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Summary Clinical Psychology 1.6 Problem 2
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Summary for problem 2 for clinical psychology
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Problem 2 – Hooley and Butcher 17th ed. & Nolen and Hoeksema 6th ed.PARAPHILIC DISORDERS
Intense sexually arousing fantasies, sexual urges or behaviors that involve 1) abnormal targets of
sexual attraction (e.g. shoes, children), 2) unusual courtship behaviors (e.g. watching others
undress or exposing themselves), 3) the desire for pain and suffering of oneself or others.
Challenging because some paraphilias, especially pedophilia, are considered pathological even if
the person is not experiencing distress. Secondly, some paraphilias are compatible with
psychological health and happiness. E.g. some with foot fetish are comfortable with this and even
find willing partners while others feel guilt and shame.
Distinction between paraphilias and paraphilic disorders: paraphilias are unusual sexual interests
but they don’t harm the individual or others. A paraphilic disorder is a paraphilia that is currently
causing the individual distress or impairment, or entails personal harm or risk of harm to other.
Nearly all such people are male. It’s difficult to estimate the prevalence because people don’t want
to disclose such deviant behavior.
DSM-5 recognizes 8 specific paraphilias:
Fetishism, transvestic fetishism, pedophilia, voyeurism, exhibitionism, frotteurism, sexual sadism,
and sexual masochism. An additional category includes several rarer disorders such as telephone
scatologia, necrophilia (desire for corpses), zoophilia (desire for animals), apotemnophilia (desire
about having a limb amputated), and coprophilia (desire for feces).
1. Fetishistic disorder:
The individual has recurrent, intense sexual fantasies about some inanimate objects or a part of
the body not typically found erotic e.g. feet, to obtain sexual gratification. Female fetishists are
very rare. The fetishistic object is required or preferred during sexual arousal/activity. Less than
1% are diagnosed because they don’t experience distress or impairment.
Many men have fascination for paraphernalia such as bras, belts, pantyhose and high heels but
this does not meet the criteria for fetishism because they are not necessary or strongly preferred
for sexual arousal.
The mode of using these objects commonly involves masturbating while kissing, tasting and
smelling these objects. About consensual sexual relationships, some partners may object to
participating and some paraphilic men are so ashamed they can’t even bring themselves to ask
their partner.
One common cause emphasizes the importance of classical conditioning and social learning. E.g.
it’s not difficult to imagine how a women’s underwear becomes eroticized but only a small
number of men develop fetishes so there must be individual differences in conditioning of sexual
responses.
, 2. Transvestic disorder:
Heterosexual men who experience sexually arousing fantasies from cross-dressing as a female, if
they experience significant distress or impairment from this condition then it’s a disorder. Drag is
not transvestic because they don’t do it for sexual pleasure. The onset is during adolescence and
involves masturbating in female clothing.
The motivation includes autogynephilia: paraphilic sexual arousal by the thought of being a
woman. They feel attracted by not the women outside them, but by the women inside them. The
strength of autogynephilic fantasies predict gender dysphoria. Not all men show autogynephilia.
Some men show similarities to fetishism, focusing on specifics of their clothing. Transvestic
fetishism causes harm to others only when accompanied by illegal acts like theft or destruction of
property. About half the men who engage in this behavior find the behavior acceptable and thus
don’t meet the criteria for a diagnosis.
A large Swedish survey showed that 3% of men and 0.4% of women have engaged in at least one
erotic cross-dressing but the actual disorder has much lower percentages. Men who has cross-
dressed had experiences more sexual abuse before the age of 10, were more easily aroused, had a
higher frequency of masturbation, had a greater use of pornography, and had other paraphilias.
Another study reported that the vast majority of these men are heterosexual and married.
3. Pedophilia:
When an adult has intense sexual urges about sexual activity with a prepubertal child, acting on
these desires in not necessary for the diagnosis if they cause the pedophile distress.
DSM-5 indicates that a child is someone who is generally age 13 or younger. In doing so, they
rejected suggestions that pedophilia be diagnosed according to the degree of the physical
maturity of the child and to include men with hebephilia (attraction to pubescent children- in the
early stages of puberty).
Pedophiles’ sexual interaction frequently involves manual or oral contact with the child’s genitals,
penetrative sex is much rarer. Nearly all pedophiles are men and 2/3 of victims are girls between
ages 8 to 11. Child molesters are likely to engage in self-justifying cognitive distortions.
Motivationally, many pedophilic molesters appear to be shy and introverted yet still desire
dominance.
It’s first recognized in adolescence and persists over a person’s life. Many pedophiles engage in
work with children or youth so that they have access. Some pedophiles never act on their
preferences (In a study, 30% reported that have never had sexual contact with children but they
watch children pornography) but many do. Adolescent and adult men with pedophilia are much
more likely to have been sexually or physically abused as children.
Recent studies suggest that alterations in the development of brain and hormonal systems may
contribute to pedophilia. When compared, men with pedophilia are more likely to have had a
head injury before age 13, have lower IQ’s, cognitive and memory deficits, differences in brain
structure, some of which are critical for normal sexual development.
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