Paraphillic Disorders Presented By: Dr Mohsan Zafar Dept. of Psychiatry and Behavioral sciences Psychosexual disorders Learning objectives: 1. To understand what are psychosexual disorders/paraphilic disorders are, 2. Classification of psychosexual disorders, 3. Management of psychosexual disorders. Table of Contents 1. Introduction 2. Voyeuristic Disorder 3. Exhibitionistic Disorder 4. Frotteuristic Disorder 5. Sexual Masochism Disorder 6. Pedophilic Disorder 7. Fetishistic Disorder 8. Transvestic Disorder Introduction Psychosexual / Paraphilic disorders refer to a group of psychiatric conditions characterized by atypical sexual interests, fantasies, or behaviors that are considered socially unacceptable or harmful. Individuals with paraphilic disorders may experience intense and recurrent sexual urges towards 1. Non-human objects, 2. Non-consenting individuals, 3. or Activities that may cause distress to themselves or others. These patterns of sexual arousal and behavior are typically outside the norm of what society considers normal or acceptable. Voyeuristic Disorder • Derive sexual gratification or excitement from watching others without their knowledge or consent. • 12% in males and 4% in females Venus Venus has a beautiful name and is the second planet from the Sun • • • Voyeuristic Disorder: Differential Diagnosis Voyeurism: is a condition where a person gets sexually aroused by secretly watching others undressing or engaging in sexual activities without their knowledge. It becomes a disorder if they act on these urges or if it causes significant distress or problems in their daily life. Otherwise, it may not need a diagnosis. Major neurocognitive disorder, intellectual developmental disorder, personality change due to another medical condition, schizophrenia, or is in a manic episode or intoxicated with substances, they may display sexually disinhibited behavior, including voyeuristic acts. However, a diagnosis of voyeuristic disorder should only be considered if this behavior occurs separately from these conditions. In adolescents with conduct disorder and individuals with antisocial personality disorder, there may be various norm-breaking and antisocial behaviors, but the specific sexual interest in secretly watching others in compromising situations is typically not present. Exhibitionistic Disorder • • Over a period of at least 6 months, the individual has acted on these sexual urges with a nonconsenting person 2–4% in the general population. Venus Venus has a beautiful name and is the second planet from the Sun • • • Exhibitionistic Disorder: Differential Diagnosis Exhibitionism : Individuals with exhibitionism get sexually aroused by exposing their genitals to someone without their knowledge. A diagnosis of exhibitionistic disorder is only warranted if they act on these urges, such as exposing themselves in public, or if it causes significant distress or impairment in their daily life. If an individual has a major neurocognitive disorder, intellectual developmental disorder, personality change due to another medical condition, schizophrenia, or is in a manic episode or intoxicated with substances, they may display sexually disinhibited behavior, including exhibitionistic acts. However, a diagnosis of exhibitionistic disorder should only be considered if this behavior occurs separately from these conditions. Conduct disorder in adolescents and antisocial personality disorder involve normbreaking and antisocial behaviors, but the specific sexual interest in exposing genitals is typically not present. Frotteuristic Disorder • Sexual arousal from touching or rubbing against a nonconsenting person • • • For a period of at least 6 months Generally in crowded places Usually in Ages 15-25 Venus Venus has a beautiful name and is the second planet from the Sun • • • Frotteuristic Disorder: Differential Diagnosis Frotteurism : Individuals with frotteurism get sexually aroused from touching or rubbing against a non-consenting person. A diagnosis of Frotteuristic disorder is only warranted if they act on these urges, such as touching others without consent, or if it causes significant distress or impairment in their daily life. If an individual has a major neurocognitive disorder, intellectual developmental disorder, personality change due to another medical condition, schizophrenia, or is in a manic episode or intoxicated with substances, they may display sexually disinhibited behavior, including engaging in Frotteuristic acts. However, a diagnosis of Frotteuristic disorder should only be considered if this behavior occurs separately from these conditions. Adolescents with conduct disorder and individuals with antisocial personality disorder may show norm-breaking and antisocial behaviors, but the specific sexual interest in touching or rubbing against a non-consenting person is usually not present in these disorders. Sexual Masochism Disorder • Over a period of at least 6 months, sexual arousal from being humiliated, beaten, bound, or made to suffer Venus Venus has a beautiful name and is the second planet from the Sun Sexual Masochism Disorder: Differential Diagnosis • Sexual masochism : Individuals with sexual masochism get sexually aroused from being humiliated, beaten, bound, or made to suffer. A diagnosis of sexual masochism disorder is only warranted if these sexual urges or behaviors cause significant distress or impair their daily life. Sexual Sadism Disorder • Over a period of at least 6 months, recurrent • Sexual arousal from the physical or psychological suffering of another person Venus Venus has a beautiful name and is the second planet from the Sun Sexual Sadism Disorder: Differential Diagnosis • • Sexual sadism : Individuals with sexual sadism get sexually aroused from causing physical or psychological suffering to others. A diagnosis of sexual sadism disorder is only warranted if these urges are acted upon with a non-consenting person or cause significant distress or impairment in their daily life. It's important to note that not all individuals with sadistic or masochistic interests experience distress related to their sexual preferences. These behaviors can also be seen in the context of conduct disorder and antisocial personality disorder, especially when they involve the infliction of suffering during sex crimes. If individuals commit rape or sexual assaults and inflict pain on their victims, it should not be automatically classified as sexual sadism disorder. To diagnose sexual sadism disorder, there should be evidence that the individual derives pleasure from causing pain and suffering to the victim, such as admitting arousal from the pain, a preference for sadistic-themed pornography, or excessive use of violence beyond what is necessary for the assault. The key is to look for a clear pattern of pleasure derived from causing pain during sexual acts, not just pain caused during the act of assault itself. • Sexual Sadism Disorder: Differential Diagnosis Individuals with conduct disorder and antisocial personality disorder may display cruel behavior towards others and force them into sexual activity. However, for a diagnosis of sexual sadism disorder, there must be evidence of an underlying pattern of sexual arousal from causing physical or psychological suffering to another person. Coercive or sadistic sexual behaviors occurring in the context of conduct disorder or antisocial personality disorder, without evidence of sexual arousal from the suffering, should not be used to diagnose sexual sadism disorder. If both sexual sadism disorder and conduct disorder/antisocial personality disorder criteria are met, both disorders may be diagnosed. Pedophilic Disorder • • • Over a period of at least 6 months Sexual attraction towards prepubescent children. Individual is at least 16 years old and at least 5 years older • than the child involved. 1% to 5% in the male population Venus Venus has a beautiful name and is the second planet from the Sun Pedophilic Disorder: Differential Diagnosis • • • Individuals with pedophilia have intense sexual fantasies or urges involving prepubescent children. A diagnosis of pedophilic disorder is only warranted if they have acted on these urges or if they cause significant distress or difficulties in their relationships. Individuals with antisocial personality disorder may sexually abuse children due to increased access. To diagnose pedophilic disorder, there must also be evidence of recurrent, intense, sexually arousing fantasies, urges, or behaviors involving prepubescent children over at least 6 months. OCD: Occasionally, some individuals express distressing and ego-dystonic thoughts about being attracted to children. However, upon clinical evaluation, there is no positive emotional connection to these thoughts, no link to actual sexual behavior (like masturbating to these thoughts), and sometimes additional distressing sexual thoughts, such as concerns about homosexuality. Transvestic Disorder • Over a period of at least 6 months, sexual arousal from cross-dressing. • Specify if: • With fetishism: If sexually aroused by fabrics, materials, or • garments. With autogynephilic: If sexually aroused by thoughts or images of self as a woman. Venus Venus has a beautiful name and is the second planet from the Sun • • • Transvestic Disorder : Differential Diagnosis Individuals with transvestism get sexually aroused from cross-dressing. A diagnosis of transvestic disorder is only warranted if these fantasies, urges, or behaviors cause significant distress or impair their daily life. This disorder may be similar to transvestic disorder, especially in men with fetishism who wear women's undergarments while masturbating with them. To distinguish transvestic disorder, specific thoughts during such activities need to be considered, like ideas of being a woman or dressing as one, and the presence of other fetishes involving soft, silky fabrics, whether used for garments or something else. Individuals with transvestic disorder do not feel incongruence between their experienced gender and their assigned gender, nor do they desire to be of the other gender. They also typically do not have a history of childhood cross-gender behaviors, which would be present in individuals with gender dysphoria. If someone meets the criteria for both transvestic disorder and gender dysphoria, they should be diagnosed with both conditions. ● Fetishistic Disorder Recurrent/intense sexual arousal from either the use of nonliving objects or a strong focus on specific body parts, other than the genitals , persist 6 months. ● Can be specified based on the specific body parts or nonliving objects involved Venus Venus has a beautiful name and is the second planet from the Sun Fetishistic Disorder: • • • Differential Diagnosis The closest diagnostic neighbor of fetishistic disorder is transvestic disorder. Fetishistic disorder is not diagnosed when the fetish objects are limited to clothes exclusively worn during cross-dressing or when the object is genitally stimulating, like a vibrator. Fetishistic disorder can co-occur with other paraphilic disorders, such as sadomasochistic behavior or transvestic disorder. If an individual is primarily sexually aroused by "forced cross-dressing" and experiences distress or impairment due to the domination or humiliation associated with the fantasy or behavior, the diagnosis of sexual masochism disorder should be considered. If someone uses a fetish object for sexual arousal without experiencing distress or impairment in their life, they would not meet the criteria for fetishistic disorder. For instance, an individual who enjoys caressing, smelling, or licking feet or toes as part of consensual sexual activities with their partner would not be diagnosed with fetishistic disorder. Similarly, someone who engages in solitary sexual behavior involving wearing rubber garments or leather boots without distress or impairment would not be diagnosed with the disorder. Etiology 1. Neurobiological factors: Research suggests that individuals with paraphilic disorders may have differences in brain structure and function, particularly in regions associated with sexual arousal and impulse control. Imbalances in neurotransmitters and hormonal changes may also contribute to the development of paraphilic interests (Viljoen & Kruger, 2016). 2. Genetic factors: While specific genes for paraphilic disorders have not been identified, there is evidence indicating a genetic predisposition to sexual behaviors and preferences. Genetic studies have shown that genetics may play a role in the development of paraphilic interests (Seto, 2017). 3. Early developmental influences: Childhood experiences, such as trauma, abuse, or neglect, may contribute to the development of paraphilic interests. Early exposure to sexual content or inappropriate sexual experiences can shape an individual's sexual preferences later in life (Greenberg, Bradford, & Curry, 1995). Etiology 1. Learning and conditioning: Classical and operant conditioning can play a role in the development of paraphilic interests. Associations between sexual arousal and specific stimuli or situations can be established through learning, leading to the development of paraphilic fantasies or behaviors (Stoller, 2008). 2. Social and cultural factors: Family dynamics, social norms, and cultural beliefs about sexuality can also influence the expression and development of paraphilic interests. 3. Co-occurring psychiatric disorders: Paraphilic disorders often co-occur with other psychiatric conditions, such as mood disorders, anxiety disorders, or personality disorders. These comorbidities may interact and contribute to the manifestation of paraphilic behaviors (Kafka, 2010). Thank You!
