Atypical Sexual Behavior (paraphilias): Signs of a Changing Culture
New York Times article recently reported that clinical psychologists are seeing an increasing number of patients reporting that they engage in abnormal sexual behavior (Goleman, 1991). Kinsey noted that in the years 1948 and 1953 as many as half of the Americans surveyed participated in sexual activities that could be considered masochistic or sadistic (such as biting or spanking) (Kinsey, et. al, 1948: Kinsey, et. Al., 1953). This trend seems to have slightly increased in prevalence, however, still remains close to the 61% mark (Donelly and Straus, 1994).
This issue raises several questions. The first is whether society has "done something" to create this phenomenon. In other words, is there an environmental factor that is making otherwise normal people engage in deviancy? Does it mean that our definitions of "normal" are changing and that these behaviors have always been a part of our culture and that they were "not talked about?" The following research will explore these questions from a historical and current clinical perspective. This research will attempt to reach a conclusion as to the cause of our culture's new obsession with atypical sexual behavior, known as paraphilia. This topic is important for the future of clinical psychology and how these patients are treated in the future.
One of the greatest difficulties in describing sexual atipicalities lies in defining what exactly one means by the term. Sexual atypicality is defined as a condition in which sexual excitement occurs and is associated with acts or imagery that are considered outside of the established norms within a particular culture. These behaviors are called paraphilias and come in many forms. Paraphilias are defined in the DSM-IV (a standard psychological inventory) as "sexual impulse disorders characterized by intensely arousing, recurrent sexual fantasies, urges and behaviors considered deviant with respect to cultural norms and that produce clinically significant distress or impairment in social, occupational or other important areas of psychosocial functioning" (APA Manual, 1994). The imagery and act that produces arousal are constant and unchanging.
To be considered a paraphilia, the behavior must cause significant distress or an inability to function effectively. A sexual behavior may be considered a paraphilia if the person has the inability to resist the sexual act, the other person does not give mutual consent or is under legal age, there are legal consequences, it results in a sexual dysfunction, or there is an interference with normal social relations. Some common paraphilias include, sadism (inflicting humiliation or suffering), masochism (receiving humiliation or suffering), fetishism (inanimate objects such as shoes, underwear, etc.), Pedophilia (focus on a prepubescent child), transvestic (cross-dressing), voyeurism (watching others), and exhibitionism (exposure of genitals to someone else). (APA Manual, 1994).
Typically, a person has more than one paraphilia. This paraphilia can cause feelings of guilt, shame, and isolation. Often a routine develops. The psychoanalytic approach theorizes that paraphilias arise early in life as a result of sexual fixation. The paraphilia is the expression of the fixation that occurred earlier in life. Some psychoanalysts feel that the paraphilia is and outward expression of anger regarding a trauma in early childhood. These people are unable to erase the trauma and it later expresses itself as a paraphilia (Masters, et. Al., 1992).
Behaviorists have another explanation, they believe that paraphilias are conditioned responses. They believe that non-sexual objects can become arousing if they are continuously associated with a pleasurable experience. They do feel that there must be a predisposing condition such as a difficulty in forming sexual relations and poor self-esteem. Sigmund Freud has an interesting perspective on this subject. He believed that the human infant expresses a variety of human sexual activity and that culture then chooses which one to promote and which ones to extinguish (Freud, 1905).
Culture and History
Culture defines what it considers to be normal and what it considers to be deviant behavior. One must examine other cultures to discover that our own definition is not always the most valid. Adults interacting with children in a sexual manner is considered normal and acceptable in some cultures. Demause (1991) wrote an extensive survey of this phenomenon that found documents with these types of relationships in a number of cultures, both in historical and current. His work revealed that this behavior is found all around the world, but the difference is how a society accepts it.
In a survey of cultural attitudes regarding sexual behaviors Kahr (1991) determined that the Hebrews were the only ancient culture that punished pedophiles. According to Kahr, our current attitudes toward pedophilia are a result of an exaggeration of the old Judeo-Christian law. In support of this theory on the prevalence of adult-child relations, Konker, (1992) found that this occurred as a part of initiation ceremonies in at least twenty countries around the world.
DeMause, Konker and Kahr agree that the Jewish practice of circumcision, penile mutilation, arises from a sadistic sexual rite, rather than as a result of the desire to protect boys from certain diseases. This supports the idea that the Western society treatment of paraphilia as a deviant behavior is the result of cultural training and does not represent a true deviance or diseased condition. It is simply a different way of looking at something that is acceptable to other societies.
Common Issues in Paraphilia
Paraphiliacs often do not seek treatment themselves. They are often not diagnosed until an arrest or another situation requires them to seek treatment. Often they have a very normal life, however, they may be inclined to seek out the situation that arouses their paraphilia, for instance, working in a women's shoe department or working with children. Often there are other problems present such as alcohol or drug abuse, intimacy problems, personality disorders, or a sexual dysfunction. The symptoms range from mild to moderate to severe (Masters, et. Al., 1992) Treatment
Many clinical techniques have been tried in people with paraphilias. Many of these treatments must occur over several years for the treatment to be successful. Therapy with hypnosis has had poor results. Current treatment strategies includes aversion therapy, in which the sexually arousing stimulus is paired with an unpleasant image, such as being arrested. Desensitization by neutralizing the anxiety associated with the arousing image in combination with relaxation techniques. Orgasmic reconditioning involves having the person masturbate using the paraphilic fantasy and then switch to a more appropriate instrument of fantasy just at the moment of orgasm. Social skill straining is also necessary.
Drug therapies are sometimes used with some success. These include antiandrogens, which temporarily lower testosterone levels have been used in repetitive sexual behaviors. One of he most popular drugs in this category is Cyproterone. Seratonergics are used for anxious or depressive symptoms. These drugs boost the level of serotonin, the hormone that is responsible for arousal and pleasant feelings. This group of drugs includes flouxetine, clomipramine, buspirone, and sertraline. These drugs have proven as effective in clinical trials. (APA Manual, 1994). Drug therapy must be long-term, as the person often returns to the deviant behavior after hormone levels return to normal (Merck, 2002).
Relationship problems are often pronounced in paraphilias. The paraphilia is the only source of sexual arousal and often the fetish replaces a normal relationship. When this occurs, the relationship suffers and the paraphilia can lead to other undesirable effects (Merck, 2002). When partners are willing to engage in these fantasies, often they do not cause problems. However if the partner is not willing, then the paraphilia causes feelings of shame and anger, which can lead to more outward expressions, either in the paraphilia itself or in another expression such as substance abuse or violent behavior (Merck, 2002).
Sadism and masochism are opposite manifestations of the same paraphilia. These behaviors involve persistent fantasies that produce arousal from either inflicting pain on others (sadism) or being the recipient of such pain (Masochism). This paraphilia usually begins in early adulthood and the fantasies are persistent and consistent. It may materialize as mild (spanking and biting) to severe (rape and violence). Sadism is considered criminal among nonconsenting adults (Merck, 2002, Chapter 192).
The DSM-III-R definition of sadism is "Over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person" (Gardner, 1996).
Our society encourages women to be seductive, sexually permissive, and enticing, whereas males are encouraged to be aggressive and pursuing (Gardner,1996). The theme of pursuit and domination is a popular media theme and therefore is a defining factor in our culture. Sadism may not be deviant or an illness, but rather a reversal of society's prescribed gender roles. These gender roles too have varying definitions in other cultures. Many normal people have these more animalistic desires, but our society prohibits them from expressing them. Sadism and masochism are just exaggerated expressions of society's definition of gender roles. However, they have still…