COUN 646 Paraphilias Research Paper Kingry

Paraphilic Disorders
Amber Kingry
Liberty University

Abstract
This paper provides an overview the current DSM-5 paraphilic disorder category. Each subcategory is examined and discussed. The subcategories included are voyeurism, exhibitionism, frotteurism, sexual masochism, sexual sadism, pedophilia, fetishism, transvestism, and paraphilia not otherwise specified. Discussion includes the proposed assessment, diagnosing criteria, and the effectiveness of current treatments for each of these paraphilic disorders. The importance of a thorough assessment is stressed in order to make an accurate diagnosis and to develop a treatment plan that will be effective for the client. Treatments included therapy models such as individual therapy, group therapy, solution-focused therapy and cognitive-behavioral therapy alone and in conjunction with pharmacological agents. The effectiveness of these treatment options are examined to determine how effective they are in paraphilias with comorbidities. The need for additional research on the long-term effects of pharmacological agents was established.

Annotated Bibliography
De Oliveira Junior, W.M., & Najjar Abdo, C.H. (2010), Unconventional sexual behaviors and their associations with physical, mental and sexual health parameters: a study in 18 large Brazilian cities. Revista Brasileira De Psiquiatria, 32(3), 264-274. This is a study of unconventional sexual behavior and socio-demographic and health parameters. This was a self-administered questionnaire of 7,022 individuals with and without unconventional sexual behaviors. Results revealed that more men (52.3%) than women (30.4%) presented with unconventional sexual behaviors. Fetishism and voyeurism were the two most common behaviors. They concluded that there was a connection between unconventional sexual behaviors and poor health status and low educational levels. This is helpful in examining the etiology of paraphilias.
Fedoroff, J.P. (2008). Sadism, sadomasochism, sex, and violence. Canadian Journal of Psychiatry, 53(10), 637-646.
Fedoroff correlates the current theories regarding the possible causes of criminal sexual sadism and the resulting diagnosis and treatment of this disorder. Efforts are made to understand motivation, patterns, physiology and neurological factors in these interactions. The author concluded that sexual sadism was a heterogeneous occurrence and that it was necessary to strive to understand the ways sadistic interest develops in order to aid in future development of effective treatments.
Firoz, K., Nidheesh Sankar, V., Rajmohan, V., Manoj Kumar, G., & Raghuram, T.M. (2014). Treatment of fetishism with naltrexone: a case report. Asian Journal of Psychiatry, 867-68. doi:10.1016/j.ajp.2013.11.006.
Fetishism is an identified sexual disorder for which there are few treatments available. These authors explore the case of a 40 year old man with a women’s underwear fetish. The individual had comorbid diagnosis of alcohol and drug use. The client was treated with naltrexone and effectively maintained remission of fetishism and the comorbidities. The authors concluded that naltrexone was successful and held the position its potential use for treatment in future cases.
Garcia, F.D., & Thibaut, F. (2011). Current concepts in the pharmacotherapy of paraphilias. Drugs 71, no. 6, 771-790.
Interest regarding the treatment of paraphilia has grown over the past several years leading to new concepts in treatment. Treatments such as antidepressants, hormonal treatments, and psychotherapy have been proposed. Garcia and Thibaut reviewed the evidence presented for these treatment options and concluded that paraphilias have marked pathological dimensions which were responsive to treatment. Long term research is still needed to confirm long term treatment effectiveness and side effects. It is apparent from the evidence presented that these disorders are under researched.
Gordon, H. (2008). The treatment of paraphilias: An historical perspectives. Criminal Behaviour and Mental Health, 18(2), 79-87. doi:10.1002/cbm.687.
Paraphilic disorders are not new and have been present throughout history. Gordon explores the historical treatment of paraphilias including approaches such as surgical and pharmacological castration. Gordon discusses the recent use of leteinizing hormone releasing agonists in pharmacological castration and the varied effectiveness. He concludes that science needs to become stronger in defining paraphilias in order to better assess and treat them. This article provides insight into centuries of paraphilic behaviors and historical treatments.
Guterman, J.T., Martin, C.V., & Rudes, J. (2011). A solution-focused approach to frotteurism. Journal of Systemic Therapies, 30(1), 59-72. doi: 10.1521/jsyt.2011.30.1.59.
Frotteurism is a paraphilia in which an individual has urges to rub their genitals against others without their consent. Guterman, Martin and Rudes offer a case example which illustrates the approach of solution-focused therapy as a treatment option. Unlike previously utilized problem focused therapy, solution-focused therapy is strength-based focusing on the client’s potential and is a collaborative approach during the change process. Though the case example was promising, there were limitations to the example which cannot be applied to all clients. Further study is needed to determine effectiveness.
Hawkinson, K., & Zamboni, B. (2014). Adult baby/diaper lovers: An exploratory study of an online community sample. Archives of Sexual Behavior, 43(5), 863-877. doi:10.1007/s10508-013-0241-7.
One type of paraphilia is the adult baby/diaper lover (ABDL) fetish. Hawkins and Zamboni found in an exploratory study of 1,934 individuals who belonged to an ABDL online community discovered that 72% of participants participated in this fetish for sexual arousal. They recommend that clinicians and researchers be cautious in making assumptions regarding individuals who practice ABDL activities. Most individuals seemed comfortable with their sexuality and their relationships with others. Understanding persons with ABDL could possibly shed light on individual sexuality whether it is typical or atypical.
Hoogeveen, J., & Van der Veer, E. (2008). Side Effects of Pharmacotherapy on Bone with Long-Acting Gonadorelin Agonist Triptorelin for Paraphilia. Journal of Sexual Medicine, 5(3), 626-630 There are only a few studies of the effects of libido inhibitors in the treatment of paraphilias. These authors examine a case study of 35 year old male treated with long-acting gonadorelin for paraphilia. This did produce decreased sexuality but various side effects were present including a large amount of bone loss. They concluded that long-term drug regimens as part of the treatment of paraphilias should be reconsidered and reasearched further.
Labelle, A., Bourget, D., Bradford, J.M.W., Alda, M. & Tessier, P. (2012). Familial paraphilia: A pilot study with the construction of genograms. ISRN Psychiatry, vol. 2012, Article 692813, p 1-9. doi:10.5402/2012/692813.
Langstrom, N., & Seto, M. (2006). Exhibitionistic and voyeuristic behavior in a Swedish national population survey. Archives of Sexual Behavior, 35(4), 437.doi:1007/s10508-006-9042-6.
Langstrom and Seto conducted a study of self-reported sexual arousal revolving around exhibitionistic and voyeuristic behaviors. In a random study of 2,450 individuals 3.1% reported arousal by exposing themselves to others and 7.7% reported sexual arousal from spying on others having sex. Both exhibitionism and voyeurism were examined for association with multiple variables. The study concluded that paraphilic behaviors were more prevalent in males with the presence of psychological problems, a lower level of satisfaction in life, increased drug and alcohol use, and increased sexual activity interest. Increased sexual interest included increased sexual partners and sexual arousal, masturbation, pornography, and increased likelihood of having a same-sex sexual partners. They concluded that the results were consistent with other research in that men with exhibitionism and voyeurism had increased odds of reporting other atypical sexual behavior.
Lawrence, A.A. (2009). Transgenderism in nonhomosexual males as a paraphilic phenomenon: Implications for case conceptualization and treatment. Sexual & Relationship Therapy 24(2), 188-206. doi:10.1080/14681990902937340.
It is important to understand the meaning and significance of transgenderism. This can assist therapists in assessing, diagnosing and developing effective treatment plans. Lawrence holds that by addressing non-homosexual male transgenderism as a paraphilic disorder allows the therapist to be more empathetic to the heightened passion that these individuals possess. Lawrence concluded that a therapist’s understanding that these feelings are not completely consistent with transsexualism can help clients experience less shame and greater self-acceptance.
McManus, M. A., Hargreaves, P., Rainbow, L., & Alison, L.J. (2013). Paraphilias: definition, diagnosis and treatment. F1000Prime Reports, 5, 36. doi:10.12703/P5-36.
Controversy remains concerning paraphilic disorders and the defining of what is normal and what is deviant. Some cultures are accepting and find some deviant actions normal versus other cultures. The authors in this article discuss these issues and the recent progress that has been made in the diagnosis and treatment of paraphilias. They concluded that the issue of determining what is normal and what is deviant is a challenge when applying the term paraphilia. This article is helpful in understanding the need for a standard norm.
Maratea, R.J. (2011). Screwing the pooch: Legitimizing accounts in a zoophilia on-line community. Deviant Behavior, 32(10), 918-943. doi:10.1080/01639625.2010.538356.
It is not uncommon for individuals who participate in atypical behaviors to attempt to justify them. Maratea seeks to expand research that looks at how deviant individuals are utilizing the internet in communicating the accounts of their behavior in an effort to neutralize them. Data from a study of 4,983 on-line individual posts resulting from 87 different discussion threads. Results from the study suggested that individuals who posted to these threads routinely justified their behaviors by attempting to neutralize them through appeals of enlightenment, claims of cultural diffusion, and neutralization by comparison to other actions such as criminal acts.
Marshall, W.L., Marshall. L.E., & Serran, G.A. (2006). Strategies in the treatment of paraphilias: A critical review. Annual Review of Sex Research, 171(1), 162-182.
Just like any other disorder, treatments have developed and proposed for paraphilic disorders. Marshall discusses that the clinician should determine what needs to be addressed beginning with an exploration of the individual’s history. Obtaining a deeper understanding of the individual also helps to identify difficulties that need to be faced and addressed as part of the treatment plan. Marshall indicates that reliability and validity in the diagnosis of paraphilias among sex offenders appears to be poor. He attributes this to the variances in interpretation of the criteria and inferences of the behaviors which leaves the door open for error. He stresses the need to evaluate individuals for multiple paraphilic disorders. This article offers insight into the assessment of disorders.
Miletski, H. (2005). A history of bestiality. Anthrozoos, 1-22.
In this article, Miletski provides a history of bestiality through the ages. Included in this historical account are art, folklore, religion, law and actual behaviors based on facts and opinion found within literary text. Miletski demonstrates how art from as far back as the Fourth Glacial Age depicted humans and animals having sexual relations. Discussion included biblical references and examples and discussed how this behavior was often part of religious ceremonies.
Mokros, A., Osterheider, M., Hucker, S., Nitschke, J. (2011). Psychopathology and sexual sadism. Law & Human Behavior (Springer Science & Business Media B.V.), 35(3), 188-199. doi:10.1007/s10979-010-9221-9.
There are several common characteristics between psychopathic personality disorder and sexual sadism. These authors conducted an empirical study based on a sample of 100 male sex offenders to text the construct of these two characteristics. Indicator variables for the two characteristics made it apparent that a two-factor model was a better fit for the study. The study concluded that psychopathy and sexual sadism, though they shared characteristics, were two separate conditions. It was noted there was a similarity in that both had difficulty comprehending the suffering of others but only sadists derived arousal or enjoyment from this.
Penner, J.J., & Penner, C.L. (2005). Counseling for sexual disorders. Gaithersburg, MD: Signature Book Printing Penner and Penner haved created a series of books intended as resources for Christian counselors. This book is one of the series and focuses on the counseling aspect of sexual disorders. This book discusses sexual dysfunction and therapeutic techniques from a biblical perspective of morality and helps to set a standard of normal for the Christian counselor. Sexual addictions are examined and contrasted with sin, compulsion, and psychopathology. These authors conclude that individual therapy alone may not be sufficient to help an individual and recommend that therapist consider collaborative group therapy and at times pharmacological therapy. It is stressed that the need for a thorough work up is necessary in determining the best course of treatment.
Thibaut, F., De La Barra, F., Gordon, H., Cosyns, P., & Bradford, J. W. (2010). The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias. World Journal of Biological Psychiatry, 11(4). 604-655. doi:10.3109/15622971003671628.
The authors of this article conducted extensive research regarding the different views and appropriate treatments of paraphilias from experts from different continents. The WFSBP has provided guidelines to evaluate the role of pharmacological agents in treating and managing paraphilias in primary adult males. The goal was to help clinicians improve the quality of care. In conclusion, an algorithm was proposed that had six different levels of treatment for different categories of paraphilias. This info was helpful in understanding the current treatment options available for various paraphilias.
Wong Sarver, N., & Gros, D. F. (2014). A modern behavioral treatment to address fetishism and associated functional impairment. Clinical Case Studies, 13(4), 336-351. doi:10.1177/1534650113512020.
There are hardly any research and treatment options available for fetishism. Wong Sarver and Gros explore two existing evidence-based modern behavioral interventions, more specifically a behavioral activation and sensate focused therapy. They are following a case study of an individual with a foot fetish/sexual impulse issue. The authors follow the 6 week brief therapy treatment and determine at the end of treatment that individual no longer met the criteria for fetishism which was still present at the 1 month post follow-up. They concluded that behavioral treatments can be successful for individuals who possesses more uncommon or rare paraphilias that would otherwise be neglected by the medical field.
Yates, P. M. (2013). Treatment of sexual offenders: Research, best practices, and emerging models. International Journal of Behavioral Consultation & Therapy, 8(3/4), 89-95.
The treatment of sexual offenders continues to evolve at a substantial pace over the years. Various theories and treatment models have been developed and refined as more is known. Yates discusses those models that currently exist for the treatment of paraphilias and those models that are emerging. She explores the research basis of these treatment models and makes recommendations for the best treatment of sexual offenders by adhering to specific parameters of effective intervention including cognitive-behavioral, skills-based orientation, and risk factors that are empirically associated with sex offenders. The goal is to reduce and eliminate these behaviors. This article is helpful when considering treatment options for paraphilias.