Atypical Sexuality

This lesson contrasts **harmless sexual variations** with clinically significant **paraphilic disorders**, using DSM-5 criteria. While some paraphilias involve non-normative desires that are victimless, others cause **distress**, **impairment**, or **harm to others**, and are therefore classified as disorders.

• Paraphilia: Persistent, intense sexual interest in non-normative targets or situations (e.g., objects, non-consenting people).
• Paraphilic Disorder: A paraphilia that causes significant distress, dysfunction, or involves harm to others (APA, 2013).
• DSM-5 Categories: Fetishism, Transvestic Fetishism, Sadism, Masochism, Voyeurism, Exhibitionism, Frotteurism, Pedophilia, plus Paraphilia NOS.

• Fetishism: Sexual arousal from objects/materials (e.g., rubber, leather) or body parts (e.g., feet):contentReference[oaicite:0]{index=0}.
• Transvestic Fetishism: Sexual arousal from cross-dressing, almost exclusively in heterosexual men; distinguished from drag or transgender identity.
• Sadism & Masochism: Sexual pleasure from inflicting (sadism) or receiving (masochism) pain, often grouped as BDSM:contentReference[oaicite:1]{index=1}.
• Voyeurism: Watching unsuspecting people undress or engage in sex.
• Exhibitionism: Exposing genitals to strangers, often includes masturbation.
• Frotteurism: Touching or rubbing against strangers in public places.
• Pedophilia: Sexual attraction to prepubescent children (often male offenders, persistent from adolescence):contentReference[oaicite:2]{index=2}.

• Telephone Scatologia: Obscene phone calls
• Necrophilia: Sexual arousal from corpses
• Zoophilia: Preference for animals
• Partialism: Focused on body parts
• Coprophilia & Urophilia: Feces and urine-related arousal

• Classical & Instrumental Conditioning: Nonsexual stimuli paired with sexual arousal can lead to fetish development.
• Social Learning: Observational modeling of sexual behavior (e.g., abuse survivors).
• Biological Theories: Some studies show **brain structure differences** (Schiffer et al., 2007; Poeppl et al., 2013).
• Cycle of Abuse: **Nunes et al. (2013)** found that many pedophiles were themselves sexually abused as children, though most abused children do not become abusers.

Most individuals with paraphilias don’t seek treatment unless legally mandated. Treatments focus on behavior modification and reducing harm or recidivism.

• Aversion Therapy: Pairing arousal with noxious stimuli (e.g., electric shock).
• Covert Sensitization: Imagined aversive outcomes replace physical stimuli.
• Cognitive Therapy: Challenges distorted thinking patterns (e.g., pedophiles believing children benefit from sex).
• Relapse Prevention: Building coping skills to avoid risky situations.

• Chemical Castration: Anti-androgen drugs (e.g., Depo-Provera) lower libido.
• Surgical Castration: Rare but results in lowest recidivism (Weinberger et al., 2005).

• High Risk: Offenders with deviant preferences (esp. pedophiles) are more likely to reoffend.
• Age Effect: Rapist recidivism decreases with age, but child molesters remain high risk until after 50.

A paraphilic disorder diagnosis requires that the paraphilia:

• Causes personal distress or functional impairment, or
• Involves harm or risk of harm to others (e.g., nonconsensual acts).