Tiêu đề Psychiatry Paraphilias and Sexual Disorder.pdf ✅

TRANSCRIBERS 1 PSYCHIATRY DR. ETHEL PAGADDU NOVEMBER EXIMIUS Paraphilias and Sexual Disorder NOS 2021 GROUP 9- RALA PARAPHILIAS § Paraphilias or perversions are sexual stimuli or acts that are deviations from normal sexual behaviors, but are necessary for some persons to experience arousal and orgasm. § These individuals can experience sexual pleasure, but are inhibited from responding to stimuli that are normally considered erotic. § The paraphiliac's sexuality is restricted to specific deviant stimuli or acts. § Persons that occasionally experiment with paraphiliac behavior (e.g., infrequent episode of bondage or dressing in costumes), but are capable of responding to more typical erotic stimuli, are not diagnosed as suffering from paraphilias. § Paraphilias can range from nearly normal behavior to behavior that is destructive or hurtful only to a person's self or to a person's self and partner, and finally to behavior that is deemed destructive or threatening to the community at large. § A special fantasy with its unconscious and conscious components is the pathognomonic element of the paraphilia, with sexual arousal and orgasm being associated phenomena that reinforce the fantasy or impulse. § The major functions of human sexual behavior are to assist in bonding, to create mutual pleasure in cooperation with a partner, to express and enhance love between two persons, and to procreate. § Paraphilias are divergent behaviors in that those acts involve aggression, victimization, and extreme one-sidedness. Epidemiology § practiced by only a small percentage of the population § DSM-5 suggests that the prevalence of paraphilias is significantly higher than the number of cases diagnosed in general clinical facilities, based on the large commercial market in paraphilic pornography and paraphernalia. § pedophilia is most common § of all children, 10 -20% have been molested by age 18 § More than 50% of all paraphilias have their onset before age 18. § Patients with paraphilia frequently have three to five paraphilias, either concurrently or at different times in their lives. § The occurrence of paraphiliac behavior peaks between ages 15 and 25 and gradually declines Etiology Psychosocial Factors § persons with a paraphilia have failed to complete the normal developmental process toward heterosexual adjustment, § what distinguishes one paraphilia from another is the method chosen by a person (usually male) to cope with the anxiety caused by the threat of castration by the father and separation from the mother § failure to resolve the oedipal crisis by identifying with the father-aggressor (for boys) or mother-aggressor (for girls) results either in improper identification with the opposite- sex parent or in an improper choice of object for libido cathexis. § Classic psychoanalytic theory holds that transsexualism and transvestic fetishism are disorders because each involves identification with the opposite-sex parent instead of the same-sex parent § Exhibitionism and voyeurism may be attempts to calm anxiety about castration because the reaction of the victim or the arousal of the voyeur reassures the paraphiliac that the penis is intact. F § fetishism is an attempt to avoid anxiety by displacing libidinal impulses to inappropriate objects § Persons with pedophilia and sexual sadism have a need to dominate and control their victims to compensate for their feelings of powerlessness during the oedipal crisis § Some theorists believe that choosing a child as a love object is a narcissistic act. § Persons with sexual masochism overcome their fear of injury and their sense of powerlessness by showing that they are impervious to harm § Other theories attribute the development of a paraphilia to early experiences that condition or socialize children into committing a paraphiliac act. § The first shared sexual experience can be important in that regard. § early experiences of abuse that is not specifically sexual, such as spanking, enemas, or verbal humiliation, can be sexualized by a child and can form the basis for a paraphilia. § Such experiences can result in the development of an eroticized child. § The onset of paraphiliac acts can result from persons' modeling their behavior on the behavior of others who have carried out paraphiliac acts, mimicking sexual behavior depicted in the media, or recalling emotionally laden events from the past, such as their own molestation. § Learning theory indicates that because the fantasizing of paraphiliac interests begins at an early age and because personal fantasies and thoughts are not shared with others (who could block or discourage them), he use and misuse of paraphiliac fantasies and urges continue uninhibited until late in life. Biological Factors o 74 percent with abnormal hormone levels, 27 percent with hard or soft neurological signs, 24 percent with chromosomal abnormalities, 9 percent with seizures, 9 percent with dyslexia, 4 percent with abnormal electroencephalograms (EEGs), 4 percent with major mental disorders, and 4 percent with mental handicaps Diagnosis and Clinical Features § the diagnostic criteria for paraphilias include the presence of a pathognomonic fantasy and an intense urge to act out the fantasy or its behavior elaboration § The fantasy, which may distress a patient, contains unusual sexual material that is relatively fixed and shows only minor variations. § Arousal and orgasm depend on the mental elaboration or the behavioral playing out of the fantasy. § Sexual activity is ritualized or stereotyped and makes use of degraded, reduced, or dehumanized objects
TRANSCRIBERS 2 PSYCHIATRY DR. ETHEL PAGADDU NOVEMBER EXIMIUS Paraphilias and Sexual Disorder NOS 2021 GROUP 9- RALA DSM-5 Diagnostic Criteria for Exhibitionism A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one's genitals to an unsuspecting stranger. B. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty. Exhibitionism § the recurrent urge to expose the genitals to a stranger or to an unsuspecting person § Sexual excitement occurs in anticipation of the exposure, and orgasm is brought about by masturbation during or after the event § the dynamic of men with exhibitionism is to assert their masculinity by showing their penises and by watching the victims' reactions “fright, surprise, and disgust.” § In this situation, men unconsciously feel castrated and impotent. § Wives of men with exhibitionism often substitute for the mothers to whom the men were excessively attached during childhood DSM-5 Diagnostic Criteria for Fetishism A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects (e.g., female undergarments). 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 female clothing used in cross-dressing (as in transvestic fetishism) or devices designed for the purpose of tactile genital stimulation (e.g., a vibrator). Fetishism § In fetishism the sexual focus is on objects (e.g., shoes, gloves, pantyhose, and stockings) that are intimately associated with the human body § The particular fetish is linked to someone closely involved with a patient during childhood and has a quality associated with this loved, needed, or even traumatizing person. § begins by adolescence, although the fetish may have been established in childhood § tends to be chronic § Sexual activity may be directed toward the fetish itself (e.g., masturbation with or into a shoe), or the fetish may be incorporated into sexual intercourse (e.g., the demand that high-heeled shoes be worn). § almost exclusively found in men § Freud: the fetish serves as a symbol of the phallus to persons with unconscious castration fears § Learning theorists believe that the object was associated with sexual stimulation at an early age. DSM-5 Diagnostic Criteria for Frotteurism A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person. B. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty. Frotteurism § usually characterized by a man's rubbing his penis against the buttocks or other body parts of a fully clothed woman to achieve orgasm § other times, he may use his hands to rub an unsuspecting victim § the acts usually occur in crowded places, particularly in subways and buses § those with frotteurism are extremely passive and isolated, and frottage is often their only source of sexual gratification § expression of aggression in this paraphilia is readily apparent DSM-5 Diagnostic Criteria for Pedophilia A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger). B. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty. C. The person is at least age 16 years and at least 5 years older than the child or children in Criterion A. Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old. Specify if: Sexually attracted to males Sexually attracted to females Sexually attracted to both Specify if: Limited to incest Specify type: Exclusive type (attracted only to children) Nonexclusive type Pedophilia § involves recurrent intense sexual urges toward, or arousal by, children 13 years of age or younger, over a period of at least 6 months § persons with pedophilia are at least 16 years of age and at least 5 years older than the victims § When a perpetrator is a late adolescent involved in an ongoing sexual relationship with a 12- or 13-year-old, the diagnosis is not warranted § Most child molestations involve genital fondling or oral sex. § Vaginal or anal penetration of children occurs infrequently, except in cases of incest. § Although most child victims coming to public attention are girls, this finding appears to be a product of the referral process. § Of those with pedophilia, 95 percent are heterosexual, and 50 percent have consumed alcohol to excess at the time of the incident.