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Is there a criterion to distinct between a philia and a paraphilia?

Is there a criterion to distinct between a philia and a paraphilia?



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The terms "Androphilia" and "Gynephilia" describe the two majorromantic and/or sexual orientation/sof humans → towards "masculine" humans and "feminine" humans, respectively.

Generally any human (including Asexuals which only lack the desire to have sex but not the romantic connection desire) will likely be classified by some in society as a "heterosexual", "homosexual" or "bisexual", according to that person'sromantic and/or sexual orientation/sand in the context of gender.

  • One can say that attractions to FTM transgenders and attraction to MTF transgenders are separate major philias "Andromimetophilia" and "Gynemimetophilia"(as somewhat accurate yet probably bad terms).

  • One could speak of a third and forth philias (or fifth and sixth philias, depending how one counts) to Male-oriented intersex individuals and Female-oriented intersex individuals.

  • One could go to the extreme and speak about philias to FTM and MTF detransitioned people.

My problem

Any of the above philias can have one or more paraphilias, which can be not harmful or does harmful but it is unclear to me if there is a criterion to distinct between a philia and a paraphilia.

Non harmful examples

  • A man with gynephilia (heterosexual) can have a paraphilia such as for women in army uniform and on the contrary, a man with androphilia (homosexual) can have a paraphilia for men in army uniform.

  • A man with gynephilia (heterosexual) can have a paraphilia for women with Gothic appearance and on contrary, a man with androphilia (homosexual) can have a paraphilia for men with Gothic appearance.

Harmful examples

  • The first harmful example is pedophiliac paraphilia:
    A man with gynephilia (heterosexual) can have a paraphilia for little girls (say under sexual maturation) and on the contrary, a man with androphilia (homosexual) can have a paraphilia for little boys (say, under sexual maturation).

  • Another harmful example is zoophilia which includes exploitation of animals who cannot give consent and might be raped.

Both pedophilia (not to be confused with hebephilia which is attraction to young teenagers) as well as zoophilia, are rare paraphilias that may manifest themselves in harmful or illegal behavior.

Interim note

As I have shown, the "philia" term can describe both sexual orientations and their sub components (not harmful and is harmful).

My question

Is there a criterion to distinct between a philia and a paraphilia?

This question encapsulates the question:

  • Does the term Philia exists in psychological literature for describingromantic and/or sexual orientation/sand not just fetishes, or alternatively, as a standalone term?

As far as I am aware, there is no such word in the English language as Philia, but it is a suffix within words.

Also, the suffix of -philia in a word does not necessarily denote anything sexual.

The -philia suffix denotes one of the following (Merriam-Webster, n.d.):

  1. friendly feeling toward
    (as in Francophilia)
  2. tendency toward
    (as in hemophilia)
  3. abnormal appetite or liking for
    (as in necrophilia)

The term paraphilia

denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners (APA, 2013 p.685).

So a man or woman in uniform will not be a paraphilia. For more on paraphilias see McManus, et al. (2013).

On the subject of -philias, there is one point you made which is not entirely accurate. You said

Both pedophilia and zoophilia are rare harmful paraphilias that require hospitalization, therapy, surveillance and generally also chemical castration.

I am not sure on zoophilia, but:

  • paedophilia and hebephilia is extremely common and therefore not rare (Gerwinn et al., 2018).

    Contrary to public perception, child sex offending (CSO) and paedophilia are not the same. Only half of all cases of CSO are motivated by paedophilic preference, and a paedophilic preference does not necessarily lead to CSO. However, studies that investigated clinical factors accompanying and contributing to paedophilia so far mainly relied on paedophiles with a history of CSO.

  • Estimates on the prevalence of paedophile CSO are wide ranging, and more accurate with better reporting, but they include:

    • 12.7% (Stoltenborgh, M. et al., 2011)
    • 24.7% (Oluwatosin, & Akinbo, 2017) and
    • 27% girls and 16% boys (Finkelhor et al., 1990)
    • 60% girls (McConaghy, 1998).
  • there are hebephiles and paedophiles who do not act out on their desires, and there are helplines such as Stop It Now! for those who are worried they may act out, so therefore
  • these sexual tendencies do not necessarily need hospitalization, therapy, surveillance and chemical castration.

Chemical castration is an idea put forward to deal with pedophilia, and even made mandatory in states such as Alabama (LegiScan, 2019). However, there is no strong scientific evidence to back the idea that this helps to stop pedophilia or hebephilia, and many criminologists argue that police investigators treating castrated men as less likely to reoffend than non-castrated men may cause an investigation bias and self-fulfilling prophecy (Horne & Lovaglia, 2008; Sismondo & Greene, 2015; Fridell, 2016).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Gerwinn, H., Weiß, S., Tenbergen, G., Amelung, T., Födisch, C., Pohl, A.,… & Wittfoth, M. (2018). Clinical characteristics associated with paedophilia and child sex offending-Differentiating sexual preference from offence status. European Psychiatry, 51, 74-85. doi: 10.1016/j.eurpsy.2018.02.002

Horne, Christine; Lovaglia, Michael J. (2008). Experiments in criminology and law: a research revolution. Rowman & Littlefield. ISBN 978-0-7425-6027-7

Finkelhor, D., Hotaling, G., Lewis, I. A., & Smith, C. (1990). Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors. Child abuse & neglect, 14(1), 19. doi: 10.1016/0145-2134(90)90077-7

Fridell, Lorie A. (2016). Producing Bias-Free Policing: A Science-Based Approach. Springer. ISBN 978-3-319-33175-1

LegiScan. (2019). Alabama House Bill 379. In LegiScan API Retrieved from: https://legiscan.com/AL/bill/HB379/2019

McConaghy, N. (1998). Paedophilia: a review of the evidence. Australian and New Zealand Journal of Psychiatry, 32(2), 252-265. doi: 10.3109/00048679809062736

McManus, M. A., Hargreaves, P., & Lee Rainbow, L. J. A. (2013). Paraphilias: definition, diagnosis and treatment. F1000prime reports, 5. doi: 10.12703/P5-36 pmcid: PMC3769077

Merriam-Webster. (n.d.). -philia. In Merriam-Webster.com dictionary. Retrieved from: https://www.merriam-webster.com/dictionary/-philia

Oluwatosin, S. A., & Akinbo, O. T. (2017). Prevalence and Public Perception on Causes of Paedophilia in Osun State Nigeria. Advances in Social Sciences Research Journal, 4(24). doi: 10.14738/assrj.424.3847

Sismondo, Sergio; Greene, Jeremy A. (2015). The Pharmaceutical Studies Reader. John Wiley & Sons. ISBN 978-1-118-89654-9

Stoltenborgh, M., van Ijzendoorn, M.H., Euser, E.M., & Bakermans-Kranenburg, M.J. (2011) A global perspective on child sexual abuse: meta-analysis of prevalence around the world. Child Maltreat, 16(2), 79-101, doi: 10.1177/1077559511403920


Diagnosing Paraphilic Disorders in Nonforthcoming Individuals

Perhaps the clearest indication that some of the changes in the paraphilic disorders section of DSM-5 were guided by forensic concerns is the various additions to the text addressing the challenge of applying the diagnostic criteria to individuals who are not forthcoming about the presence or impact of sexual pathology. Individuals, particularly in forensic settings, are motivated to deny or minimize deviant sexual urges or behaviors to avoid the negative forensic and social consequences of paraphilic disorder diagnoses. The DSM-IV-TR text was largely silent about the use of the paraphilic disorder diagnoses in forensic settings, noting only that “individuals who act out with a non-consenting partner in a way that may be injurious to the partner may be subject to arrest and incarceration” (Ref. 12, p 566).

In contrast, DSM-5 contains numerous additions to the descriptive text for paraphilic disorders intended to provide guidance to evaluators in forensic contexts. Specifically, the texts for the voyeuristic, exhibitionistic, frotteuristic, sexual sadism, and pedophilic disorders were written using the same template and include similar statements regarding their application to nondisclosing individuals. For example, the first sentence in the Diagnostic Features section for all of these disorders states: “The diagnostic criteria for [X] disorder are intended to apply both to individuals who more or less freely disclose this paraphilic interest and to those who categorically deny any sexual arousal from [X] despite substantial objective evidence to the contrary” (e.g., Ref. 1, p 687). Each Diagnostic Features section also includes a paragraph describing the various ways that nondisclosing individuals may present, followed by the comment that “despite their non-disclosing position, such individuals may be diagnosed with [a paraphilic disorder]” (e.g., Ref. 1, p 692). Each paragraph ends with the explicit statement that a history of recurrent paraphilic behavior is sufficient to meet criterion A: for example, “Recurrent frotteuristic behavior constitutes satisfactory support for frotteurism (by fulfilling Criterion A)” (Ref. 1, p 692). As discussed above, statements such as these that suggest that recurrent sexually offending behavior alone is sufficient to ascertain the presence of a paraphilia are in conflict with the evidence ( 20,22 ) that a substantial proportion of sex offenses are not a manifestation of a paraphilic arousal pattern.

Moreover, such statements appear to run counter to the change in the Criterion A wording intended to clarify that the behaviors must be a manifestation of a paraphilic sexual arousal pattern. However, much depends on whether one interprets phrases such as frotteuristic behavior to mean implicitly that the modifier frotteuristic requires the behavior to be a manifestation of a frotteuristic arousal pattern or whether it is simply descriptive of the type of behavior (i.e., rubbing against an unsuspecting individual). It is too soon to tell to what extent this subtle difference in interpretation will be used in forensic evaluations to argue for or against the necessity of establishing that the behavior is a manifestation of a paraphilic arousal pattern.

Voyeuristic, exhibitionistic, frotteuristic, and sexual sadism disorders each include additional text indicating that the construct of “recurrent” behaviors can be interpreted as “having acted on the sexual urges with three or more victims on separate occasions” (Ref. 1, p 687) or with fewer victims if there are multiple occasions of acting on the paraphilic urges with the same unwilling individual. Victim count requirements were originally part of the proposed diagnostic criteria sets for these paraphilic disorders (as well as for pedophilic disorder), but were ultimately rejected from inclusion in the criteria sets 25 because of the lack of broad clinical consensus. Moreover, the proposal to include victim count requirements in the diagnostic criteria was derived entirely from a single study 26 that examined the diagnostic sensitivity of phallometric testing for pedophilia. Given that this study did not include any subjects with the four DSM-5 paraphilic disorders that actually include this victim count threshold in their descriptive texts, the validity of these thresholds should be considered questionable and raise concerns regarding both false-positive and false-negative diagnoses. Curiously, although the text for pedophilic disorder also notes that the “presence of multiple victims … is sufficient but not necessary for diagnosis” (Ref. 1, p 698), it avoids offering a specific victim count.


Causes of gerontophilia at the paraphilia level

Although relationships between people of different ages do not necessarily imply the presence of gerontophilia, in cases where a paraphilia is being discussed, the question may arise as to what makes this fixation with the elderly appear . In this sense, there are multiple explanations that can be found. It should be noted that we are talking about paraphilia, not about falling in love with someone who happens to be that age.

One of them tells us about the presence of an insecure, dependent or needy personality that would see in being old a stimulus that has traditionally been associated with wisdom, experience, protection and warmth. This view of old age may cause some people to develop a certain sexual desire for these characteristics, which makes them feel safe.

It may also arise in the context of people who feel unable to relate successfully to people their age (something that also occurs in some cases of paedophilia).

Another possibility arises from conditioning: it is possible that in a situation of sexual excitement the image or some type of stimulus related to old age may have appeared by chance, which may have subsequently been positively reinforced (for example through masturbation).

Related to this, cases have also been observed in which the existence of this type of attraction is derived from traumatic experiences , such as sexual abuse in childhood, in which the sexual act with people much older than the subject himself has somehow been normalized. Sexual excitement has been associated with the difference in age or with old age, generally acquiring a certain compulsive tinge towards the elderly.

Another possible reason can be found in the fragility of the elderly or the fact that they have someone to care for them: the elderly are generally people in poor health, who may need help and may be somewhat dependent. Some people may find it sexually stimulating to be necessary and help the elderly .

The opposite pole would be found in the search for relationships of domination-submission: an old man can be more fragile than his partner, something that puts the gerontophiliac in a position of certain superiority at the level of physical power. In this case, special caution should be taken with regard to the possibility of an attempt to abuse the old person in question , as there may be a vexatious component that seeks to subject the old person .


Types

The sensory regions for the feet and genitals lie next to each other, as shown in this cortical homunculus.

In a review of 48 cases of clinical fetishism in 1983, fetishes included clothing (58.3%), rubber and rubber items (22.9%), footwear (14.6%), body parts (14.6%), leather (10.4%), and soft materials or fabrics (6.3%). A 2007 study counted members of Internet discussion groups with the word fetish in their name. Of the groups about body parts or features, 47% belonged to groups about feet (podophilia), 9% about body fluids (including urophilia, scatophilia, lactaphilia, menophilia, mucophilia), 9% about body size, 7% about hair (hair fetish), and 5% about muscles (muscle worship). Less popular groups focused on navels (navel fetishism), legs, body hair, mouth, and nails, among other things. Of the groups about clothing, 33% belonged to groups about clothes worn on the legs or buttocks (such as stockings or skirts), 32% about footwear (shoe fetishism), 12% about underwear (underwear fetishism), and 9% about whole-body wear such as jackets. Less popular object groups focused on headwear, stethoscopes, wristwear, pacifiers, and diapers (diaper fetishism).

Erotic asphyxiation is the use of choking to increase the pleasure in sex. The fetish also includes an individualized part that involves choking oneself during the act of masturbation, which is known as auto-erotic asphyxiation. This usually involves a person being connected and strangled by a homemade device that is tight enough to give them pleasure but not tight enough to suffocate them to death. This is dangerous due to the issue of hyperactive pleasure seeking which can result in strangulation when there is no one to help if the device gets too tight and strangles the user.

Devotism involves being attracted to body modifications on another person that are the result of amputation. Devotism is only a sexual fetish when the person who has the fetish considers the amputated body part on another person the object of sexual interest.

Under the DSM-5, fetishism is sexual arousal from nonliving objects or specific nongenital body parts, excluding clothes used for cross-dressing (as that falls under transvestic disorder) and sex toys that are designed for genital stimulation. Fetishism usually becomes evident during puberty, and may develop prior to that. No single cause for fetishism has been conclusively established.

DSM-V Diagnostic Criteria for Fetishistic Disorder

  • A. Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on non genital body part(s), as manifested by fantasies, urges, or behaviors.
  • B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • C. The fetish objects are not limited to articles of clothing used in cross-dressing (as in transvestic disorder) or devices specifically designed for the purpose of tactile genital stimulation (e.g., vibrator).
  • In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in fetishistic behaviors are restricted.
  • In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment.

Transvestic Disorder

Excessive sexual or erotic interest in cross-dressing

Transvestism is the practice of cross-dressing, which is the act of wearing items of clothing and other accoutrements commonly associated with the opposite sex within a particular society. The term cross-dressing refers to an action or a behavior, without attributing or implying any specific causes or motives for that behavior. Cross-dressing is not synonymous with being transgender. A transvestic fetishist is a person who cross-dresses as part of a sexual fetish. According to the fourth edition of Diagnostic and Statistical Manual of Mental Disorders, this fetishism was limited to heterosexual men however, DSM-5 does not have this restriction, and opens it to women and men, regardless of their sexual orientation.

There are two key criteria before a psychiatric diagnosis of “transvestic fetishism” is made:

  1. Recurrent, intense sexually arousing fantasies, urges, or behaviour, involving cross-dressing.
  2. This causes clinically significant distress or impairment, whether socially, at work, or elsewhere.

Thus, transvestic fetishism is not considered a mental illness unless it causes significant problems for the person concerned, however many people who are diagnosed with transvestic fetishism are against their fetish being described as an illness.

Transvestic fetishism, fetishistic transvestism and sometimes transvestism are also often used to describe any sexual behavior or arousal that is in any way triggered by the clothes of the other gender. Especially the latter is problematic, because transvestism and cross-dressing are neither a sexual fetish, nor do they necessarily have anything to do with sexual behavior or arousal.

Also, not every sexual behavior where clothes of the opposite gender are involved is transvestic fetishism, they are also often used in sexual roleplay without being a fetish. Also, many transgendered people, mostly transwomen, also cross-dress before coming out in sexual contexts to relieve their cross-gender feelings. This behavior is likewise not considered transvestic fetishism, as it is not cross-dressing for sexual pleasure, rather it is simply their self-gender expression.

Some male transvestic fetishists collect women’s clothing, e.g. nightgowns, babydolls, slips, and other types of nightwear, lingerie stockings and pantyhose, items of a distinct feminine look and feel. They may dress in these feminine garments and take photographs of themselves while living out their secret fantasies. Many men love the feeling of wearing silk or nylon and adore the silky fabric of women’s nightwear, lingerie and nylons.

Most transvestic fetishists are said to be heterosexual men, although there are no studies that accurately represent either their sexual orientation or gender, and most information on this is based on anecdotal evidence or informal surveys.

A small number of people with transvestic fetishism, as the years pass, want to dress and live permanently as women, and desire surgical or hormonal sex reassignment. In such cases the diagnosis should be changed to transsexualism (or gender dysphoria).

DSM-V Diagnostic Criteria for Transvestic Disorder

  • A. Over a period of at least 6 months, recurrent and intense sexual arousal from cross dressing, as manifested by fantasies, urges, or behaviors.
  • B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • With fetishism: If sexually aroused by fabrics, materials, or garments.
  • With autogynephiiia: If sexually aroused by thoughts or images of self as female.
  • In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to cross-dress are restricted.
  • In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment.

Pedophilia and IQ: more research needed

James Cantor is a psychologist who has popularized the notion that pedophiles have low IQ. I will show that this is based on a single study, not supported by other research, and should not be considered a settled matter.

The 2004 study

The foundation of Dr. Cantor’s claim is Cantor et al. (2004). Dr. Cantor and colleagues analyzed an expanded version of the same sample (p. 290) in Blanchard et al. (2007). These studies are generally high quality, but have never been reproduced. A substantial portion of primary research is known to be false, even when there are no obvious flaws in the methodology (Ioannidis, 2005). Only 64.6% of published independent replication attempts in psychology confirm the original results (Makel et al., 2012), and this is likely overestimated by the file-drawer effect. For this reason, it’s critical that findings be independently reproduced, especially in a field with as many variables as psychology.

The major problem with this study, in my view, is that it used a non-equivalent control group. The pedophiles were largely child molesters there were some child pornography users in the sample, but they had higher IQ (Blanchard et al., 2007, p. 297). The closest possible comparison group would be non-pedophilic child molesters. Instead, Dr. Cantor used general sexology patients as controls, specifically excluding ones with offenses against children. His concern was that some child molesters who measure as non-pedophilic during phallometry might simply be suppressing their arousal. However, phallometry can reliably distinguish groups of pedophiles from non-pedophiles (Blanchard et al., 2001), so even if there were a few pedophiles hidden in the control group, it would not be enough to conceal any group difference in IQ.

The 2005 meta-analysis

In addition to the 2004 study, Dr. Cantor cites his later meta-analysis, Cantor et al. (2005), to support the IQ association. The problem is that this meta-analysis did not actually compare pedophiles to non-pedophiles. Instead, it examined three proxy variables that are known to associate with pedophilia in child molesters: victim age, victim gender, and victim relationship. Compared to non-pedophilic child molesters, pedophilic molesters are more likely to have younger victims, male victims, and extrafamilial victims. Consequently, if pedophiles have low IQ, one would expect child molesters with young, male, or extrafamilial victims to have low IQ. The single best indicator of pedophilia in child molesters is having a male victim Seto & Lalumière (2001) found it was twice as reliable as victim age based on a sample of over 1000 offenders (p. 20).

Dr. Cantor’s meta-analysis found that offenders with younger victims had lower IQ, but there was no correlation between IQ and victim gender or relationship (p. 561). Two of three proxy variables, including the most important, gender, did not support his hypothesis. Contary to Dr. Cantor, I interpret this as strong evidence against his hypothesis, since there are other obvious explanations for the relationship between IQ and victim age (e.g., younger victims are easier targets for low-functioning molesters).

Contradicting research

A number of studies have found that pedophiles have normal IQ. These studies differ from Cantor et al. (2004) in that they include non-pedophilic child molesters as controls, and some exclude subjects with mental retardation from both groups. Although these findings put Dr. Cantor’s claim in question, the sample sizes are too small to settle the matter. I should also point out that both Dr. Cantor’s study (Cantor et al., 2004, p. 5) and the studies below did not administer full IQ tests they estimated IQ using simpler tests. These simpler tests are likely sufficient to detect group differences.

  • Eastvold et al. (2011): “PEDs [pedophilic child molesters] had a higher IQ than NSOs [nonsexual criminal offenders] (p = .014), and there was a trend for NPEDs [non-pedophilic child molesters] to have a higher IQ than NSOs (p = .051). PEDs also had better SK [semantic knowledge] than NSOs (p = .035).”
  • Schiffer & Vonlaufen (2011): “no significant difference in intelligence quotient (IQ) levels between all groups”. Pedophilic child molesters: 108.5 Non-pedophilic child molesters: 107.5 Forensic controls: 103.2 Healthy controls: 110.2
  • Suchy et al. (2009): No significant differences. Pedophilic child molesters: 106.59 Non-pedophilic child molesters: 102.05 Community controls: 105.62
  • Strassberg et al. (2012): This study used two samples. Sample one: “The 3 groups (PEDs, N-PEDs, CNTs) did not differ on […] estimated IQ (M = 104.6, SD = 8.1, range, 84–121)”. Sample two: “There was a significant difference among the groups on estimated IQ the criminal controls scored significantly lower in IQ (M = 96.92, SD = 9.94) than either the pedophilic child molesters (M = 105.89, SD = 11.32) or nonpedophilic child molesters (M = 104.46, SD = 12.57). The 2 child molester groups did not differ significantly on estimated IQ.”

I am not alone in believing that these findings undermine the relationship between pedophilia and IQ. Eastvold et al. (2011) write,

“Importantly, this study sample was remarkably similar to our previous sample (Suchy et al., 2009a, 2009b). In both samples, IQs and semantic knowledge (SK) were average, with PEDs’ IQ and SK being slightly (nonsignificantly) higher than those of NPEDs, in the context of approximately 13 years of education for both groups. The IQ and SK of child molesters in the present study were slightly higher than those of NSOs. This appears to contradict published reports documenting positive correlations between IQs and victim age (Blanchard et al., 2007 Cantor et al., 2004 Cantor, Blanchard, et al., 2005). However, such findings may be misleading and can likely be explained by the heterogeneity of study samples and inclusion of individuals with mental retardation. The only other reported comparison between pedophilic and nonpedophilic child molesters (Blanchard et al., 2007) found no IQ differences, consistent with our findings. Further examination of phallometrically defined non-mentally retarded pedophilic and nonpedophilic child molesters would likely continue to dispute relationships between pedophilia and lower IQs.”

The bottom line

There is not enough evidence to make any conclusion about the IQ of pedophiles. One study supports a connection, but several others do not, including, in my opinion, Dr. Cantor’s own meta-analysis. Of course, Dr. Cantor’s thesis is plausible, and we can’t reject the possibility just because it’s unpleasant. The important thing to keep in mind is that, even if the association exists, it’s only the center of a bell curve. It says nothing about the intelligence of any given pedophile. Even if some pedophiles have lower IQ, many do not. Unfortunately, Dr. Cantor never emphasizes this to the media. He must know that the public always misinterprets this sort of statistic. When he explains the association between height, handedness and pedophilia, he often adds that it doesn’t mean short, left-handed people are pedophiles. Why doesn’t he give pedophiles the same consideration?


Is there a criterion to distinct between a philia and a paraphilia? - Psychology

"What is the total number of behaviors in a week that culminate in orgasm?" (Maxmen & Ward, 1995, p. 325), Kinsey referred to this as the individual's "total sexual outlet" Maxmen and Ward note that only 5% of men have an outlet of 7 or greater, while the majority of men with paraphilic disorder have persistent hypersexual desire and tie or exceed this number.

"What are the different ways that you become aroused to the point of orgasm?" (Maxmen & Ward, 1995, p. 325), eliciting an honest answer to this question will reveal paraphilias and related behavior (promiscuity, dependence on pornography, and compulsive masturbation). Morrison (1995) discusses interviewing on sensitive topics, including a client's sexual life.

Paraphilia [para: "beyond" or "along side of" philia: "love"]: sexual deviations

Ford, C.S. & Beach, F.A. (1951). Patterns of Sexual Behavior. New York: Harper.

"sexual disorders characterized by persistent and intense fantasies or desires, usually for nonhuman objects for sexual activities involving pain, domination or submission or for nonconsenting partners, such as young children." (Weiner & Rosen, 1999, p. 421)

"a paraphilia is the involuntary and repeated need for unusual or bizarre imagery, acts, or objects to induce sexual excitement." (Maxmen & Ward, 1995, p. 324)

Weiner and Rosen suggest that it is: "the repetitive and persistent character of the sexual fantasies or urges" which uniquely define paraphilias (p. 421) they note that these disturbances are sometimes referred to as disorders of sexual compulsivity or impulsivity.

Paraphilias usually interfere with interpersonal relationships "or normal pair bonding" to some degree (Weiner & Rosen, 1999, p. 421) "The essential disorder is in the lack of capacity for mature and participating affectionate sexual behavior with adult partners." (Meyer & Seitsch, 1996, p. 154)

A distinction may be made between "victimless" paraphilias and those involving victimization of a nonconsenting partner this validity of distinction has been questioned

legally paraphilias are usually prosecuted as "sex crimes", adjudicated offenders are referred to as "sex offenders", and there may be reporting requirements for both clients and therapists significantly different than those which usually exist for mental health cases

Although DSM-IV bases subclassification of paraphilia on the stimulus/activities found to be sexually arousing, some research suggests many paraphilic individuals engage in multiple forms of deviant sexual behavior: Abel, Becker, Cunningham-Rathner, Mittelman, & Rouleau (1988) reported that less than 10% of their patients had a single paraphilia, approximately 20% had two paraphilic diagnoses, 32% had three or four diagnoses, and 38% had engaged in five or more concomitant paraphilic behaviors other investigators have reported high rates of multiple paraphilias (see Weiner & Rosen, 1999)

Individuals with paraphilias do not usually seek treatment or disclose information voluntarily the reported prevalence data is viewed by everyone as a small fraction of the actual level of behavior

Most paraphilias are predominantly male disorders, the age of onset is often prior to age 18, and individuals often report high frequencies of behavior over time

Exhibitionism

as with all paraphilias, prevalence figures are highly suspect but appears to be a common sexual offense

not all cases are harmless

prevalence may decline past 40 years of age, possibly associated with the general reduction of impulsiveness reported with advancing age

almost exclusively male clinical population, onset usually prior to age 18, approximately 1/3 never married and high reported rates of unsatisfactory interpersonal relationships in samples

"scopophilia" or "scoptophilia"

"An essential feature is the lack of awareness in the victim being observed, in contrast to consensual forms of voyeurism, such as occurs in sex clubs and X-rated movies." (Weiner & Rosen, 1999, p. 425)

Fetishism

"partial fetishism" refers to using the fetish object for stimulating arousal

"complete fetishism" requires use of the fetish object to achieve orgasm

"Partialism" is a fetish behavior involving intense erotic attraction to specific parts of the body, to the exclusion of sexual interest in the partner or the partner's body as a whole [Paraphilia NOS in DSM-IV]

usually begins in adolescence and may decline after age 25 (Abel & Osborn, 1992)

autoerotic asphyxiation

28% of subscribers to sadomasochistic magazines found to be female (Breslow, Evans, Langley, 1985)

cross dressing for sexual arousal, may be associated with either masturbatory or heterosexual activity

not diagnosed when cross dressing occurs exclusively during a gender identity disorder

not diagnosed when motivation for cross dressing is not sexual in nature

heterosexual males may cross dress without arousal

homosexual males may cross dress for entertainment purposes

homosexual males may cross dress to attract heterosexual clients

coprophilia: smearing feces
klismaphilia: self-administering enemas
mysophilia: lying in filth
partialism: exclusive focus on parts of the body
zoophilis: sexual activity with animals
necrophilia: having sex with a corpse
telephone scatologia: making lewd telephone calls
urophilia: urinating on others or being urinated on

a focus of erotic attraction or interest upon prepubescent children

Pedophilia does not follow a single pattern (Finkelhor & Arraign, 1986 see also Weiner & Rosen, 1999 )

homosexual/heterosexual

incestuous/nonincestuous

penetrative/nonpenitrative sex

sadistic physical harm/incidental physical harm

some cases of sexual abuse of children by adult females have been reported

Child Sexual Abuse (not exactly the mirror image of pedophilia)

The prevalence of child sexual abuse is unknown, in 2000 child sexual abuse comprised approximately 10% of the officially reported child abuse cases and approximately 88,000 substantiated or indicated cases were found (Putman, 2003). Only about half of victims found in community surveys had disclosed to anyone (Putman, 2003).

Females are at higher risk for child sexual abuse (2.5 to 3 times greater risk than boys) males account for 22-29% of victims (Putman, 2003) risk rises with age, physical disabilities, absence of a parent. A step-father in the home doubles the risk for girls. Socioeconomic status, race, and ethnicity have not been found to be significant risk factors (but may relate to likelihood of reporting and symptom expression). Intergenerational transmission of child sexual abuse appears less than that seen for physical abuse. (Putman, 2003)

A number of child and adult psychiatric disorder have been associated with childhood sexual abuse, including depression, sexualized behavior, neurobiological sequelae (Putman, 2003)

"As a group, individuals with histories of CSA, irrespective of their psychiatric diagnosis, manifest significant problems with affect regulation, impulse control, somatization, sense of self, cognitive distortions, and problems with socialization. Many of these processes are believed to have developmentally sensitive neuronal and behavioral periods related to brain maturation and early caretaker interactions" (Putman, 2003, p. 273)

Pelcovitz et al. (1997) recommended a proposed diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS)

"(1) altered affect regulation such as persistent dysphoria, chronic suicidal preoccupation, and explosive or inhibited anger (2) transient alterations of consciousness, such as flashbacks and dissociative episodes (3) altered self-perceptions including helplessness, shame, guilt, and self-blame (4) altered relationships with others, such as persistent distrust, withdrawal, failures of self-protection, and rescuer fantasies (5) altered systems of meanings, including loss of sustaining faith, hopelessness, and despair and (6) somatization (Herman, 1992)."

Not all sexually abused children have emotional and behavioral sequelae, up to 40% present with no symptoms (Putman, 2003), 10% to 20% of these may deteriorate over the next 12 to 18 months. Long term deterioration ("sleeper effect") is poorly understood and not well predicted by family-environmental and abuse-related variables (Putman, 2003)


Filias y parafilias: definition, types and characteristics

Although the term "filia" has a very broad meaning and can refer to any type of hobby, in Psychology we use it especially in the field of sexuality. When the philias are very marked and atypical we speak of paraphilia .

In this article we will describe the characteristics of the most common or striking types of philia and paraphilias . To contextualize these categories it is important to previously define the concepts of philia and paraphilia.


What Behaviors Are Considered Paraphilias?

Exhibitionism ("Flashing")
Exhibitionism involves someone exposing their genitals to an unsuspecting stranger. The individual with this problem, sometimes called a "flasher," feels a need to surprise, shock, or impress their victims. The condition is usually limited to the exposure with no other harmful advances being made. Nevertheless, "indecent exposure" is illegal. Actual sexual contact with the victim is rare. However, the person may masturbate while exposing themselves or while fantasizing about exposing themselves.

Continued

Fetishism
People with fetishes have sexual urges associated with non-living objects. The person becomes sexually aroused by wearing or touching the object. For example, the object of a fetish could be an article of clothing, such as underwear, rubber clothing, women's shoes, women's underwear, or lingerie. The fetish may replace sexual activity with a partner or may be integrated into sexual activity with a willing partner. When the fetish becomes the sole object of sexual desire, sexual relationships often are avoided. A related disorder, called partialism, involves becoming sexually aroused by a body part, such as the feet, breasts, or buttocks.

Frotteurism
With this problem, the focus of the person's sexual urges is on touching or rubbing their genitals against the body of a non-consenting, unfamiliar person. In most cases of frotteurism, males rub their genital area against a female, often in a crowded public location. The contact made with the other person is illegal.

Pedophilia
People with pedophilia have fantasies, urges, or behaviors that involve illegal sexual activity with a child or children. The children involved are generally 13 years of age or younger. The behavior includes undressing the child, encouraging the child to watch the abuser masturbate, touching or fondling the child's genitals, and forcefully performing sexual acts on the child.

Continued

Some pedophiles, known as exclusive pedophiles, are sexually attracted only to children and are not attracted to adults. Some limit their activity to incest, involving only their own children or close relatives. Others victimize other children. Predatory pedophiles may use force or threaten their victims with what will happen if they disclose the abuse. Health care providers are legally bound to report such abuse of minors.

Pedophile activity constitutes rape and is a felony offense punishable by imprisonment.

Sexual Masochism
Individuals with this disorder use the act -- real, not simulated -- of being humiliated, beaten, or otherwise made to suffer in order to achieve sexual excitement and climax. These acts may be limited to verbal humiliation, or they may involve being beaten, bound, or otherwise abused. Masochists may act out their fantasies on themselves by such acts as cutting or piercing their skin or burning themselves. Or they may seek out a partner who enjoys inflicting pain or humiliation on others. Activities with a partner include bondage, spanking, and simulated rape.

Continued

Sadomasochistic fantasies and activities are not uncommon among consenting adults. In most of these cases, however, the humiliation and abuse are acted out in fantasy. The participants are aware that the behavior is a "game" and actual pain and injury is avoided.

A potentially dangerous, sometimes fatal, masochistic activity is autoerotic partial asphyxiation. With this activity, a person uses ropes, nooses, or plastic bags to induce a state of asphyxia (interruption of breathing) at the point of orgasm. This is done to enhance orgasm, but accidental deaths sometimes occur.

Sexual Sadism
Individuals with this disorder have persistent fantasies in which sexual excitement results from inflicting psychological or physical suffering (including humiliation and terror) on a sexual partner. This disorder is different from minor acts of aggression in normal sexual activity -- for example, rough sex. In some cases, sexual sadists are able to find willing partners to participate in the sadistic activities.

At its most extreme, sexual sadism involves illegal activities such as rape, torture, and even murder, in which case the death of the victim produces sexual excitement. It should be noted that while rape may be an expression of sexual sadism, the infliction of suffering is not the motive for most rapists, and the victim's pain generally does not increase the rapist's sexual excitement. Rather, rape involves a combination of sex and gaining power over the victim. These individuals need intensive psychiatric treatment and may be jailed for these activities.

Continued

Transvestitism
Transvestitism, or transvestic fetishism, refers to the practice by heterosexual males of dressing in female clothes to produce or enhance sexual arousal. The sexual arousal usually does not involve a real partner but includes the fantasy that the individual is the female partner as well. Some men wear only one special piece of female clothing, such as underwear, while others fully dress as female, including hair style and make-up. Cross-dressing as a transvestite is not a problem unless it is necessary for the individual to become sexually aroused or experience sexual climax.

Voyeurism ("Peeping Tom")
This disorder involves achieving sexual arousal by observing an unsuspecting and non-consenting person who is undressing or unclothed or engaged in sexual activity. This behavior may conclude with masturbation by the voyeur. The voyeur does not seek sexual contact with the person they are observing. Other names for this behavior are "peeping" or "peeping Tom."


Paraphilia Diagnosis

The DSM-IV, or The Diagnostic and Statistical Manual of mental disorders, sets the standards for diagnosis of paraphilia as having to meet/demonstrate the following criteria:

  • “Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving 1) nonhuman objects, 2) the suffering or humiliation of oneself or one’s partner, or 3) children or other non-consenting persons, that occur over a period of at least 6 months.”
  • “The behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

Eight types of paraphilic disorders have been itemized in the DSM-IV, but in real life situations, those who are exhibiting one paraphilia most often exhibit an inclination for other paraphilic behaviors as well. An example of this lies in the reports given by individuals that have been incarcerated for pedophilia. Often there have been reports suggesting that while they have engaged in pedophilia, they are primarily attracted by other deviant behaviors and types of paraphilia such as voyeurism or exhibitionism. According to The University of Texas, presence of paraphilic behavior may signify a principal sexual impulsivity disorder that is characterized by sexual compulsivity and hypersexuality, and in some cases, sexual aggression.


The most common paraphilias

Voyeurism is one of the most common sexual fixations out there. It’s the excitement derived from watching a person, without their knowledge, who’s naked or having sex. Exhibitionism is another common philia, it’s a sexual tension only resolved by showing the genitals to an unsuspecting person.

Frotteurism is another common sexual fixation. It’s the feeling of excitement when rubbing one’s genitals against another person without their consent. Masochism and sexual sadism are part of it, which are about finding pleasure in the pain and suffering of oneself or another. In addition, fetishism may be one of the most commonly known paraphilias. This is the excitement towards inanimate objects or body parts other than the genitals the feet, for example.

Keep in mind that paraphilias don’t involve harm to self or others, they don’t generate discomfort, and don’t exceed the limits of consent and agreement between those who practice them paraphilic disorders do.


The most common paraphilias

Voyeurism is one of the most common sexual fixations out there. It’s the excitement derived from watching a person, without their knowledge, who’s naked or having sex. Exhibitionism is another common philia, it’s a sexual tension only resolved by showing the genitals to an unsuspecting person.

Frotteurism is another common sexual fixation. It’s the feeling of excitement when rubbing one’s genitals against another person without their consent. Masochism and sexual sadism are part of it, which are about finding pleasure in the pain and suffering of oneself or another. In addition, fetishism may be one of the most commonly known paraphilias. This is the excitement towards inanimate objects or body parts other than the genitals the feet, for example.

Keep in mind that paraphilias don’t involve harm to self or others, they don’t generate discomfort, and don’t exceed the limits of consent and agreement between those who practice them paraphilic disorders do.


Filias y parafilias: definition, types and characteristics

Although the term "filia" has a very broad meaning and can refer to any type of hobby, in Psychology we use it especially in the field of sexuality. When the philias are very marked and atypical we speak of paraphilia .

In this article we will describe the characteristics of the most common or striking types of philia and paraphilias . To contextualize these categories it is important to previously define the concepts of philia and paraphilia.


What Behaviors Are Considered Paraphilias?

Exhibitionism ("Flashing")
Exhibitionism involves someone exposing their genitals to an unsuspecting stranger. The individual with this problem, sometimes called a "flasher," feels a need to surprise, shock, or impress their victims. The condition is usually limited to the exposure with no other harmful advances being made. Nevertheless, "indecent exposure" is illegal. Actual sexual contact with the victim is rare. However, the person may masturbate while exposing themselves or while fantasizing about exposing themselves.

Continued

Fetishism
People with fetishes have sexual urges associated with non-living objects. The person becomes sexually aroused by wearing or touching the object. For example, the object of a fetish could be an article of clothing, such as underwear, rubber clothing, women's shoes, women's underwear, or lingerie. The fetish may replace sexual activity with a partner or may be integrated into sexual activity with a willing partner. When the fetish becomes the sole object of sexual desire, sexual relationships often are avoided. A related disorder, called partialism, involves becoming sexually aroused by a body part, such as the feet, breasts, or buttocks.

Frotteurism
With this problem, the focus of the person's sexual urges is on touching or rubbing their genitals against the body of a non-consenting, unfamiliar person. In most cases of frotteurism, males rub their genital area against a female, often in a crowded public location. The contact made with the other person is illegal.

Pedophilia
People with pedophilia have fantasies, urges, or behaviors that involve illegal sexual activity with a child or children. The children involved are generally 13 years of age or younger. The behavior includes undressing the child, encouraging the child to watch the abuser masturbate, touching or fondling the child's genitals, and forcefully performing sexual acts on the child.

Continued

Some pedophiles, known as exclusive pedophiles, are sexually attracted only to children and are not attracted to adults. Some limit their activity to incest, involving only their own children or close relatives. Others victimize other children. Predatory pedophiles may use force or threaten their victims with what will happen if they disclose the abuse. Health care providers are legally bound to report such abuse of minors.

Pedophile activity constitutes rape and is a felony offense punishable by imprisonment.

Sexual Masochism
Individuals with this disorder use the act -- real, not simulated -- of being humiliated, beaten, or otherwise made to suffer in order to achieve sexual excitement and climax. These acts may be limited to verbal humiliation, or they may involve being beaten, bound, or otherwise abused. Masochists may act out their fantasies on themselves by such acts as cutting or piercing their skin or burning themselves. Or they may seek out a partner who enjoys inflicting pain or humiliation on others. Activities with a partner include bondage, spanking, and simulated rape.

Continued

Sadomasochistic fantasies and activities are not uncommon among consenting adults. In most of these cases, however, the humiliation and abuse are acted out in fantasy. The participants are aware that the behavior is a "game" and actual pain and injury is avoided.

A potentially dangerous, sometimes fatal, masochistic activity is autoerotic partial asphyxiation. With this activity, a person uses ropes, nooses, or plastic bags to induce a state of asphyxia (interruption of breathing) at the point of orgasm. This is done to enhance orgasm, but accidental deaths sometimes occur.

Sexual Sadism
Individuals with this disorder have persistent fantasies in which sexual excitement results from inflicting psychological or physical suffering (including humiliation and terror) on a sexual partner. This disorder is different from minor acts of aggression in normal sexual activity -- for example, rough sex. In some cases, sexual sadists are able to find willing partners to participate in the sadistic activities.

At its most extreme, sexual sadism involves illegal activities such as rape, torture, and even murder, in which case the death of the victim produces sexual excitement. It should be noted that while rape may be an expression of sexual sadism, the infliction of suffering is not the motive for most rapists, and the victim's pain generally does not increase the rapist's sexual excitement. Rather, rape involves a combination of sex and gaining power over the victim. These individuals need intensive psychiatric treatment and may be jailed for these activities.

Continued

Transvestitism
Transvestitism, or transvestic fetishism, refers to the practice by heterosexual males of dressing in female clothes to produce or enhance sexual arousal. The sexual arousal usually does not involve a real partner but includes the fantasy that the individual is the female partner as well. Some men wear only one special piece of female clothing, such as underwear, while others fully dress as female, including hair style and make-up. Cross-dressing as a transvestite is not a problem unless it is necessary for the individual to become sexually aroused or experience sexual climax.

Voyeurism ("Peeping Tom")
This disorder involves achieving sexual arousal by observing an unsuspecting and non-consenting person who is undressing or unclothed or engaged in sexual activity. This behavior may conclude with masturbation by the voyeur. The voyeur does not seek sexual contact with the person they are observing. Other names for this behavior are "peeping" or "peeping Tom."


Is there a criterion to distinct between a philia and a paraphilia? - Psychology

"What is the total number of behaviors in a week that culminate in orgasm?" (Maxmen & Ward, 1995, p. 325), Kinsey referred to this as the individual's "total sexual outlet" Maxmen and Ward note that only 5% of men have an outlet of 7 or greater, while the majority of men with paraphilic disorder have persistent hypersexual desire and tie or exceed this number.

"What are the different ways that you become aroused to the point of orgasm?" (Maxmen & Ward, 1995, p. 325), eliciting an honest answer to this question will reveal paraphilias and related behavior (promiscuity, dependence on pornography, and compulsive masturbation). Morrison (1995) discusses interviewing on sensitive topics, including a client's sexual life.

Paraphilia [para: "beyond" or "along side of" philia: "love"]: sexual deviations

Ford, C.S. & Beach, F.A. (1951). Patterns of Sexual Behavior. New York: Harper.

"sexual disorders characterized by persistent and intense fantasies or desires, usually for nonhuman objects for sexual activities involving pain, domination or submission or for nonconsenting partners, such as young children." (Weiner & Rosen, 1999, p. 421)

"a paraphilia is the involuntary and repeated need for unusual or bizarre imagery, acts, or objects to induce sexual excitement." (Maxmen & Ward, 1995, p. 324)

Weiner and Rosen suggest that it is: "the repetitive and persistent character of the sexual fantasies or urges" which uniquely define paraphilias (p. 421) they note that these disturbances are sometimes referred to as disorders of sexual compulsivity or impulsivity.

Paraphilias usually interfere with interpersonal relationships "or normal pair bonding" to some degree (Weiner & Rosen, 1999, p. 421) "The essential disorder is in the lack of capacity for mature and participating affectionate sexual behavior with adult partners." (Meyer & Seitsch, 1996, p. 154)

A distinction may be made between "victimless" paraphilias and those involving victimization of a nonconsenting partner this validity of distinction has been questioned

legally paraphilias are usually prosecuted as "sex crimes", adjudicated offenders are referred to as "sex offenders", and there may be reporting requirements for both clients and therapists significantly different than those which usually exist for mental health cases

Although DSM-IV bases subclassification of paraphilia on the stimulus/activities found to be sexually arousing, some research suggests many paraphilic individuals engage in multiple forms of deviant sexual behavior: Abel, Becker, Cunningham-Rathner, Mittelman, & Rouleau (1988) reported that less than 10% of their patients had a single paraphilia, approximately 20% had two paraphilic diagnoses, 32% had three or four diagnoses, and 38% had engaged in five or more concomitant paraphilic behaviors other investigators have reported high rates of multiple paraphilias (see Weiner & Rosen, 1999)

Individuals with paraphilias do not usually seek treatment or disclose information voluntarily the reported prevalence data is viewed by everyone as a small fraction of the actual level of behavior

Most paraphilias are predominantly male disorders, the age of onset is often prior to age 18, and individuals often report high frequencies of behavior over time

Exhibitionism

as with all paraphilias, prevalence figures are highly suspect but appears to be a common sexual offense

not all cases are harmless

prevalence may decline past 40 years of age, possibly associated with the general reduction of impulsiveness reported with advancing age

almost exclusively male clinical population, onset usually prior to age 18, approximately 1/3 never married and high reported rates of unsatisfactory interpersonal relationships in samples

"scopophilia" or "scoptophilia"

"An essential feature is the lack of awareness in the victim being observed, in contrast to consensual forms of voyeurism, such as occurs in sex clubs and X-rated movies." (Weiner & Rosen, 1999, p. 425)

Fetishism

"partial fetishism" refers to using the fetish object for stimulating arousal

"complete fetishism" requires use of the fetish object to achieve orgasm

"Partialism" is a fetish behavior involving intense erotic attraction to specific parts of the body, to the exclusion of sexual interest in the partner or the partner's body as a whole [Paraphilia NOS in DSM-IV]

usually begins in adolescence and may decline after age 25 (Abel & Osborn, 1992)

autoerotic asphyxiation

28% of subscribers to sadomasochistic magazines found to be female (Breslow, Evans, Langley, 1985)

cross dressing for sexual arousal, may be associated with either masturbatory or heterosexual activity

not diagnosed when cross dressing occurs exclusively during a gender identity disorder

not diagnosed when motivation for cross dressing is not sexual in nature

heterosexual males may cross dress without arousal

homosexual males may cross dress for entertainment purposes

homosexual males may cross dress to attract heterosexual clients

coprophilia: smearing feces
klismaphilia: self-administering enemas
mysophilia: lying in filth
partialism: exclusive focus on parts of the body
zoophilis: sexual activity with animals
necrophilia: having sex with a corpse
telephone scatologia: making lewd telephone calls
urophilia: urinating on others or being urinated on

a focus of erotic attraction or interest upon prepubescent children

Pedophilia does not follow a single pattern (Finkelhor & Arraign, 1986 see also Weiner & Rosen, 1999 )

homosexual/heterosexual

incestuous/nonincestuous

penetrative/nonpenitrative sex

sadistic physical harm/incidental physical harm

some cases of sexual abuse of children by adult females have been reported

Child Sexual Abuse (not exactly the mirror image of pedophilia)

The prevalence of child sexual abuse is unknown, in 2000 child sexual abuse comprised approximately 10% of the officially reported child abuse cases and approximately 88,000 substantiated or indicated cases were found (Putman, 2003). Only about half of victims found in community surveys had disclosed to anyone (Putman, 2003).

Females are at higher risk for child sexual abuse (2.5 to 3 times greater risk than boys) males account for 22-29% of victims (Putman, 2003) risk rises with age, physical disabilities, absence of a parent. A step-father in the home doubles the risk for girls. Socioeconomic status, race, and ethnicity have not been found to be significant risk factors (but may relate to likelihood of reporting and symptom expression). Intergenerational transmission of child sexual abuse appears less than that seen for physical abuse. (Putman, 2003)

A number of child and adult psychiatric disorder have been associated with childhood sexual abuse, including depression, sexualized behavior, neurobiological sequelae (Putman, 2003)

"As a group, individuals with histories of CSA, irrespective of their psychiatric diagnosis, manifest significant problems with affect regulation, impulse control, somatization, sense of self, cognitive distortions, and problems with socialization. Many of these processes are believed to have developmentally sensitive neuronal and behavioral periods related to brain maturation and early caretaker interactions" (Putman, 2003, p. 273)

Pelcovitz et al. (1997) recommended a proposed diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS)

"(1) altered affect regulation such as persistent dysphoria, chronic suicidal preoccupation, and explosive or inhibited anger (2) transient alterations of consciousness, such as flashbacks and dissociative episodes (3) altered self-perceptions including helplessness, shame, guilt, and self-blame (4) altered relationships with others, such as persistent distrust, withdrawal, failures of self-protection, and rescuer fantasies (5) altered systems of meanings, including loss of sustaining faith, hopelessness, and despair and (6) somatization (Herman, 1992)."

Not all sexually abused children have emotional and behavioral sequelae, up to 40% present with no symptoms (Putman, 2003), 10% to 20% of these may deteriorate over the next 12 to 18 months. Long term deterioration ("sleeper effect") is poorly understood and not well predicted by family-environmental and abuse-related variables (Putman, 2003)


Types

The sensory regions for the feet and genitals lie next to each other, as shown in this cortical homunculus.

In a review of 48 cases of clinical fetishism in 1983, fetishes included clothing (58.3%), rubber and rubber items (22.9%), footwear (14.6%), body parts (14.6%), leather (10.4%), and soft materials or fabrics (6.3%). A 2007 study counted members of Internet discussion groups with the word fetish in their name. Of the groups about body parts or features, 47% belonged to groups about feet (podophilia), 9% about body fluids (including urophilia, scatophilia, lactaphilia, menophilia, mucophilia), 9% about body size, 7% about hair (hair fetish), and 5% about muscles (muscle worship). Less popular groups focused on navels (navel fetishism), legs, body hair, mouth, and nails, among other things. Of the groups about clothing, 33% belonged to groups about clothes worn on the legs or buttocks (such as stockings or skirts), 32% about footwear (shoe fetishism), 12% about underwear (underwear fetishism), and 9% about whole-body wear such as jackets. Less popular object groups focused on headwear, stethoscopes, wristwear, pacifiers, and diapers (diaper fetishism).

Erotic asphyxiation is the use of choking to increase the pleasure in sex. The fetish also includes an individualized part that involves choking oneself during the act of masturbation, which is known as auto-erotic asphyxiation. This usually involves a person being connected and strangled by a homemade device that is tight enough to give them pleasure but not tight enough to suffocate them to death. This is dangerous due to the issue of hyperactive pleasure seeking which can result in strangulation when there is no one to help if the device gets too tight and strangles the user.

Devotism involves being attracted to body modifications on another person that are the result of amputation. Devotism is only a sexual fetish when the person who has the fetish considers the amputated body part on another person the object of sexual interest.

Under the DSM-5, fetishism is sexual arousal from nonliving objects or specific nongenital body parts, excluding clothes used for cross-dressing (as that falls under transvestic disorder) and sex toys that are designed for genital stimulation. Fetishism usually becomes evident during puberty, and may develop prior to that. No single cause for fetishism has been conclusively established.

DSM-V Diagnostic Criteria for Fetishistic Disorder

  • A. Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on non genital body part(s), as manifested by fantasies, urges, or behaviors.
  • B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • C. The fetish objects are not limited to articles of clothing used in cross-dressing (as in transvestic disorder) or devices specifically designed for the purpose of tactile genital stimulation (e.g., vibrator).
  • In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in fetishistic behaviors are restricted.
  • In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment.

Transvestic Disorder

Excessive sexual or erotic interest in cross-dressing

Transvestism is the practice of cross-dressing, which is the act of wearing items of clothing and other accoutrements commonly associated with the opposite sex within a particular society. The term cross-dressing refers to an action or a behavior, without attributing or implying any specific causes or motives for that behavior. Cross-dressing is not synonymous with being transgender. A transvestic fetishist is a person who cross-dresses as part of a sexual fetish. According to the fourth edition of Diagnostic and Statistical Manual of Mental Disorders, this fetishism was limited to heterosexual men however, DSM-5 does not have this restriction, and opens it to women and men, regardless of their sexual orientation.

There are two key criteria before a psychiatric diagnosis of “transvestic fetishism” is made:

  1. Recurrent, intense sexually arousing fantasies, urges, or behaviour, involving cross-dressing.
  2. This causes clinically significant distress or impairment, whether socially, at work, or elsewhere.

Thus, transvestic fetishism is not considered a mental illness unless it causes significant problems for the person concerned, however many people who are diagnosed with transvestic fetishism are against their fetish being described as an illness.

Transvestic fetishism, fetishistic transvestism and sometimes transvestism are also often used to describe any sexual behavior or arousal that is in any way triggered by the clothes of the other gender. Especially the latter is problematic, because transvestism and cross-dressing are neither a sexual fetish, nor do they necessarily have anything to do with sexual behavior or arousal.

Also, not every sexual behavior where clothes of the opposite gender are involved is transvestic fetishism, they are also often used in sexual roleplay without being a fetish. Also, many transgendered people, mostly transwomen, also cross-dress before coming out in sexual contexts to relieve their cross-gender feelings. This behavior is likewise not considered transvestic fetishism, as it is not cross-dressing for sexual pleasure, rather it is simply their self-gender expression.

Some male transvestic fetishists collect women’s clothing, e.g. nightgowns, babydolls, slips, and other types of nightwear, lingerie stockings and pantyhose, items of a distinct feminine look and feel. They may dress in these feminine garments and take photographs of themselves while living out their secret fantasies. Many men love the feeling of wearing silk or nylon and adore the silky fabric of women’s nightwear, lingerie and nylons.

Most transvestic fetishists are said to be heterosexual men, although there are no studies that accurately represent either their sexual orientation or gender, and most information on this is based on anecdotal evidence or informal surveys.

A small number of people with transvestic fetishism, as the years pass, want to dress and live permanently as women, and desire surgical or hormonal sex reassignment. In such cases the diagnosis should be changed to transsexualism (or gender dysphoria).

DSM-V Diagnostic Criteria for Transvestic Disorder

  • A. Over a period of at least 6 months, recurrent and intense sexual arousal from cross dressing, as manifested by fantasies, urges, or behaviors.
  • B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • With fetishism: If sexually aroused by fabrics, materials, or garments.
  • With autogynephiiia: If sexually aroused by thoughts or images of self as female.
  • In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to cross-dress are restricted.
  • In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment.

Pedophilia and IQ: more research needed

James Cantor is a psychologist who has popularized the notion that pedophiles have low IQ. I will show that this is based on a single study, not supported by other research, and should not be considered a settled matter.

The 2004 study

The foundation of Dr. Cantor’s claim is Cantor et al. (2004). Dr. Cantor and colleagues analyzed an expanded version of the same sample (p. 290) in Blanchard et al. (2007). These studies are generally high quality, but have never been reproduced. A substantial portion of primary research is known to be false, even when there are no obvious flaws in the methodology (Ioannidis, 2005). Only 64.6% of published independent replication attempts in psychology confirm the original results (Makel et al., 2012), and this is likely overestimated by the file-drawer effect. For this reason, it’s critical that findings be independently reproduced, especially in a field with as many variables as psychology.

The major problem with this study, in my view, is that it used a non-equivalent control group. The pedophiles were largely child molesters there were some child pornography users in the sample, but they had higher IQ (Blanchard et al., 2007, p. 297). The closest possible comparison group would be non-pedophilic child molesters. Instead, Dr. Cantor used general sexology patients as controls, specifically excluding ones with offenses against children. His concern was that some child molesters who measure as non-pedophilic during phallometry might simply be suppressing their arousal. However, phallometry can reliably distinguish groups of pedophiles from non-pedophiles (Blanchard et al., 2001), so even if there were a few pedophiles hidden in the control group, it would not be enough to conceal any group difference in IQ.

The 2005 meta-analysis

In addition to the 2004 study, Dr. Cantor cites his later meta-analysis, Cantor et al. (2005), to support the IQ association. The problem is that this meta-analysis did not actually compare pedophiles to non-pedophiles. Instead, it examined three proxy variables that are known to associate with pedophilia in child molesters: victim age, victim gender, and victim relationship. Compared to non-pedophilic child molesters, pedophilic molesters are more likely to have younger victims, male victims, and extrafamilial victims. Consequently, if pedophiles have low IQ, one would expect child molesters with young, male, or extrafamilial victims to have low IQ. The single best indicator of pedophilia in child molesters is having a male victim Seto & Lalumière (2001) found it was twice as reliable as victim age based on a sample of over 1000 offenders (p. 20).

Dr. Cantor’s meta-analysis found that offenders with younger victims had lower IQ, but there was no correlation between IQ and victim gender or relationship (p. 561). Two of three proxy variables, including the most important, gender, did not support his hypothesis. Contary to Dr. Cantor, I interpret this as strong evidence against his hypothesis, since there are other obvious explanations for the relationship between IQ and victim age (e.g., younger victims are easier targets for low-functioning molesters).

Contradicting research

A number of studies have found that pedophiles have normal IQ. These studies differ from Cantor et al. (2004) in that they include non-pedophilic child molesters as controls, and some exclude subjects with mental retardation from both groups. Although these findings put Dr. Cantor’s claim in question, the sample sizes are too small to settle the matter. I should also point out that both Dr. Cantor’s study (Cantor et al., 2004, p. 5) and the studies below did not administer full IQ tests they estimated IQ using simpler tests. These simpler tests are likely sufficient to detect group differences.

  • Eastvold et al. (2011): “PEDs [pedophilic child molesters] had a higher IQ than NSOs [nonsexual criminal offenders] (p = .014), and there was a trend for NPEDs [non-pedophilic child molesters] to have a higher IQ than NSOs (p = .051). PEDs also had better SK [semantic knowledge] than NSOs (p = .035).”
  • Schiffer & Vonlaufen (2011): “no significant difference in intelligence quotient (IQ) levels between all groups”. Pedophilic child molesters: 108.5 Non-pedophilic child molesters: 107.5 Forensic controls: 103.2 Healthy controls: 110.2
  • Suchy et al. (2009): No significant differences. Pedophilic child molesters: 106.59 Non-pedophilic child molesters: 102.05 Community controls: 105.62
  • Strassberg et al. (2012): This study used two samples. Sample one: “The 3 groups (PEDs, N-PEDs, CNTs) did not differ on […] estimated IQ (M = 104.6, SD = 8.1, range, 84–121)”. Sample two: “There was a significant difference among the groups on estimated IQ the criminal controls scored significantly lower in IQ (M = 96.92, SD = 9.94) than either the pedophilic child molesters (M = 105.89, SD = 11.32) or nonpedophilic child molesters (M = 104.46, SD = 12.57). The 2 child molester groups did not differ significantly on estimated IQ.”

I am not alone in believing that these findings undermine the relationship between pedophilia and IQ. Eastvold et al. (2011) write,

“Importantly, this study sample was remarkably similar to our previous sample (Suchy et al., 2009a, 2009b). In both samples, IQs and semantic knowledge (SK) were average, with PEDs’ IQ and SK being slightly (nonsignificantly) higher than those of NPEDs, in the context of approximately 13 years of education for both groups. The IQ and SK of child molesters in the present study were slightly higher than those of NSOs. This appears to contradict published reports documenting positive correlations between IQs and victim age (Blanchard et al., 2007 Cantor et al., 2004 Cantor, Blanchard, et al., 2005). However, such findings may be misleading and can likely be explained by the heterogeneity of study samples and inclusion of individuals with mental retardation. The only other reported comparison between pedophilic and nonpedophilic child molesters (Blanchard et al., 2007) found no IQ differences, consistent with our findings. Further examination of phallometrically defined non-mentally retarded pedophilic and nonpedophilic child molesters would likely continue to dispute relationships between pedophilia and lower IQs.”

The bottom line

There is not enough evidence to make any conclusion about the IQ of pedophiles. One study supports a connection, but several others do not, including, in my opinion, Dr. Cantor’s own meta-analysis. Of course, Dr. Cantor’s thesis is plausible, and we can’t reject the possibility just because it’s unpleasant. The important thing to keep in mind is that, even if the association exists, it’s only the center of a bell curve. It says nothing about the intelligence of any given pedophile. Even if some pedophiles have lower IQ, many do not. Unfortunately, Dr. Cantor never emphasizes this to the media. He must know that the public always misinterprets this sort of statistic. When he explains the association between height, handedness and pedophilia, he often adds that it doesn’t mean short, left-handed people are pedophiles. Why doesn’t he give pedophiles the same consideration?


Paraphilia Diagnosis

The DSM-IV, or The Diagnostic and Statistical Manual of mental disorders, sets the standards for diagnosis of paraphilia as having to meet/demonstrate the following criteria:

  • “Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving 1) nonhuman objects, 2) the suffering or humiliation of oneself or one’s partner, or 3) children or other non-consenting persons, that occur over a period of at least 6 months.”
  • “The behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

Eight types of paraphilic disorders have been itemized in the DSM-IV, but in real life situations, those who are exhibiting one paraphilia most often exhibit an inclination for other paraphilic behaviors as well. An example of this lies in the reports given by individuals that have been incarcerated for pedophilia. Often there have been reports suggesting that while they have engaged in pedophilia, they are primarily attracted by other deviant behaviors and types of paraphilia such as voyeurism or exhibitionism. According to The University of Texas, presence of paraphilic behavior may signify a principal sexual impulsivity disorder that is characterized by sexual compulsivity and hypersexuality, and in some cases, sexual aggression.


Diagnosing Paraphilic Disorders in Nonforthcoming Individuals

Perhaps the clearest indication that some of the changes in the paraphilic disorders section of DSM-5 were guided by forensic concerns is the various additions to the text addressing the challenge of applying the diagnostic criteria to individuals who are not forthcoming about the presence or impact of sexual pathology. Individuals, particularly in forensic settings, are motivated to deny or minimize deviant sexual urges or behaviors to avoid the negative forensic and social consequences of paraphilic disorder diagnoses. The DSM-IV-TR text was largely silent about the use of the paraphilic disorder diagnoses in forensic settings, noting only that “individuals who act out with a non-consenting partner in a way that may be injurious to the partner may be subject to arrest and incarceration” (Ref. 12, p 566).

In contrast, DSM-5 contains numerous additions to the descriptive text for paraphilic disorders intended to provide guidance to evaluators in forensic contexts. Specifically, the texts for the voyeuristic, exhibitionistic, frotteuristic, sexual sadism, and pedophilic disorders were written using the same template and include similar statements regarding their application to nondisclosing individuals. For example, the first sentence in the Diagnostic Features section for all of these disorders states: “The diagnostic criteria for [X] disorder are intended to apply both to individuals who more or less freely disclose this paraphilic interest and to those who categorically deny any sexual arousal from [X] despite substantial objective evidence to the contrary” (e.g., Ref. 1, p 687). Each Diagnostic Features section also includes a paragraph describing the various ways that nondisclosing individuals may present, followed by the comment that “despite their non-disclosing position, such individuals may be diagnosed with [a paraphilic disorder]” (e.g., Ref. 1, p 692). Each paragraph ends with the explicit statement that a history of recurrent paraphilic behavior is sufficient to meet criterion A: for example, “Recurrent frotteuristic behavior constitutes satisfactory support for frotteurism (by fulfilling Criterion A)” (Ref. 1, p 692). As discussed above, statements such as these that suggest that recurrent sexually offending behavior alone is sufficient to ascertain the presence of a paraphilia are in conflict with the evidence ( 20,22 ) that a substantial proportion of sex offenses are not a manifestation of a paraphilic arousal pattern.

Moreover, such statements appear to run counter to the change in the Criterion A wording intended to clarify that the behaviors must be a manifestation of a paraphilic sexual arousal pattern. However, much depends on whether one interprets phrases such as frotteuristic behavior to mean implicitly that the modifier frotteuristic requires the behavior to be a manifestation of a frotteuristic arousal pattern or whether it is simply descriptive of the type of behavior (i.e., rubbing against an unsuspecting individual). It is too soon to tell to what extent this subtle difference in interpretation will be used in forensic evaluations to argue for or against the necessity of establishing that the behavior is a manifestation of a paraphilic arousal pattern.

Voyeuristic, exhibitionistic, frotteuristic, and sexual sadism disorders each include additional text indicating that the construct of “recurrent” behaviors can be interpreted as “having acted on the sexual urges with three or more victims on separate occasions” (Ref. 1, p 687) or with fewer victims if there are multiple occasions of acting on the paraphilic urges with the same unwilling individual. Victim count requirements were originally part of the proposed diagnostic criteria sets for these paraphilic disorders (as well as for pedophilic disorder), but were ultimately rejected from inclusion in the criteria sets 25 because of the lack of broad clinical consensus. Moreover, the proposal to include victim count requirements in the diagnostic criteria was derived entirely from a single study 26 that examined the diagnostic sensitivity of phallometric testing for pedophilia. Given that this study did not include any subjects with the four DSM-5 paraphilic disorders that actually include this victim count threshold in their descriptive texts, the validity of these thresholds should be considered questionable and raise concerns regarding both false-positive and false-negative diagnoses. Curiously, although the text for pedophilic disorder also notes that the “presence of multiple victims … is sufficient but not necessary for diagnosis” (Ref. 1, p 698), it avoids offering a specific victim count.


Causes of gerontophilia at the paraphilia level

Although relationships between people of different ages do not necessarily imply the presence of gerontophilia, in cases where a paraphilia is being discussed, the question may arise as to what makes this fixation with the elderly appear . In this sense, there are multiple explanations that can be found. It should be noted that we are talking about paraphilia, not about falling in love with someone who happens to be that age.

One of them tells us about the presence of an insecure, dependent or needy personality that would see in being old a stimulus that has traditionally been associated with wisdom, experience, protection and warmth. This view of old age may cause some people to develop a certain sexual desire for these characteristics, which makes them feel safe.

It may also arise in the context of people who feel unable to relate successfully to people their age (something that also occurs in some cases of paedophilia).

Another possibility arises from conditioning: it is possible that in a situation of sexual excitement the image or some type of stimulus related to old age may have appeared by chance, which may have subsequently been positively reinforced (for example through masturbation).

Related to this, cases have also been observed in which the existence of this type of attraction is derived from traumatic experiences , such as sexual abuse in childhood, in which the sexual act with people much older than the subject himself has somehow been normalized. Sexual excitement has been associated with the difference in age or with old age, generally acquiring a certain compulsive tinge towards the elderly.

Another possible reason can be found in the fragility of the elderly or the fact that they have someone to care for them: the elderly are generally people in poor health, who may need help and may be somewhat dependent. Some people may find it sexually stimulating to be necessary and help the elderly .

The opposite pole would be found in the search for relationships of domination-submission: an old man can be more fragile than his partner, something that puts the gerontophiliac in a position of certain superiority at the level of physical power. In this case, special caution should be taken with regard to the possibility of an attempt to abuse the old person in question , as there may be a vexatious component that seeks to subject the old person .