Chapter 15 Summary

  1. Most variations in sexual desire and behavior are not mental disorders but represent minority interests or a means of adding excitement to sexual relationships.
  2. Fetishism is sexual arousal by objects, materials, or body parts. Transvestic fetishists are sexually aroused by cross-dressing, but not all cross-dressers are fetishists—others may cross-dress for practical reasons, for entertainment purposes, or as an expression of a transgender identity.
  3. Bondage, dominance, and sadomasochism (collectively known as BDSM) involves sexual arousal by the infliction or receipt of humiliation, degradation, or physical pain. BDSM practices generally take place in safe, consensual settings.
  4. The boundary between normal and abnormal sexuality is imprecise and subjective and is defined socially as well as medically. According to the American Psychiatric Association (APA), paraphilias are sexual feelings or behaviors that are targeted at nonhuman objects or nonconsenting people, or that involve suffering or humiliation, and that cause significant distress, social dysfunction, or harm to others. Paraphilic behaviors directed at nonconsenting people are illegal.
  5. In general, paraphilias are extensions or exaggerations of normal sexual feelings or behaviors. Far more men than women have paraphilias. It is common for a person to develop multiple paraphilias over time. Paraphiliacs who commit sex offenses may have deficient social skills and psychological problems, and some have suffered child abuse, but others have unremarkable personalities and histories.
  6. Exhibitionists are sexually aroused by exposing their genitals to others (usually women) in public places. Making obscene phone calls is a variation on exhibitionism. Voyeurs spy on women who are undressed or engaged in sex. Frotteurs make body contact with women in crowds. Autoerotic asphyxia is often combined with BDSM elements; it is a highly dangerous practice.
  7. Pedophiles are sexually attracted to prepubescent children more than to adults. Pedophiles and child molesters are overlapping but nonidentical groups. Most pedophiles are attracted to children of one sex more than the other. Hebephiles are aroused by pubescent children.
  8. Zoophiles are aroused by sexual contact with animals. Necrophiles are aroused by dead bodies.
  9. Although rape is not generally considered a paraphilia, the commission of violent sexual acts because the perpetrator experiences the violence itself as sexually arousing is paraphilic. Paraphilic sadism has motivated many notorious serial killers.
  10. Sex offenders repeat their offenses (recidivism) less often than many other kinds of offenders. Certain factors, such as mental retardation, alcohol use, and a history of violence or sexual contact with unrelated children are associated with an increased likelihood of recidivism.
  11. A variety of theories attempt to explain paraphilias. Biological theories attribute paraphilias to neurological, endocrinological, or genetic disturbance. Behavioral theories see them as the result of distorted learning processes or as the result of a blockage of normal sexual expression. Some categorize paraphilias as forms of obsessive–compulsive disorder (OCD). It has also been suggested that paraphilias result from the disintegration of the normal behavioral sequence of courtship (courtship disorder). Other theories point to the experience of abuse during childhood as the trigger for abuse of others in later life (cycle of abuse).
  12. The various theories of paraphilia have led to diverse forms of treatment. Behavioral approaches, such as aversion therapy, attempt to help paraphiliacs unlearn their paraphilias and learn normal sexual desires.
  13. Psychotherapeutic approaches include cognitive therapy, which attempts to correct the paraphiliac’s thinking; social skills training programs, which encourage normal communication with women; and relapse prevention programs, which help sex offenders identify and avoid situations in which they are likely to reoffend. In controlled trials, the behavioral and psychotherapeutic approaches have not been shown to reduce the likelihood that a paraphilic sex offender will reoffend.
  14. Biological approaches include the use of drugs that reduce testosterone levels or block testosterone’s effects, as well as selective serotonin reuptake inhibitors (SSRIs). The drugs appear to be quite effective but can have serious side effects. Castration is an effective but highly controversial method of preventing recidivism by men who commit repeated, serious sex crimes.