Sex hormones, neurotransmitters, and psychopharmacological treatments in men with paraphilic disorders

Paraphilic disorders are psychiatric syndromes primarily characterized by deviant sexual thoughts, cravings, urges, and/or behaviors. Paraphilic men may engage in inappropriate sexual behaviors when cravings for socially unacceptable sexual acts become overpowering. These often chronic disorders may not only cause emotional distress and social embarrassment to the afflicted patient but also to the targets of their paraphilic focus. The primary objective of this article is to examine and review data on the efficacy and tolerability of the testosterone-lowering agents medroxprogesterone acetate, cyproterone acetate, and leuprolide acetate. The secondary goal is to review data on less conventional and more innovative pharmacological treatments, particularly the serotonin-specific reuptake inhibitors.     

Sex Hormones,Neurotransmitters, and Psychopharmacological Treatments in Men with Paraphilic Disorders

SUMMARY

Paraphilic disorders are psychiatric syndromes primarily characterized by deviant sexual thoughts, cravings, urges, and/or behaviors. Paraphilic men may engage in inappropriate sexual behaviors when cravings for socially unacceptable sexual acts become overpowering. These often chronic disorders may not only cause emotional distress and social embarrassment to the afflicted patient but also to the targets of their paraphilic focus. The primary objective of this article is to examine and review data on the efficacy and tolerability of the testosterone-lowering agents medroxprogesterone acetate, cyproterone acetate, and leuprolide acetate. The secondary goal is to review data on less conventional and more innovative pharmacological treatments, particularly the serotonin-specific reuptake inhibitors.     

The Prevalence of Paraphilic Interests and Behaviors in the General Population: A Provincial Survey

Paraphilic sexual interests are defined as unusual or anomalous, but their actual occurrence in nonclinical samples is still unknown. This study looked at desire for and experience of paraphilic behaviors in a sample of adult men and women in the general population. A secondary goal was to compare the results of two survey modes—traditional landline telephone versus online. A total of 1,040 persons classified according to age, gender, education, ethnic background, religious beliefs, area of residency, and corresponding to the norm for the province of Quebec were interviewed. Nearly half of this sample expressed interest in at least one paraphilic category, and approximately one-third had had experience with such a practice at least once. Voyeurism, fetishism, frotteurism, and masochism interested both male and female respondents at levels above what is usually considered to be statistically unusual (15.9%). Interestingly, levels of interest in fetishism and masochism were not significantly different for men and women. Masochism was significantly linked with higher satisfaction with one’s own sexual life. As expected, the online mode generated more acknowledgment of paraphilic interest than the telephone mode. These results call into question the current definition of normal (normophilic) versus anomalous (paraphilic) sexual behaviors.     

Self-regulation and the etiology of sexual deviance: evaluating causal theory

Recently introduced theories of sex offending, including the self-regulation model and the multimodal self-regulation theory, have implicated self-regulatory deficits as a key variable in the development of sexually inappropriate interests and behaviors. While dysregulation has been considered an important component of a variety of behavioral, emotional, and interpersonal disorders, sexual behaviors have rarely been conceptualized within this context. In this study, we have examined a number of variables linked to self-regulation and dysfunctional outcomes in a sample of 95 sex-offending men. Results of a path analysis demonstrated that self-regulatory deficits were significantly predictive of paraphilic and antisocial behaviors in this group. Implications for our understanding of the etiology of sexual deviance and future research in this area are discussed.     

Mapping the boundaries of courtship disorder

The courtship disorder hypothesis maintains that voyeurism, exhibitionism, toucheurism‐frotteurism, and the preferential rape pattern are expressions of the same disorder (courtship disorder). Earlier studies had shown that with the exception of the preferential rape pattern these paraphilias co‐occur to a reasonably high degree. The present study (1) demonstrated that the preferential rape pattern co‐occurs with the above reasonably well established expressions of courtship disorder to a higher degree than other main paraphilic activity patterns do and (2) supported the conjecture that in addition to an erotic preference for unfamiliarity of target person‐or‐object (noted by earlier authors), three other paraphilic target‐person or object preferences may be connected with courtship disorder, though they are not at all virtually obligatory as is erotic unfamiliarity. These are choosing children and adults alike as target persons of the paraphilic activities, non‐gender dysphoric transvestism, and fetishism.     

An Exploration of Differences Between Small Samples of Female Sex Offenders With Prepubescent Versus Postpubescent Victims

The general consensus among researchers is that the prevalence of sexual paraphilias among female sexual offenders is low relative to male sexual offenders (Cortoni & Gannon, 2013). In addition, there is very limited information about gender specific paraphilic behaviors and characteristics pertaining to females who commit sexual assaults (Pflugradt & Allen, 2014). This study examined the characteristics of female, solo sexual offenders who sexually assaulted prepubescent (n = 14) and postpubescent (n = 15) children. A content analysis was utilized to examine their psychological characteristics. Nonparametric analysis indicated that significantly more offenders with prepubescent victims had multiple paraphilias, poor cognitive problem-solving, noncompliance with supervision, and negative social influences. Limitations and future research directions are discussed.     

The DSM-5’s Proposed New Categories of Sexual Disorder: The Problem of False Positives in Sexual Diagnosis

The proposals that have emerged from the DSM-5 revision process have triggered considerable controversy, especially regarding potential invalid inflation of diagnostic categories. To illustrate the kinds of issues that have emerged, I closely examine the proposed new categories of sexual disorder. The DSM-5 Sexual and Gender Identity Disorders Work Group is proposing the addition of three categories of disorder to the DSM-5??hypersexuality, hebephilia (as part of a revised pedophilia category that would become pedohebephilia), and coercive paraphilic disorder (basically a ??nonconsent?? or rape paraphilia). These proposals are driven by perceived clinical or forensic needs. I argue, however, that their conceptual soundness remains problematic; each could lead to large numbers of false positive diagnoses (i.e., diagnoses that mistakenly label a normal variant of behavior as a mental disorder), with potential for serious forensic abuse in ??sexually violent predator?? civil commitment proceedings.     

Sexual dysfunction: overview of prevalence,etiological factors,and treatments

Sexual dysfunctions and sexual problems are reviewed from the perspective of prevalence, broad etiological factors, and available treatments. Although a large percentage of individuals experience sexual problems, with estimates between 10 and 52% of men and 25 and 63% of women, the prevalence of sexual dysfunctions that meet diagnostic criteria is lower and less well established by large scale population-based studies. Sexual problems and dysfunctions are correlated with other health conditions, including cardiovascular disorders, common diseases such a s diabetes, health habits, and mental health. Adequate sexual functioning also appears to be associated with personal well-being and relationship stability, although this may be more accurate for men than women. Efficacious and effective treatments exist for some of the sexual disorders, and there is an increasing focus on medical (particularly pharmacological) treatments being tested by the pharmaceutical industry. Sexual problems and dysfunctions have been notably under-researched, particularly from the perspective on consequences to individual mental health, relationships, and family functioning.     

Commentary: Problems with the Sexual Disorders Sections of DSM-5

There are a number of problems with the sexual disorders sections of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. These problems must be understood in a historical context, namely the evolution of criteria for psychosexual disorders from DSM-II (1968) to DSM-5 (2013). There are many inconsistencies in the DSM-5 criteria for different sexual disorders. Given these inconsistencies—and the history of diagnostic criteria for homosexuality and gender identity disorder from DSM-II to DSM-5—it is possible that, like homosexuality, DSM-5 gender dysphoria could disappear from future editions of the manual. Even if that does not happen, there are numerous problems with the DSM-5 sexual disorders that require attention.     

What Types of Pornography Do People Use and Do They Cluster? Assessing Types and Categories of Pornography Consumption in a Large-Scale Online Sample

Previous research on exposure to different types of pornography has primarily relied on analyses of millions of search terms and histories or on user exposure patterns within a given time period rather than the self-reported frequency of consumption. Further, previous research has almost exclusively relied on theoretical or ad hoc overarching categorizations of different types of pornography, when investigating patterns of pornography exposure, rather than latent structure analyses of these exposure patterns. In contrast, using a large sample of 18- to 40-year-old heterosexual and nonheterosexual Croatian men and women, this study investigated the self-reported frequency of using 27 different types of pornography and statistically explored their latent structures. The results showed substantial differences in consumption patterns across gender and sexual orientation. However, latent structure analyses of the 27 different types of pornography assessed suggested that although several categories of consumption were gender and sexual orientation specific, common categories across the different types of pornography could be established. Based on this finding, a five-item scale was proposed to indicate the use of nonmainstream (paraphilic) pornographic content, as this type of pornography has often been targeted in previous research. To the best of our knowledge, no similar measurement tool has been proposed before.     

Mexican and Mexican American male sexual behavior & spread of AIDS in California∗

Data generated by the authors' field research on the bisexual and homosexual behaviors of men of Mexican origin living in southern California are presented and compared with the same behaviors of Anglo men in California and Mexican men in Mexico. Preferences for playing either the anal receptive or insertive sexual role and a focus on anal intercourse by unacculturated and less acculturated men of Mexican origin who have sex with men are the sexual behaviors judged to be most significantly different from Anglo men who have sex with men in California. Sexual socialization and acculturation were found to be the most important determinants of whether an individual's adult patterns of homosexual behavior will be more or less influenced by Mexican or Anglo homosexuality in spite of the length of time they may have lived in California. Evidence is presented about the effects that acculturation, preference for a sexual role in anal intercourse, and endogamy have on the spread of the AIDS virus in the Mexican origin population in California.     

Female sexual pain disorders and cognitive behavioral therapy

Female sexual pain disorders are prevalent and have a deleterious effect on women's well-being. Because there are psychological elements to this pain, cognitive-behavioral therapy (CBT) may be a viable treatment alternative, particularly when compared to more physically invasive treatments such as surgery or medication. This article provides a critical analysis of research studies in this area by evaluating each study in detail, identifying gaps in the research base, and providing directions for future study. For the most part, all of the studies reviewed in this article found CBT to be effective. However, CBT modalities with minimal therapist direction or interaction were found to be problematic. In addition, there may be other noninvasive treatment types that are equally or more effective, such as biofeedback or supportive psychotherapy.     

Female Sexual Pain Disorders and Cognitive Behavioral Therapy

Female sexual pain disorders are prevalent and have a deleterious effect on women's well-being. Because there are psychological elements to this pain, cognitive–behavioral therapy (CBT) may be a viable treatment alternative, particularly when compared to more physically invasive treatments such as surgery or medication. This article provides a critical analysis of research studies in this area by evaluating each study in detail, identifying gaps in the research base, and providing directions for future study. For the most part, all of the studies reviewed in this article found CBT to be effective. However, CBT modalities with minimal therapist direction or interaction were found to be problematic. In addition, there may be other noninvasive treatment types that are equally or more effective, such as biofeedback or supportive psychotherapy.     

THE FEDERAL INDUSTRIAL COMMITTEE OF THE A.A.S.W. Its History,Objectives and Relevance to Members.

Most authors discuss sexual deviations (often called psychosexual abnormalities or perversions*¹) under the general heading of neuroses or personality disorders. There appears to be a general consensus among psychiatrists that sexual deviations are ways in which sexual gratification is obtained, mainly or exclusively, without penile-vaginal intercourse. It is felt that the primary aims of sexuality are pleasure and reproduction and that this, at some stage, ought to include coitus between a male and female. A new definition is proposed in Part II.     

Eating Disorders and Additional Psychopathology in Women

Eating disordered individuals are often found to exhibit additional psychopathology such as depression, anxiety, substance abuse, and "borderline symptoms" such as self-injury and suicidality. This pilot study examined 535 female subjects with eating disorders to determine the relationship between such additional psychopathology and a prior history of sexual abuse. While few differences were found on general psychiatric/psychological symptoms as measured by the SCL-90-R, subjects that reported a history of sexual abuse were found to have more prior suicide attempts and hospitalizations, and more frequent self-injury and alcohol problems. These findings suggest that symptoms seen in some eating disorder patients that are frequently described as "borderline" may be indicators for a history of sexual abuse.     

Cultural issues in disclosures of child sexual abuse

Cultural norms affect the likelihood that child sexual abuse will be discovered by an adult or disclosed by a child. Cultural norms also affect whether abused children's families will report child sexual abuse to authorities. This article explores the ways ethnic and religious culture affect child sexual abuse disclosure and reporting, both in the United States and internationally. Guidelines for culturally sensitive child abuse interviewing are provided to facilitate disclosures of abuse from culturally diverse children in formal settings.     

Introduction to the Current Commentaries

ABSTRACT

Despite federal and state laws and policies aimed at preventing sexual misconduct by school employees, one in ten American students will experience sexual abuse or misconduct at the hands of a K-12 school employee. To explore why such sexual misconduct continues to occur, this study examined the effectiveness of education policies by investigating whether and how school employees understand these policies, how they are implemented, and how loopholes may undermine their intent. This qualitative case study was conducted in three Virginia school districts and included 46 semi-structured interviews with school district employees and county, state, and federal government employees associated with cases of school employee sexual misconduct, and extensive document analysis of school policies and procedures, laws, and court records. Analyses revealed an absence of policy implementation, demonstrated most seriously by a lack of awareness and understanding of policies among school employees, underreporting, and ineffective data collection. The study also identified a number of loopholes in the implementation of policies, resulting from a mismanaged intergovernmental system. The analysis suggests that understanding and implementation of policies meant to prevent sexual misconduct by school employees are fragmented; this fragmentation may be contributing to the continued prevalence of sexual misconduct by school employees.     

The Long-Term Consequences of Childhood Incestuous Victimization upon Adult Women's Psychological Symptomatology

Current estimates of the prevalence of incest suggest that 16-20% of the women in the United States may be victims of such sexual abuse by the age of 18. The long-term consequences of incestuous victimization appear lo be numerous, producing in its victims feelings of powerlessness, stigmatization, and betrayal many years after the abuse. Some of the diagnostic consequences of childhood sexual abuse include affective disorders, substance abuse, eating disorders, anxiety disorders, dissociative disorders, post-traumatic stress disorder. and sexual dvsfunction. Therefore. the vumse of the present study was to comp&e adult women who were'viciims of childhood incest to various control groups to determine whether there were differences in psychological symptomatology. The results of this study suggest that the long-term consequences of incest are numerous and varied. Adult incest survivors reported greater levels of psychological distress as well as more types of symptomatology when compared to all three control groups. Overall. the data describing the incest survivors indicated that they were significantly more dcpressed, alienated, inhibited. socially introverted, and yet interpersonally more sensitive than other groups studied.     

Gender Differences in What Is Desired in the Sexual Relationship

It has been proposed that women possess a "person centered" orientation to sexuality- the goal of sex is to express affection to another person in a committed relations. Conversely, men possess a "body centered" orientation toward sex-the goal of sex is physical gratification. These different orientations toward sex in relatidnships should lead men and women to have different desires in the sexual relationship. We hypothesized that women will desire more activities in sex that demonstrate love and intimacy, while men will desire more activities that focus on arousal aspects of the sexual activity itself (more partner initiative; more variety). Two samples were used to test the hypotheses: 189 undergraduate students and 53 newly married couples. Men and women were asked how much they desired their partner to do less or more of a variety of activities during sex. The results indicated that there were gender differences found in what was desired from the sexual relationship that were consistent with our predictions. These differences may be explained by differential socialization and/or different evolutionary pressures.