Atypical Sexual Behaviors
Introduction
I. A few points about atypical sexual behavior in general should be noted before consider specific
behaviors
A. In many instances there are gradations of a sexual behavior existing on a continuum
1. Most people enjoy looking at other people, but if someone spends many hours each day
just looking at others we would probably assume that person has a problem
B. Because many behaviors vary in degree, it is not surprising that many of us recognize some
degree of atypical behaviors or feelings in ourselves, perhaps only in private fantasy
1. Usually, such behavior or feelings should be accepted as natural as long as they do not
interfere with our optimal functioning or the rights of others
The Most Common Paraphilias
I. Unusual or problematic sexual behaviors are scientifically known as paraphilias
A. Paraphilia means love (philia) beyond the usual (para)
B. There about 50 different paraphilias and each exists in fantasy and in reality
C. Generally accepted that the prevalence and variety paraphilias are greater in males than
females but as indicated previously, in most instances little is known about them
II. Paraphilia behaviors are unconventional sexual behaviors that are obsessive and compulsive
A. They can interfere with relationships & intimacy
B. Defined as recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving:
C. Also the behavior, urges or fantasies cause significant stress in social, occupational or other
important areas of functioning
III. Paraphilia includes sexual behaviors that many people view as distasteful, unusual or abnormal
& that they subsequently rejected
Exhibitionism
I. Called flashing or indecent exposure; occurs when an individual achieves sexual gratification by
exhibiting the genitals to observers
II. Amer. Psychiatric Assn. - over a period of least 6 months recurrent intense, sexually arousing
fantasies, sexual urges or behaviors involving exposure of one's genitals to unsuspecting stranger
A. Exhibitionism is good example of sexual behavior that is difficult to classify as one that
causes problems
III. Exhibitionism has its origins in the primate courtship or the allurement ritual of displaying the
genitalia as an invitation to copulation
A. Male exhibitionist is compulsively driven to display his erect penis to elicit from a stranger a
startle response ranging from curiosity to alarm or panic in
IV. Marshall (1991) - exhibitionists have important deficit in capacity for intimacy; stated that this
feature must be addressed in treatment
V. There are 3 key features of true exhibitionism including:
VI. A few facts about exhibitionists might help to put this behavior into perspective
A. The exhibitionist receives sexual gratification through the victim's (observer's) response
B. Exhibitionists feel inadequate; they're afraid of rejection; they're shy and commonly have had
unsatisfactory sexual relationships
VII. Although people often think exhibitionists are violent and aggressive, they usually are not
A. It is extremely rare for exhibitionists to do more than display the genitals
Voyeurism
I. The term voyeurism or scopophilia (love of viewing) means obtaining sexual pleasure from
watching unsuspecting people undress or engage in sexual behavior
II. Amer. Psych. Assn. (1998) official definition - "over a period of at least 6 months recurrent,
intense, sexually arousing fantasies, sexual urges or behaviors involving the act of observing an
unsuspecting person who is naked, in the process of disrobing or engaging in sexual activity"
A. A peeping Tom is a voyeur
B. A voyeur learns from experience where to find people to watch
C. Voyeurs who are often shy & lonely & lack social skills commonly fantasized about having
sexual relations with the people they're watching & often masturbate while fantasizing
D. Voyeurs derive satisfaction from:
III. Some degree of voyeurism probably exists in everyone; society even condones some forms of
voyeurism
Obscene Communications
I. Most common & traditional form of obscene communication has been obscene telephone calls
II. Erotic telephone calling is a form of erotic distancing
A. As do the exhibitionist & voyeur, obscene caller or writer obtains sexual pleasure from a
distance & not from direct contact with another person
B. Recipient may be a stranger or consenting listener
III. In national survey in Canada, Smith & Morra (1994) found that 83.2 % of females had received
obscene or threatening telephone calls at some time in their life
A. Divorced & separated females, young females & females living in major metropolitan areas
were most likely to have been victims of this harassment
B. Typical caller was an adult male unknown to victim
C. Katz (1994) – found that in 6 months proceeding a national survey in U.S., 16% of women
had received at least one call
1. Women younger than 65 years old & those who were neither married nor widowed were
more likely to receive such a call
IV. Obscene telephone callers have counterparts in those whose primary turn-on is not genital
sexual activity with a partner, but erotic narrations or readings
A. The obscene letter writer or the obscene computer message sender is hoping for sexual
gratification as well
V. According to U.S. Dept. of Justice – "any comment, request, suggestion, proposal, image, or
other communication which is obscene or indecent, knowing that the recipient of the
communication is under 18 years of age" is illegal
A. In addition, "any indecent communication for commercial purposes, which is available to any
person under 18 years of age or to any other person without the person's consent is illegal
VI. What should someone who receives an obscene communication do?
A. Above all, people are advised to remain calm & not reveal shock or fright
B. Recommended response is to say nothing and end the communication
C. In case of obscene phone calls, it might be helpful to get an unlisted phone number, obtain
caller ID and/or contact the police about threatening or repeated calls
Masochism & Sadism
I. Sacrificial paraphilias are those in which one or both partners in atone for wicked acts by
undergoing an act of penance or sacrifice
A. Penalty ranges from humiliation & hurt to blood sacrifice & death
B. Self sacrifice, masochism and partner sacrifice is sadism; either may be voluntary or forced
II. Definitions by the American Psychiatric Assn. (2005)
A. Sexual masochism - "over a period of at least 6 months, recurrent, intense sexually arousing
fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being
humiliated, beaten, bound or otherwise made to suffer"
B. Sexual sadism - "over a period of at least 6 months, recurrent, intense sexually arousing
fantasies, sexual urges or behaviors involving acts (real, not simulated) in which the
psychological or physical suffering (including humiliation of the victim) is sexually exciting
to a person"
III. Sexual masochism - sexual gratification that results from experiencing pain; might include
scratching, beating & the use of various devices
IV. Sexual sadism occurs when an individual gets sexual gratification from inflicting pain on
another person; hallmark of sadism is intentional torture of victim to sexually arouse offender
A. Sadists obviously make good partners for masochists, but sadomasochistic partner matching
is difficult to achieve because it requires that fantasies of 2 people match completely
V. Domination & degradation are important to both sadist & masochist
A. Some psychiatrists feel that sadism is an expression of anger & hostility
B. Masochism, on other hand, is sometimes thought to result from a belief that sex is dirty & evil
VI. Sadomasochism is a paraphilia that combines both sadistic & masochistic sexual behavior
A. Main characteristic is eroticizing of pain
B. What appears to outsider to be painful is experienced as somewhat painful, but mostly
pleasurable & very sexually arousing to sadomasochist
C. Sadomasochists tend to alternate between masochistic & sadistic roles
D. There is more information available on masochism & sadism that on most other paraphilias
E. Shainess (1997) said noticeable masochism symptoms include low self-esteem, chameleonlike
behavior &, most important, prevalence of linguistic forms (self-abasement & apology)
VII. Sexual masochism is more common in males, but the incidence in females is on the rise
A. Masochists often seek partners to tie up, humiliate, blindfold or hurt
B. Some sadists also require the pain or humiliation of a partner to function sexually
1. As long as it occurs with a consenting partner, sadism is not considered a psychological
disorder
VIII. Masochism can range from mild to extreme versions
A. Examples of modern versions might include bondage (being tied up for the purpose of sexual
arousal) or being spanked or overpowered by physical force
IX. Sadism can also be a consensual activity in milder forms
A. For example, it might involve role-playing with dominant & submissive roles, such as master
& slave
B. Sadism is commonly found in association with other paraphilias - particularly masochism,
fetishism, & transvestism
X. Sadism & masochism are good examples of sexual behaviors in which we need to differentiate
between fantasy & behavior
Transvestism
I. Transvestism is sometimes confused with transsexualism & homosexuality
A. Transvestite takes pleasure in wearing clothing of the other sex & is likely to achieve sexual
gratification from doing so but……
B. Transvestism also known as cross-dressing or dressing in drag
1. Some homosexual men dress in drag for fun
2. Some people with a gender identity disorder dress in clothes of other gender to try to pass
as the other gender or because they simply feel that is their proper gender
3. Transvestism is considered to be a psychological disorder only when a person meets the
following conditions; he:
II. Some transvestite's cross dress only periodically and the use of female clothes (most transvestites
are males) may approximate a fetish
III. 1032 periodic cross-dressers (transvestites) responded to an anonymous survey
A. 87% described themselves as heterosexual; all except 17% were or had been married
B. These transvestites strongly approved of both their masculine & feminine selves equally
IV. Most transvestites begin to experiment with cross-dressing when they are children or adolescents
A. Some feel guilty & uncomfortable about this preference; others do not
V. It is common for transvestism to be classified as a fetish
A. It is usually done in private, although undergarments can also be worn in public under regular
street clothes
B. Transvestites will often masturbate while wearing female clothing and/or make-up while
fondling specific items
Fetishism
I. Fetishism is a paraphilia in which an inanimate object elicits sexual arousal
A. Articles of clothing & materials made of rubber, silk, fur or leather are common fetishistic
objects
B. Amer. Psych. Assn. (2005) defines symptoms of fetishism as
1. "Over a period of at least 6 months, recurrent, intense, sexually arousing fantasies, sexual
urges or behaviors involving the use of nonliving objects
II. Fetishist may masturbate while engaging in fetishistic behavior or may just enjoy stimulation
from the objects
A. In a related paraphilia, partialism, people are aroused by a particular body part (breasts,
muscular chests, feet, etc.)
III. Generally, a person who has fetishism must have the fetish present to become sexually excited
A. It usually begins in childhood or adolescence & is most common among males
IV. Inanimate object fetishes can be categorized into 2 types: form fetishes & media fetishes
A. In form fetish
B. In media fetish
V. List of objects that fetishists can use for sexual gratification is inexhaustible, but….
A. Among the more common inanimate (form fetish) objects
B. Common media objects include leather, rubber, silk & fur
VI. In most cases, the person with a fetish is no danger to others & pursues the use of the fetish
objects in private, usually through masturbation
VII. Its causes not clearly understood –
Other Paraphilias - Bestiality
I. Bestiality (or zoophilia) is sexual contact with animals
A. In Kinsey's research (1948,1953) - ~8% males & 4% of females reported having had sexual
experiences with animals at some time
B. The frequency of bestiality was higher (17% for males) for those raised in rural areas
II. Human sexual relationships with animals have been an interesting topic for some people for
hundreds of years
A. Stories of human-animal contact are found throughout ancient folklore
B. Historically, taboos against human-animal contact have been severe
III. Sexual experience with animals is usually only a transitory experience for young people who
do not have acceptable sexual partners
A. It most likely occurs during adolescence & most people move on to more common adult
sexual relations with humans
Other Paraphilias - Frottage
I. Frottage - act of obtaining sexual pleasure from rubbing or pressing against a nonconsenting person
A. Amer. Psych. Assn. official definition is "over a period of at least 6 months, recurrent,
intense, sexually arousing fantasies, sexual urges, or behaviors involving touching & rubbing
against a nonconsenting person"
Other Paraphilias - Necrophilia
I. Necrophilia - a rather rare behavior in which a person receives sexual pleasure from viewing or
having sexual relations with a dead person
II. Sometimes necrophiliacs (almost all of whom are men) pay women to pretend to be dead in
order to provide sexual pleasure
III. Necrophiliacs are usually severely emotionally disturbed, sexually & socially inept & hate &
fear women
IV. It is interesting to note that necrophilia was depicted within the range of normal expression in
the television program, Buffy the Vampire Slayer
Other Paraphilias - Troilism
I. Troilism - having sexual relations with another person while a third person watches
A. In one respect, troilism combines elements of exhibitionism & voyeurism
B. In another respect, it represents an illusion of prostitution because there are elaborate ruses &
pretenses of prostitution
II. Troilism clearly does not qualify as a safe sexual activity
Other Paraphilias - Asphyxiophilia
I. Asphyxiophilia - desire for a state of O2 deficiency in order to enhance sexual excitement & orgasm
A. It has also been called erotic or autoerotic suicide, sexual suicide, autoerotic strangulation,
autoerotic asphyxiation, hypoxophilia & erotic accident
II. Self-induced oxygen deficiency is used to produce sexual euphoria, increased excitement or
heightened orgasm during masturbatory activities
A. Reduced supply of oxygen to brain results in giddiness, light-headedness or exhilaration that
is reported to enhance sexual climax
III. Oxygen deficiency can be induced in many ways
A. Because the circumstances & features of autoerotic deaths are not commonly known, they're
often misinterpreted as suicides or homicides
IV. Conservative estimates indicate 500 - 1000 autoerotic fatalities each year in US & that such
deaths are steadily increasing; majority of the victims are adolescents & young adults
V. There are several theories to account for life-threatening autoerotic behaviors
VI. Asphyxiophilia is really a subcategory of sexual masochism
A. Although not unheard of for it to be practiced with a partner, it is usually done as a solitary act
B. The practice is intended to produce sexual pleasure, but practitioners are well aware of the
inherent risk of the risk element
C. There are no known signs of predisposition to this behavior or the existence of the paraphilia
Other Paraphilias - Klismaphilia
I. In klismaphilia, sexual arousal is obtained from enema use
II. Klismaphiles most often prefer the receiving role, but less commonly erotic arousal may be
associated with administering an enema
A. The background of many individuals who show klismaphilia often indicates that as infants or
young children they were frequently given enemas by concerned & loving mothers
B. Since klismaphilia involves anal contact, it is not safe sex unless latex gloves are used
Other Paraphilias - Coprophilia
I. In coprophilia, sexual pleasure is associated with feces
II. People who show coprophilia reach high levels of sexual excitement by watching someone
defecate or by defecating on someone; connection with arousal may also go back to childhood
III. Because HIV can be present in any body tissues or fluids, coprophilia is not a safe sex
Other Paraphilias – Urophilia
I. In urophilia, sexual pleasure is associated with urine
A. Similarly to coprophilia, the person may want to urinate on someone or be urinated on
B. Again, as with coprophilia, there may be childhood beginnings for urophilia
II. Urophilia has been referred to as "golden showers" or "watersports"
III. Urophilia is not safe sexual activity because HIV & other STIs can be transmitted through urine
Treatment for Paraphilias - Background
I. A number of issues surface when one considers treatment for paraphilias
A. For example, people with paraphilias often do not want treatment
B. Also, they often feel they cannot control their urges, so they cannot accept personal
responsibility for their actions
II. In spite of these issues, it is appropriate to consider what might be done to help those with
paraphilia; possible treatments fall into 3 categories
Treatment for Paraphilias - Psychotherapy
I. Not much information is available about successful treatment of paraphilias by psychotherapy
II. The purpose of psychoanalysis is to discover unconscious conflicts that are believed to originate
in childhood
Treatment for Paraphilias - Behavior Therapy
I. Behavior therapy applies learning principles to help people change their behavior
II. Many techniques have been used to help change paraphilic behavior
A. In systematic desensitization, therapist tries to break the link between sexual stimulus (such
as leather for a fetishist) & the inappropriate response (sexual stimulation)
B. In aversion therapy, the undesirable behavior (such as masturbation for a voyeur) is paired
repeatedly with a negative stimulus, such as a painful (but harmless) electroshock
C. In social training, the individual is helped to improve his or her social skills
D. In orgasmic reconditioning, the goal is to increase sexual arousal by socially appropriate
stimuli
Treatment for Paraphilias - Drug Therapy
I. Though no drug can eliminate such behavior, some chemicals are at times helpful in reducing sex drive
intensity; can also help establish environment for more successful treatment using other approaches
A. For example, Prozac, which is commonly used for treating depression, has been used to help
some people reduce obsessions & compulsions
B. Also, antiandrogen drugs, chemicals that reduce the sex drive by lowering the testosterone
level in the bloodstream, can reduce sexual desire & erections in males
II. International Association for the Treatment of Sexual Offenders was founded in 1998
A. It is committed to advocate for humane, dignified, compassionate, ethical & effective
treatment of sexual offenders
Sexual Addiction
I. In 1998, President Clinton's sexual activity stirred up the debate over sexual addiction
A. The idea that some people might have very strong, or even insatiable, sexual needs has been
around a long time – nymphomania, satyriasis, Don Juanism
II. Some experts believe that sexual addiction is mainly a male abnormality caused by childhood
trauma that usually requires intense psychotherapy
A. Many others say this is nonsense because there is no such thing as too much sexual behavior,
unless it is with the wrong partner
III. Dodge et al. (2004) found that college students who are sexually compulsive are more likely to
participate in sexual behaviors that are high risk in terms of HIV/STI infection
IV. Bancroft & Vukadinovic (2004) reported that out-of-control sexual behavior seems to result
from a variety of mechanisms
V. Sexual addiction can involve a wide variety of practices
A. Sometimes an addict has trouble with just one unwanted behavior, sometimes with many
B. As in other addictions, the sexual addict experiences powerlessness over a compulsive behavior
VI. Among the writings about sexual addiction have been several books by Patrick Carnes, who
outlines 10 practical & useful indicators of compulsive sexual behavior
A. A pattern of out-of-control behavior
B. Severe consequences caused by sexual behavior
C. The inability to stop despite adverse consequences
D. Persistent pursuit of self-destructive or high-risk behavior
E. Ongoing desire or effort to limit sexual behavior, usually at a partner's insistence
F. Sexual obsession & fantasy as a primary coping strategy
G. Increasing amounts of sexual experience because the current level of activity is no longer
sufficient
H. Severe mood changes related to sexual activity
I. Inordinate amounts of time spent in obtaining sexual activity, being sexual and/or recovering
from sexual experience and
J. Neglect of important social, occupational and/or recreational activities caused by behavior
VII. The main way to identify any addictive behavior is to consider whether it is causing negative
or unwelcome problems & yet the person continues to do it anyway
VIII. In more recent years, one form of sexual addiction is cybersex addiction
A. There may be many symptoms of cybersex addiction; common symptoms are:
B. Although there is no agreement about how to deal with compulsive sex activity - if it can be done
all - organizations formed to help people deal with their activities if they feel there is problem
IX. Initial process of treatment can be divided into 3 major stages:
A. Identification of the problem
B. Behavior contracting (clearly defining specific sexual behaviors which are to be eliminated &
how this will be done) and
C. Relapse prevention (providing support, managing stress, improving relationships, working
out financial & other problems, etc.
X. Recovering addicts require external sources of social reinforcement & support for changing
lifelong patterns of behavior