection, especially if it’s repeated. Friedrich and Gerber (1994) studied five adolescent boys who engaged in hypoxy- philia and found extensive early histories of choking in combination with physical or sexual abuse. The combination seems to have encouraged each boy to associate choking with sexual arousal. Cognitive-behavioural explanations of sexual masochism focus on the pairing of sexual excitement with punishment. A child may be punished when discovered mas- turbating, for example, or a boy may reflexively experience an erection if his penis accidentally rubs against his parent’s body while he’s being spanked. With repeated encounters like these, pain and pleasure may become linked. Many exhibitionists, voyeurs, frotteurs, and other people with paraphilias have poor interpersonal skills when it comes to women, and fear of rejection may cause them to avoid normal social interactions with women (Griffee et al., 2014; Leue et al., 2004). Their furtive, paraphilic behaviours may provide sexual release without the risk of rejection. Observational learning may also play a role. A parent, for example, may inadver- tently model exhibitionistic behaviour to a young son, leading the son to eroticize the act of exposing himself. A person may also read books or magazines or view films or TV programs with paraphilic content and find it arousing. Media may give people the idea of trying paraphilic behaviour, and they may find it exciting, especially if acts such as exhibitionism or voyeurism provide rushes of adrenaline. However, we should be care- ful about drawing conclusions about cause-and-effect relationships. To date the small amount of research on risk factors for the development of paraphilias has suggested that conditioning (e.g., exposure to paraphilic stimuli in media) is more likely to maintain rather than initiate paraphilic arousal (Zucker & Seto, 2015). In other words, viewing a pornographic depiction of a particular paraphilic activity is unlikely to cause someone to develop the paraphilia, but it may help to reinforce paraphilic interest in the person who already has the paraphilia. Psychoanalysts suggest that some cases of early punishment by the mother can lead to the devel- opment of aberrant sexual fantasies and deviant behaviour. Odilon Dimier/PhotoAlto sas/Alamy Stock Photo

Sexual Variations 461 Sociological Perspectives LO 16.6 Discuss sociological perspectives on paraphilias. Sociological perspectives focus on the effects of the group and of society on individual and group behaviour. Sexual masochists and sadists, for example, require partners. Most sado-masochists learn S&M rituals, make sexual contacts, acquire sexual para- phernalia, and confirm their sado-masochistic identities within an S&M subculture—a loosely connected network of S&M clubs, specialty shops, organizations, magazines, and so on. But the S&M subculture exists within the context of the larger society, and its rituals mirror widely based social and gender roles. Martin Weinberg (1987) has proposed a sociological model that focuses on the social context of sado-masochism. S&M rituals generally involve some form of dominance and submission. Weinberg (1987) has attributed their erotic appeal to the opportunity to reverse the customary power relationships that exist between males and females and between social classes. Within the confines of the carefully scripted S&M encounter, the meek can be powerful, and the powerful can be meek. People from lower socioeco- nomic classes or in menial jobs may be drawn to S&M so they can enact dominant roles. Dominance-and-submission games allow people to accentuate or reverse the gender stereotypes that identify masculinity with dominance and femininity with submissive- ness. Interviews and observations involving sado-masochists have suggested that most often, dominance-and-submission relationships tend to be consistent with traditional masculine and feminine gender roles in society (Damon, 2002; Santtila et al., 2002). Although there are many exceptions, in S&M rituals, men more often tend to be domi- nant, and women to be submissive. An Integrated Perspective: The “Lovemap” LO 16.7 Discuss the “lovemap.” Paraphilias may have complex biopsychosocial origins (Downing, Morland, & Sullivan, 2014; Seligman & Hardenburg, 2000). Might our understanding of them therefore be best approached from a theoretical framework that incorporates multiple perspectives? John Money (2003), for example, traced the origins of paraphilias to childhood. He believed every person has what he called a lovemap , which forms in the brain during childhood. The lovemap contains the image of the person’s ideal lover, and includes the types of stimuli and activities that become sexually arousing to the individual (Goldie, 2014). In the case of paraphilias, lovemaps become distorted by early traumatic experiences such as incest, antisexual upbringings, and abuse or neglect. Research has suggested that voyeurs and exhibitionists have often been victims of childhood sexual abuse (Barbaree & Blanchard, 2008; Blokland & Lussier, 2015). Not all children exposed to such influences develop paraphilic compulsions, however. For reasons that remain unknown, some children exposed to these influences appear to be more likely to develop distorted lovemaps than others. Genetic predispositions, hormonal factors, brain abnormalities, or a combination of these and other factors may play a role in determining one’s vulnerability to vandalized lovemaps (Lehne, 2009). Treatment of Paraphilic Disorders As noted at the beginning of this chapter, there is a distinction between a paraphilia, as defined in the DSM-5 , and a paraphilic disorder (American Psychiatric Association, 2013a). Interest in, and enjoyment of, paraphilic behaviours such as fetishism and con- sensual BDSM are not considered mental disorders requiring treatment. However, para- philic behaviours that are distressing to the individual and/or cause harm to the self lovemap A representation in the mind and in the brain of the idealized lover and the idealized erotic activity with the lover.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

462 Chapter 16 or others fall into the category of paraphilic disorders. And it’s the paraphilic disorders that we consider here with respect to potential treatments. Treatment for the paraphilias raises a number of issues. First, many people with paraphilias don’t want or voluntarily seek treatment. Ontario criminologist Ron Langevin (2006) followed nearly 800 sex offenders from the 1960s through the first decade of the twenty-first century and found that only about half wanted and completed courses of treatment. Many offenders are seen by health care providers only when they come into conflict with the law, or at the urging of family members or partners. Second, health care providers may encounter ethical problems when asked to con- tribute to the judicial process by trying to persuade sex offenders (who are virtually all male) to change their behaviour. Health care providers traditionally help clients clarify or meet their own goals; it’s not their role to impose societal goals on individuals. Some health care providers believe the criminal justice system—not the health care system— ought to enforce social standards. Third, health care providers realize that they’re generally unsuccessful in treating resistant or recalcitrant clients. Unless the motivation to change is present, therapeutic efforts are often wasted. And fourth, sex offenders typically claim that they can’t control their impulses. Accepting personal responsibility for one’s actions is a prelude to change. If therapy is to be constructive, then, it must break through the offenders’ personal mythology that they are powerless to control the criminal behaviour. Despite these issues, many offenders are referred for treatment by the courts. Some seek therapy themselves, because they’ve come to see how their behaviour harms them- selves and others (Langevin, 2006). Psychoanalytic Psychotherapy LO 16.8 Discuss the psychoanalytic treatment of paraphilic disorders. Psychoanalysis focuses on resolving unconscious conflicts that are believed to originate in childhood and to give rise to pathological problems such as paraphilias in adulthood. The aim of therapy is to help bring unconscious conflicts, principally Oedipal conflicts, into conscious awareness, so they can be worked through in light of the individual’s adult personality (Laws & Marshall, 2003). Psychoanalytic therapy for the paraphilias has not been subjected to experimen- tal evaluation. We therefore don’t know whether successes are due to the psychoana- lytic treatment itself or to other factors, such as spontaneous improvement or a client’s willingness to change. Cognitive-Behavioural Therapy LO 16.9 Discuss the cognitive-behavioural treatment of paraphilic disorders. Whereas psychoanalysis tends to entail a lengthy process of exploring the childhood origins of problem behaviours, cognitive-behavioural therapy is briefer and focuses on changing behaviour. Cognitive-behavioural therapy has spawned a number of tech- niques to help eliminate paraphilic behaviours and strengthen appropriate sexual behaviours. These techniques include systematic desensitization, aversion therapy, social-skills training, covert sensitization, and orgasmic reconditioning (Kaplan & Krueger, 2012; Marshall & Marshall, 2015). Systematic desensitization attempts to break the link between the sexual stimulus (such as a fetishistic stimulus) and the inappropriate response (sexual arousal). The client is first taught to relax selected muscle groups in his or her body. Muscle relaxation is then repeatedly paired with a series of progressively more arousing paraphilic images or fantasies. Relaxation comes to replace sexual arousal in response to each stimulus, including the most provocative. cognitive-behavioural therapy Systematic application of the principles of learning in order to modify a problem behaviour. systematic desensitization A method for terminating the connection between a stimulus (such as a fetishistic object) and an inappropriate response (such as sexual arousal to the paraphilic stimulus). The individual practises muscle relaxation in the presence of a series of increasingly arousing stimuli, until he or she learns to remain relaxed (and not sexually aroused) in their presence.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Sexual Variations 463 In aversion therapy , the undesirable sexual behaviour (e.g., masturbation to fetish- istic fantasies) is repeatedly paired with an aversive stimulus (e.g., a harmless but pain- ful electric shock or a nausea-inducing chemical), in the hope that the client will develop a conditioned aversion to the paraphilic behaviour. Covert sensitization is a variation of aversion therapy in which paraphilic fantasies are paired with an aversive stimulus in the client’s imagination. In a broad-scale appli- cation, 38 pedophiles and 62 exhibitionists, more than half of whom were court-referred, were treated by pairing imagined aversive images or odours with fantasies of the prob- lem behaviours (Maletzky, 1980). Clients were instructed to fantasize pedophiliac or exhibitionistic scenes. Then: At a point when sexual pleasure is aroused, aversive images are presented. Examples might include a pedophiliac fellating a child, but discovering a fester- ing sore on the boy’s penis, an exhibitionist exposing to a woman, but suddenly being discovered by his wife or the police, or a pedophiliac laying a young boy down in a field, only to lie next to him in a pile of dog feces. (Maletzky, B. M. (1980). Self-referred vs. court-referred sexually deviant patients: Success with as- sisted covert sensitization. Behavior Therapy, 11, 306–314. , p. 308) Maletzky used this treatment weekly for six months, then followed it with booster sessions every three months for three years. The procedure resulted in at least a 75% reduction in the deviant activities and fantasies for more than 80% of the study partici- pants, at follow-up periods of up to 36 months. Social-skills training focuses on helping the individual improve his ability to relate to the other gender. The therapist might first model a desired behaviour, such as asking a woman out on a date or handling a rejection. The client might then role- play the behaviour, with the therapist playing the part of the woman. Following the role-play enactment, the therapist provides feedback and additional guidance and modelling, to help the client improve his skills. This process is repeated until the client masters the skill. Orgasmic reconditioning aims to increase sexual arousal to socially appropriate sexual stimuli, by pairing culturally appropriate imagery with orgasmic pleasure. The person is instructed to become sexually aroused by masturbating to paraphilic images or fantasies. But as he approaches the point of orgasm, he switches to appropriate imagery and focuses on it during orgasm. These images and fantasies eventually acquire the capac- ity to elicit sexual arousal. Orgasmic reconditioning is often combined with other tech- niques, such as social-skills training, so desirable social behaviours can be strengthened. Although behavioural-therapy techniques tend to have higher reported success rates than most other methods, our knowledge about their efficacy is limited by reliance on uncontrolled case studies. Without appropriate controls, we can’t isolate the effective elements of therapy or determine whether the results are due merely to the passage of time or to other factors unrelated to treatment. It’s possible that clients who are highly motivated to change may succeed in doing so with any systematic approach. Medical Approaches LO 16.10 Discuss medical treatment of paraphilic disorders. There may be no medical cures for the paraphilias. No drug or surgical technique elimi- nates paraphilic ideas while leaving other cognitive functions intact. But some progress has been reported in the use of selective serotonin reuptake inhibitors (SSRIs), which are mainly used as antidepressants, to treat exhibitionistic disorder, voyeuristic disorder, and fetishistic disorder (Assumpcao, Garcia, Delavenne, Bradford, & Thibaut, 2014; Thibaut, 2012). Why antidepressants? In addition to treating depression, SSRIs are often used to treat obsessive-compulsive disorder, a psychological disorder involving recurrent aversion therapy A method for terminating an undesirable sexual behaviour. The behaviour is repeatedly paired with an aversive stimulus, such as electric shock, until the person develops a conditioned aversion to the stimulus. covert sensitization A form of aversion therapy in which thoughts about engaging in undesirable behaviours are repeat- edly paired with imagined aversive stimuli. pedophile A person with pedophilia, a para- philia that involves sexual interest in children. social-skills training A method of behavioural therapy that relies on coaching and prac- tice to build social skills. orgasmic reconditioning A method for strengthening the connection between sexual arousal and an appropriate sexual stimu- lus. It involves repeatedly pairing the desired stimulus with orgasm.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

464 Chapter 16 obsessions (intrusive ideas) and/or compulsions (urges to repeat certain behaviours or thoughts). Paraphilic behaviour has an obsessive-compulsive quality. People with paraphilias often experience intrusive, repetitive fanta- sies and urges (Saleh, 2009). People who experience such intense urges that they risk committing sexual offences may also be helped by drugs that reduce testosterone levels in the bloodstream (Houts, Taller, Tucker, & Berlin, 2011; Kellar & Hignite, 2014). Testosterone is closely linked to sex drive and interest. In men, antiandro- gen drugs reduce sexual desire and frequency of erection and ejaculation. Medroxyprogesterone acetate (MPA, sold as Depo-Provera), which is admin- istered by weekly injection, is the antiandrogen most extensively used to treat sex offenders. It suppresses the male sexual appetite, lowering the intensity of the sex drive and erotic fantasies and urges, so the man may feel less compelled to act on them (Briken, Hill, & Berner, 2011; Houts et al., 2011). Antiandrogens do not, however, eliminate all paraphilic urges or completely change a person’s sexual behaviour (Thibaut, 2012). The use of antiandrogens is sometimes incorrectly referred to as chemical castration. Surgical castration, the surgical removal of the testes, has sometimes been performed on convicted rapists and violent sex offenders (del Busto & Harlow, 2011). Surgical castra- tion eliminates testicular sources of testosterone. Antiandrogens suppress but do not eliminate testicular production of testosterone. Unlike surgical castration, antiandrogen effects can be reversed when the treatment is terminated. Although we have amassed a great deal of research on paraphilic disorders, our under- standing of them and treatment approaches to them remain less than satisfactory. Thus far, researchers and clinicians have been unable to find a cure for paraphilic disorders to the point where problematic sexual desires are completely eliminated. Current treatment strategies are more likely to focus on reducing problematic sexual urges to a manageable level and enabling individuals with paraphilic disorders to manage their sexual impulses. Sexual Addiction, Compulsive Sexual Behaviour, and Hypersexuality LO 16.11 Discuss the concepts of sexual addiction, compulsive sexual behaviour, and hypersexuality. Three terms have been used to describe a psychological disorder in which a person is unable to control an excessively frequent sexual behaviour: sexual addiction, sexu- ally compulsive behaviour, and hypersexuality (cybersex addiction will be discussed Chapter 18). The terminology we use is important. While all three terms apply to out-of-control sexual behaviours, they each imply somewhat different conceptualizations of the factors underlying those behaviours, and therefore the most effective ways of addressing them. Sexual Addiction Of these three terms, you’re probably most familiar with “sexual addiction,” which is frequently used in the media. The concept of sexual addiction as a clinically defined psychological disorder was articulated and popularized by the 1983 book Out of the Shadows: Understanding Sexual Addiction , by Patrick Carnes. In this conceptualization, sexual addiction is similar to other addictions, such as alcohol, drug, and gambling addictions. A sex addict engages in sexual behaviour to relieve anxiety but typically doesn’t achieve a high level of gratification. The addict feels bad about the behaviour but is unable to control or resist it. Attempts to stop lead to further anxiety (withdrawal symptoms), which fuels the person’s preoccupation or Appropriate Behaviour? Research indicates that parental nudity that isn’t sexually suggestive isn’t harmful to a child. KPG Payless2/Shutterstock

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Sexual Variations 465 craving to engage in this behaviour. The sex addict becomes caught in a spiral of anxiety and loss of control that often leads to risk-taking, inappropriate behaviours, and exces- sive levels of sexual activity that take over the addict’s life. Treatments are similar to the treatments for other addictions, including 12-step programs and group therapies such as Sexaholics Anonymous (Schneider & Irons, 2001). Compulsive Sexual Behaviour Although the term “sex addiction” is popular, some experts argue that excessively frequent, out-of-control sexual behaviour is not an indication that a person is addicted to sex. They reject the belief that a person can be addicted to a basic human function such as sex the same way he or she can be addicted to a substance such as alcohol or a drug. Rather, they argue that a sexual behaviour that’s frequent enough to interfere with a person’s ability to carry on with his or her daily life is best seen as an obsessive- compulsive disorder (Coleman, 2003, 2011). Compulsive sexual behaviour is characterized by recurrent, sexually arousing fantasies that the individual is unable to get out of his or her mind, and intense sexual urges that, when acted upon, temporarily relieve anxiety. Psychotherapy similar to that used for other obsessive-compulsive behaviours is used to treat compulsive sexual behaviour. Medications such as certain types of antidepressants can also be helpful for obsessive-compulsive disorders (Ravindran & Stein, 2010). Hypersexuality Neither sexual addiction nor compulsive sexual behaviour is listed as a specific diagnostic category in the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013a). Hypersexuality, however, was being considered for inclusion as a distinct clinical disorder in the DSM-5 but was ultimately not included because of a lack of supportive scientific evidence and concerns about how a psychiatric diag- nosis of hypersexuality might be used in legal settings (Walton, Cantor, Bhullar, & Lykins, 2017). The proposed diagnostic criteria for hypersexuality are similar to those commonly described for sexual addiction and compulsive sexual behaviour (Kafka, 2010): • Time consumed by the sexual fantasies or behaviours interferes with other impor- tant activities and obligations. • The person repetitively engages in the sexual fantasies or behaviours in response to mood states such as anxiety or depression. • Frequency and intensity of the sexual fantasies or behaviours causes clinically significant personal distress. • The sexual fantasies or behaviours are not due to medication or drug abuse. • The person has been unable reduce the frequency of the sexual fantasies or behaviours. SOURCE: Kafka, M.P. (2010). Hypersexual disorder: a proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39(2), 377–400. Like sexual addiction and compulsive sexual behaviour, the concept of hypersexuality as a specific mental disorder is controversial (e.g., Fedoroff, 2011; Federoff, Di Gioacchino, & Murphy, 2013; Walton et al., 2017) and, as noted, was not included as a diagnostic cate- gory in the DSM-5 . Paul Fedoroff at the Royal Ottawa Hospital has argued that acceptance of the concept of hypersexuality as a mental disorder would pathologize consensual sex- ual thoughts and behaviours by linking them with psychiatric problems such as addiction, anxiety, depression, and compulsions. He’s concerned that people with mood disorders will instead be labelled hypersexual and as a result will not receive appropriate treatment.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

LO 16.1 List and discuss different approaches to defin- ing normal versus deviant sexual behaviour. This chapter examines a number of sexual behaviours that deviate from the norm. It’s important to clarify what we mean when we say a sexual behaviour is abnormal, or deviant. Sexual behaviours that are statistically unusual or violate societal norms have often been labelled as devi- ant. A third approach to assessing if a sexual behaviour is deviant is whether the behaviour causes harm to the self or others. LO 16.2 List and define the paraphilias. Patterns of sexual arousal in response to atypical stimuli are called paraphilias. In many cases, paraphilias are harmless (e.g., cross-dressing). However, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013a), when a paraphilia causes an individual to be distressed or poten- tially causes harm to the individual or others, it can be considered to be a paraphilic disorder. In fetishism, an inanimate object comes to elicit sexual arousal. A transvestite becomes excited by wearing articles of clothing—the fetishistic objects—of the other gender. An exhibitionist experiences the compulsion to expose himself to strangers. The obscene phone caller becomes sexually aroused by shocking his victim. A voyeur becomes sexu- ally aroused by watching and doesn’t seek sexual relations with the target. A sexual masochist associates the receiving of pain or humiliation with sexual arousal. Sexual sadism is charac- terized by persistent, powerful urges and sexual fantasies that involve inflicting pain and suffering on others in order to achieve sexual excitement or gratification. Most frotteuristic acts—rubbing against nonconsent- ing persons—take place in crowded places such as buses, subway cars, and elevators. Frotteurism is also known as mashing. Zoophiliacs desire sexual contact with animals. Necrophiliacs desire sexual contact with dead people. LO 16.3 Discuss biological perspectives on paraphilias. Many people with paraphilias have higher than normal sex drives. Their brains may also respond differently to sexual stimuli. LO 16.4 Discuss psychoanalytic perspectives on paraphilias. Classical psychoanalytic theory suggests that paraphilias in males are psychological defences against castration anxiety. LO 16.5 Discuss cognitive-behavioural perspectives on paraphilias. Some learning theorists argue that unusual stimuli may acquire sexually arousing properties through association with sexual arousal or orgasm. LO 16.6 Discuss sociological perspectives on paraphilias. According to Weinberg’s sociological model, the erotic appeal of S&M rituals may result from the opportunity to reverse the customary power relationships that exist between the genders and between socioeconomic classes in society at large. LO 16.7 Discuss the “lovemap.” Money suggested that childhood experiences etch a pat- tern in the brain—a lovemap—that determines which stimuli and activities become sexually arousing. In para- philias, these lovemaps become distorted by early trau- matic experiences. LO 16.8 Discuss the psychoanalytic treatment of para- philic disorders. Psychoanalysis aims to bring unconscious Oedipal conflicts that prompt paraphilic behaviour into awareness, so they can be worked through in adulthood. LO 16.9 Discuss the cognitive-behavioural treatment of paraphilic disorders. Cognitive-behavioural therapy attempts to eliminate para- philic behaviours through such techniques as systematic desensitization, aversion therapy, social-skills training, covert sensitization, and orgasmic reconditioning. LO 16.10 Discuss medical treatment of paraphilic disorders. SSRIs, which are usually used as antidepressants, tend to curb compulsive behaviour and depress sexual response. Both SSRIs and antiandrogen drugs decrease sexual desire and can help individuals control their sexual urges. LO 16.11 Discuss the concepts of sexual addic- tion, compulsive sexual behaviour, and hypersexuality. “Sexual addiction,” “compulsive sexual behaviour,” and “hypersexuality” are terms used to describe excessively frequent, out-of-control sexual behaviours. Chapter Review

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Sexual Variations 467 Multiple-Choice Questions 1. Which of the following is not used to distinguish normal from abnormal sexual behaviour? (a) statistical norms (b) pain thresholds (c) social norms (d) personal distress and anxiety 2. Which of the following are most likely to need to risk capture, to heighten their sexual arousal? (a) sado-masochists (b) coprophiliacs (c) exhibitionists (d) mashers 3. People who become sexually aroused by experi- encing pain inflicted by their sexual partners are ____________________. (a) partialists (b) sexual masochists (c) sexual sadists (d) toucherists 4. A man who dresses in women’s clothing for the purposes of sexual gratification is labelled as a ____________________. (a) transsexual (b) partialist (c) frotteur (d) transvestite 5. What percentage of women attending a New York City university reported that they had been victims of frotteurism? (a) 24% (b) 42% (c) 54% (d) 64% 6. Hébert and Weaver’s study of BDSM practitioners found that with respect to personality characteristics, ____________________. (a) dominants and submissives differed on measures of empathy and agreeableness (b) BDSM practitioners were very different from people who do not practise BDSM (c) BDSM practitioners were not very different from people who do not practise BDSM. (d) dominants scored lower than submissives on a measure of life satisfaction 7. People who are excessively aroused by particular body parts, such as the feet, breasts, or buttocks, are said to exhibit ____________________. (a) partialism (b) frotteurism (c) voyeurism (d) transvestism 8. Which of the following is included as a distinct para- philic disorder in the DSM-5 ? (a) hypersexuality (b) sexual addiction (c) compulsive sexual behaviour (d) none of the above 9. Which approach to the treatment of paraphilia uses social-skills training and systematic desensitization? (a) psychoanalysis (b) antiandrogen therapy (c) cognitive-behavioural therapy (d) antidepressant therapy 10. The image of an ideal lover and of the types of activities a person finds arousing that forms in the brain during childhood is known as a ____________________. (a) sexual script (b) lovemap (c) gender stereotype (d) fantasy Test Your Learning Answers: 1. b; 2. c; 3. b; 4. d; 5. a; 6. c; 7. a; 8. d; 9. c; 10. b

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Related Documents