Defining Abnormal Sexual Behavior

Defining Abnormal Sexual Behavior

• A statistical definition deems sexual behavior abnormal if it is rare or not widely practiced
• A sociological approach defines abnormal sexual behavior as that which violates societal norms
• A psychological approach uses discomfort, inefficiency, and bizarreness as criteria to determine abnormality

Medical vs. Continuum Approaches to Sexual Behavior

• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes 8 paraphilic disorders
• Paraphilia is an intense, persistent sexual interest beyond genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners
• The normal to abnormal continuum views sexual behavior as gradations, rather than separate categories
• A mild or even strong preference is normal, while extreme necessity is abnormal

Fetishes

• Encompass sexual fantasies, urges, or behaviors involving nonliving objects to produce or enhance arousal
• This may occur with or without a partner
• This usually occurs over a period of at least six months
• The urges, behaviors, or fantasies lead to significant distress
• Media fetish involves arousal from the material of an object.
  • Hard media fetishes involve leather or rubber
  • Soft media fetishes involve silk or fur
• Form fetish involves arousal from the object's shape

Theories Behind Fetish Development

• Learning theory suggests fetishes develop from classical conditioning, linking a fetish object with sexual arousal and orgasm
• Cognitive theory proposes fetishists have cognitive distortions, perceiving unconventional stimuli as erotic
• Addiction theory views fetishism as a pathological relationship, using a sexual event/process as a substitute for healthy relationships

Compulsive Sexual Behavior

• Characterized by intense, arousing fantasies, urges, and behaviors that are intrusive, driven, and repetitive
• It involves a lack of impulse control
• Often leads to social and legal sanctions
• Interferes with personal/occupational functioning
• Creates health risks

Sadism and Masochism

• A sexual sadist derives sexual satisfaction from inflicting pain on another person
• A sexual masochist derives sexual satisfaction from experiencing pain

Styles of Interaction:

• Bondage and discipline involves using physical or psychological restraints to enforce servitude
• Dominance and submission (D-S) involves consensual power exchange to control sexual stimulation and behavior
• Milder forms of sadomasochism (S-M) may be common
• The causes of sadomasochism are unknown
• Sadistic or masochistic fantasies are more frequent than real-life SM behavior
• Most people in BDSM prefer the submissive role
• Key to S-M is not pain, but dominance and submission
• Controlled performance and illusion of control, not actual control, is central to D-S activity

Voyeurism and Exhibitionism

• A voyeur is someone sexually aroused from secretly viewing nudes
• Voyeurism becomes paraphilic when fantasies, urges, or behaviors last 6+ months and cause significant distress/dysfunction
• Exhibitionism involves deriving sexual pleasure from exposing genitals in inappropriate situations
• The causes of exhibitionism are not fully known

Hypersexuality and Asexuality

• Hypersexuality is an excessive, insatiable sex drive where sexuality overshadows all other concerns
• Nymphomania is hypersexuality in women
• Satyriasis is hypersexuality in men
• Asexuality is the lack of sexual attraction to either sex
• Asexuality is different from both abstaining from sexual behavior and celibacy

Cybersex Use and Abuse

• Cybersex is characterized by anonymity, accessibility, and affordability
• Online Sexual Activity (OSA) includes cybersex, which involves two or more people engaging in sexual talk for pleasure
• 1% of cybersex users are considered cybersex compulsives
• Compulsives attained high compulsivity scores, were more often male, single/dating, and reported bisexuality
• They spent an average of 15-25 hours/week on cybersex
• 21% experienced jeopardized areas of life, especially personal relationships

Other Sexual Variations

• Asphyxiophilia (hypoxyphilia) involves inducing oxygen deficiency to enhance excitement and orgasm
• This activity is dangerous
• Zoophilia (bestiality) is sexual contact with an animal
• Frotteurism is the touching/rubbing one's genitals against a non-consenting person
• Troilism (triolism) is a sexual encounter where one partner watches the other engage with a third party
• Saliromania is a desire, mainly in men, to damage or soil a woman or her clothes
• Coprophilia is when feces are important to sexual satisfaction
• Urophilia is when urine is important to sexual satisfaction
• Necrophilia is sexual contact with a dead person
• Sexsomnia (sleep sex) involves automatic, unintentional sexual behaviors during sleep
• Sexsomnia is considered a sleep disorder, rather than a paraphilia

Pedophilic Disorder

• Characterized by recurrent, intense sexually arousing fantasies, urges, or behaviors involving prepubescent/young adolescents (≤ 13 years)

Prevention and Treatment of Paraphiliac Disorders

• Primary prevention is difficult
• Diagnostic categories are not always clear-cut
• Multiple diagnoses are not uncommon
• Interest in preventive programs for children has increased
• Medical treatments include hormonal and psychopharmacological interventions
  • Hormonal treatment drugs are used to reduce androgen production or block its effects
  • Psychopharmacological treatments are used to influence psychological functioning and behavior
• Cognitive-Behavioral therapies are helpful
  • Such as behavior therapy, social skills training, modification of distorted thinking
  • Relapse prevention is key
• Multisystemic Therapy (MST) is used for young sex offenders
  • MST combines family therapy, skills training, and cognitive-behavioral therapy
  • MST addresses denial of offense, minimizes access to potential victims, and promotes normative social experiences
• Skills training programs teach conversation, intimacy development, and basic sex education
• In skills training programs, sex surrogates may socially and sexually interact with the client and a therapist
• 12-step programs, based on Alcoholics Anonymous, are a common treatment
• Programs and treatments vary in effectiveness by type of offender
• Hormonal medications have shown largest effect
• Programs are more effective with voluntary participation