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perversion

 
American Heritage Dictionary:

per·ver·sion

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(pər-vûr'zhən, -shən) pronunciation
n.
    1. The act of perverting.
    2. The state of being perverted.
  2. A sexual practice or act considered abnormal or deviant.
perversive per·ver'sive (-sĭv, -zĭv) adj.

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Oxford Companion to the Body:

perversion

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Sexual perversion is usually implicitly assumed to mean some kind of unnatural, abnormal form of sexual behaviour. As such, its meaning is particularly fluid, depending on the position of the person using it, and their assumptions about the natural and the normal. While there would probably be a fairly broad consensus in favour of declaring necrophiliac cannibalism to be a perversion, very few forms of sexual practice have not been defined by someone, somewhere, as perversion.

Act versus object

Perversity can be broken down into two categories: perverse acts and perverse objects. Acts which involve some other use of the genitals beyond the insertion of the penis into the vagina followed by ejaculation have often been categorized as perversions. Masturbation, either mutual or solitary, comes into this category, as does oral sex. The use of contraception to thwart the reproductive purpose of intercourse has also been defined as perverted. It might be supposed that the one act which can always be defined as the normal, natural thing is sexual intercourse intended for the begetting of children (or at least, without the deliberate interposition of means to prevent this happening) between two persons of opposite sexes married to one another. At least in the abstract this is the case, but when it comes down to the practical, even the most reproductively intentioned married couple may be engaging in something which someone could define as perversion. The very position which one society regards as almost too natural even to think about may be regarded by another as an obscene variation calculated to inflame sensuality.

Acts which may in themselves be regarded as either perverse or bordering upon perversity may, however, be considered permissible if they conduce to better reproductive sex between married couples. Catholic confessional manuals, and twentieth century works on marriage advice, have licensed practices such as clitoral titillation or oral sex, or variations in sexual position, provided these were performed with the intention of rendering intercourse either more likely to be fertile, or (in the latter example) to induce better bonding between the couple thus improving the stability of the institution of marriage. The manifesto for such attitudes was proclaimed by the Dutch gynaecologist Theodor Van de Velde in his Ideal Marriage (1926): ‘Ideal Marriage permits normal, physiological activities the fullest scope, in all desirable and delectable ways’, while banishing ‘All that is morbid, all that is perverse’. The ‘full range of contact and connection between human beings, for sexual intercourse’ was clearly marked as pertaining ‘exclusively to normal intercourse between opposite sexes’. Thus Van de Velde was able to provide detailed instructions for preliminary ‘love-play’ and for variant positions suitable for different occasions, while firmly closing the door on ‘the Hell-gate of the Realm of Sexual Perversions’.

While this does open up the possibility of acts being (perversely) indulged in for their own sake as a means of selfish gratification rather than the enhancement of a relationship, it also moves the question from the issue of the acts to that of the object. Perversity thus becomes not merely a matter of using the genitals in a ‘wrong’ way, but also of experiencing sexual feelings towards some object considered to be unnatural: for example, the body of an individual of the same gender, an animal, or some item of apparel, which are, under the rubric of ‘the natural’, not supposed to be endowed with erotic allure. However, even this became an area open to finesse: with the rise of the notion of ‘congenital inversion’ (an inborn homosexual tendency), sexologists made a distinction between ‘inverted sexual practices’ innately normal to those engaging in them, and ‘perversions’ indulged in for sensual variety by those who had no such excuse. Some cultures permit certain forms of homosexual interaction, and even ritualize these to some extent, while not having any category for homosexual relationships outside those bounds. This can be seen, for example, in societies where there is an accepted role of effeminate male homosexual, or which accept age-differentiated relationships between men and adolescent boys with an assumed pedagogic purpose. Behaviour which transgresses these structural norms, however, may be stigmatized.

The perverse and ‘normality’

A perhaps more ‘modern’ way of considering perversion has been to place the defining barrier around the quality of the relationship. Something which leads to a reciprocal and mutually meaningful relationship between two individuals (whatever their gender and practices) may be regarded as natural and healthy. Impersonal acts and those unlikely to result in the formation of a pair-bond are thus still assigned to the realm of the perverse. The implicit model remains, of course, heterosexual matrimony.

Early sexologists both created and tried to defuse the question of the perverse by differentiating practices which were a distortion or a corruption of the sexual instinct from those which were (however deplorable), an exaggeration of ‘natural’ tendencies. This latter category could include manifestations of excessive sexual desire, exhibitionism and voyeurism, and the milder forms of fetishism and sadomasochism (particularly where the latter fitted received notions of male aggression and female passivity). However, as pioneer British sexologist Havelock Ellis pointed out, nearly all so-called perversions were capable of being interpreted as exaggerations of some tendency within ‘normal’ sexuality.

Most of the practices defined as perverse have been and are still found either exclusively or much more commonly among men. This may represent women's lack of opportunities, since, in most societies throughout history, if not confined to marriage and motherhood, their only other role has been that of prostitute, indulging male quirks of desire rather than manifesting their own. Some female ‘perversions’, such as desire for clitoral stimulation, have been quite clearly defined by male assumptions about the appropriate form of female sexual satisfaction: indeed active sexual desire in the female has been interpreted as ‘perverse’. Since discussions of sexuality have often focused on women, it is therefore interesting to note that descriptions of ‘perversion’ are more likely to deal with men.

— Lesley A. Hall

See also fetishism; sadomasochism; sexual orientation.

Columbia Encyclopedia:

sexual perversion

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perversion, sexual, in psychology, sexual behavior deemed pathological by its deviation from "normal" sexual desire. The definition of sexual perversion has shifted considerably over time: indeed, it has never been an uncontested category of meaning. For example, homosexual desire has long been stigmatized as sexual perversion among many segments of Western society (and remains so among some), but within the field of psychology, it is no longer considered pathological. Use of the term perversion itself has come under wide criticism in recent years. Today, psychologists generally refer to nontraditional sexual behavior as sexual deviation or, in cases where the specific object of arousal is unusual, as paraphilia. There are a number of recognized disorders of this type. In fetishism, the object of sexual desire is either an inanimate object or a nongenital part of the human anatomy. Voyeurism involves the covert viewing of other individuals who are naked, undressing, or engaged in sexual activity, as the primary means of sexual arousal. Sexual arousal as a result of physical contact with prepubescent children is described as pedophilia. Other forms of sexual deviation include exhibitionism, incest, transvestism, necrophilia, sadism, and masochism. Many of these behaviors, when they involve the participation of nonconsenting adults (or children, consenting or not), are punishable by law. Although rape is not classified as a paraphilia, it is a serious sexual deviance, and perhaps the most highly reviled form of sexual gratification. Most forms of sexual deviance are accompanied by any number of other psychological disorders.

Bibliography

See V. Bullough, Sexual Variance in Society and History (1980).

Gale Dictionary of Psychoanalysis:

Perversion

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To posit a "perverse" sexuality is to imply the existence of a "normal" variety with reference to which certain acts and object-choices are deemed deviant. In the Three Essays on the Theory of Sexuality (1905d), Sigmund Freud stated that the aim of adult sexuality was to reach orgasm by means of genital penetration, but he tempered this rather normative statement by observing that "the disposition to perversions is itself of no great rarity but must form a part of what passes as the normal constitution" (p. 171).

This was the basis of Freud's celebrated formula according to which "neurosis is the negative of perversion" (pp. 165, 231). In his turn—or perhaps rather his return—to Freud, Jacques Lacan followed up by underlining the importance of the absence of the father in cases of perversion, and at the same time claimed that perversion was above all attributable to the mother's putting her child in the place of the phallus (2002 [1955-56], p. 188). The pervert-to-be was thus chained to the desire/demand of the mother. It should be borne in mind, however, that Lacan was chiefly interested in the form of a "third structure" between the psychotic structure and the neurotic, so that for him perversion was a specific structural category rather than a class of sexual behavior to be set against an established norm.

It is difficult, from the psychoanalytical perspective, to frame a satisfactory definition of what, among adult sexual activities and object-choices, might constitute a symptom. Should homosexuality, for example, always be looked upon as a symptom? Or should it be viewed simply as a variation of male or female sexuality? Psychoanalysts are sharply divided on this clinical question.

First of all, the polymorphous features of adult sexuality hardly need underlining. Countless patients, whether heterosexual or homosexual, describe an infinite variety of erotic scenarios, fetish objects, masquerades, sadomasochistic games, and so on, which constitute private areas in their love lives, and which they experience neither as compulsive nor as indispensable to their sexual gratification.

Since every psychological symptom constitutes an attempt at self-cure intended to spare the sufferer painful mental conflict, this may be said equally of symptomatic sexuality (inasmuch as we are able to define it). Such a constructive approach to the meaning and aim of sexual symptoms, and of the reason for their formation, invariably leads to the conclusion that they embody infantile solutions to the confusions and anxieties attending sexual difference and sexual identity. The need to reinvent the sexual act often turns out to be closely tied to the parents' unconscious, or to silent messages or deceptive communications from the parents concerning sexual identity, adult sexuality, and notions of "feminine" and "masculine."

If some patients can achieve sexual satisfaction only by recourse to fetishistic, sadomasochistic, or other scenarios, the analyst might well wish that their sex life were less constrained, less subject to rigid conditions; yet if such erotic rituals are indeed for them the sine qua non of sexual relations, there is no justification for wanting these patients to abandon their erotic practices, whether or not other people consider them perverse.

As for the primal scene and the troubling fantasies to which it is apt to give rise, these tend—apart from their genital aspects and the phallic-oedipal conflicts they arouse well before the oedipal crisis proper—to bear the stamp of the pregenital: the fantasies in question feature devoration, or erotic and sadistic exchanges of an anal or fecal kind. When such fantasies predominate, they often fail to be integrated into genital eroticism and thus lead to so-called perverse sexual solutions.

Even more inhibiting than fantasies originating in the pregenital psychosexual stage are archaic fantasies involving vampirism, implosion, and fears of the loss of identity or of the sense of the boundaries of the body. When such fantasies, characteristic of early infancy, play a predominant part in the mental reality of adult individuals, sexual and love relationships are liable to be experienced as a threat of castration, annihilation, or death.

In order to achieve a gratifying sexual or love life, individuals inhabited by such terrifying fantasies find themselves obliged by the force of their unconscious to invent means whereby their castration anxiety and fear of annihilation—to which may be added feelings of confusion as to sexual identity, of emptiness, and of inner death—can be transformed into eroticized games. As an absolute prerequisite to sexual relations, adults in this situation commonly require complex theatrics: constraining conditions, disguises of all sorts, pregenital sexual behavior including the exchange of excrement, and so on—all meticulously stage-managed.

Most patients who re-enact the primal scene in this way feel that their erotic acts and object-choices are conflict-free and consonant with their desires, even if other people adjudge them perverse. The specific form assumed by a person's sexual predilections becomes a clinical problem in need of solution only if it causes that person to suffer. The real question is not whether particular acts or preferences should be judged deviant, but when a given deviation should be considered a variation from adult sexuality within the context of a significant object-relationship and therefore be treated as symptomatic.

A good many authors continue to us the term "perversion" in a pejorative way, but only inasmuch as it connotes a proclivity towards evil. Thus Robert Stoller (1975) confines the use of the word, which he defines as "the erotic form of hatred," to any sexual act whereby a person seeks deliberately to hurt someone else. Joyce McDougall (1995) uses the term "neosexual" to qualify the kind of scenarios described above and suggests that "perverse" be applied exclusively to specific relations, notably sexual relations, imposed by one individual on another who does not consent thereto (as for instance a child or a mentally disturbed person): in other words, sexual relationships in which one of the partners is utterly indifferent to the vulnerability or the desire of the other. It is worth noting that these same acts belong more often than not to the class of behavior that is condemned by the law: sexual abuse of minors, rape, exhibitionism, and so forth. The sexual activity of consenting adults, whether or not it is considered deviant with respect to supposed norms, tends not to be treated as illegal.

In short, where neosexual practices do no harm to either partner, nor seem to display a relentless compulsiveness of which the subject him or herself complains, the analyst has no cause to wish another erotic perspective upon the patient. It should be remembered that neosexualities serve not only to repair breaches in the sense of sexual and subjective identity but also, unconsciously, to protect their internal objects from the subject's hate and destructiveness, which derive in part from the unworked-out oral and anal impulses characteristic of incorporative infantile love. In the course of an analysis, the meaning of the love relationships of sexual innovators is revealed. It transpires in fact that their "choices" represent the best solution that the sometime child was able to find in response to messages from the parents. The feeling of choice is nonexistent, whether the individual is heterosexual, homosexual, autosexual, and/or neosexual.

Thanks to the uncovering of neosexual scenarios, what had been nonsensical becomes significant and meaningful, and a feeling of vitality prevails, at least momentarily, over inner death. These same problems might otherwise have produced graver outcomes of a psychotic or psychopathological order. Despite the often constraining conditions imposed by patients' compulsions and anxiety, which so often define the repertoire of sexual deviations, the underlying self-curative intent in face of conflicts of a neurotic or psychotic kind means that Thanatos is bound and that Eros triumphs over death.

Bibliography

Freud, Sigmund. (1905d). Three essays on the theory of sexuality. SE, 7: 123-234.

Lacan, Jacques. (2002 [1955-56]). On a question prior to any possible treatment of psychosis. InÉcrits: A selection. (Bruce Fink, Trans.). New York: Norton.

McDougall, Joyce. (1995). The many faces of Eros: A psychoanalytic exploration of human sexuality. New York: W.W. Norton.

Stoller, Robert. (1975). Perversion: The erotic form of hatred. New York: Pantheon.

Further Reading

Bach, Sheldon. (1994). The language of perversion and the language of love. Northvale, NJ: Jason Aronson.

Goldberg, Arnold. (1995). The problem of perversion. The view from self psychology. New Haven, CT: Yale University Press.

Kernberg, Otto F. (1991). Sadomasochism, sexual excitement, and perversion. Journal of the American Psychoanalytic Association, 39, 333-362.

—JOYCE MCDOUGALL

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Paraphilia

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Paraphilia
Classification and external resources
MeSH D010262

Paraphilia (in Greek para παρά = beside and -philia φιλία = friendship, meaning love) is a biomedical term used to describe sexual arousal to objects, situations, or individuals that are not part of normative stimulation and that may cause distress or serious problems for the paraphiliac or persons associated with him or her. A paraphilia involves sexual arousal and gratification towards sexual behavior that is atypical or extreme.[1] The term was coined by Wilhelm Stekel in the 1920s.[2] Sexologist John Money later popularized the term as a nonpejorative designation for unusual sexual interests.[3][4][5][6] He described paraphilia as "a sexuoerotic embellishment of, or alternative to the official, ideological norm."[7]

In the late 19th century, psychologists and psychiatrists started to categorize various paraphilias as they wanted a more descriptive system than the legal and religious constructs of sodomy[8] and perversion.[9] Before the introduction of the term paraphilia in the DSM-III (1980), the term sexual deviation was used to refer to paraphilias in the first two editions of the manual.[10] In 1981 an article published in American Journal of Psychiatry described paraphilia as "recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving:[11]

  1. Non-human objects
  2. The suffering or humiliation of oneself or one's partner
  3. Children
  4. Non-consenting persons[12]

Until 1973, homosexuality was included in this list.[13][14][15][16]

The view of paraphilias as disorders is not universal. Some groups seeking greater understanding and acceptance of sexual diversity have lobbied for changes to the legal and medical status of unusual sexual interests and practices. Charles Allen Moser, a physician and advocate for sexual minorities, has argued that the diagnoses should be eliminated from diagnostic manuals.[17] Psychiatrist Glen Gabbard writes that despite efforts by Stekel and Money, "the term paraphilia remains pejorative in most circumstances."[18]

In the current version of the DSM (DSM-IV-TR), a paraphilia is not diagnosable as a psychiatric disorder unless it causes distress to the individual or harm to others.[1] The DSM-5 draft adds a terminology distinction between the two cases, stating that "paraphilias are not ipso facto psychiatric disorders", and defining paraphilic disorder as "a paraphilia that causes distress or impairment to the individual or harm to others".[19] This will make a clear distinction between a healthy person with a non-normative sexual behavior and a person with a psychopathological non-normative sexual behavior.

Contents

General concerns

Terminological

Paraphilial psychopathology is not the same as psychologically normative adult human sexual behaviors, sexual fantasy, and sex play. These terms have been used in interchangeable ways which can allow for cognitive and clinical diagnostic misjudgment to occur. Consensual adult activities and adult entertainment that may involve some aspects of sexual roleplay, novel, superficial, or trivial aspects of sexual fetishism, or may incorporate the use of sex toys are not necessarily paraphilic.[12]

Classification

It is not known how many different kinds of paraphilias exist; one source lists as many as 549 paraphilias.[20] Because so many paraphilias exist, one needs to classify them in an orderly and meaningful way. It has long been argued that the Diagnostic and Statistical Manual of Mental Disorders (DSM) system of classification makes unjustified categorical distinctions between disorders, and between normal and abnormal. Although the DSM-5 may move away from this categorical approach in some limited areas, some argue that a fully dimensional, spectrum or complaint-oriented approach would better reflect the evidence.[21][22]

There is scientific and political controversy regarding the continued inclusion of sex-related diagnoses such as the paraphilias in the DSM.[23]

Homosexuality

Homosexuality was at one time categorized as a form of paraphilia.[14] Sigmund Freud and his proponents considered homosexuality and paraphilias to be forms of psychosexual infantilism. In a 1951 symposium discussing psychiatrist Benjamin Karpman's paper "The Sexual Psychopath,"[24] psychiatrist Emil Gutheil said, "Looking back upon my own experience with so-called psychopaths, I find one characteristic they all have in common, and that is their infantilism. Take the man who is a homosexual. In his paraphilia he regresses to the time he was bisexual, that is, to his infantile level."[24]

By the mid-20th century, mental health practitioners began formalizing "deviant sexuality" classifications into categories. Researcher Anil Aggrawal writes that the 1952 first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) specified "the type of the pathological behavior, such as homosexuality, transvestism, pedophilia, fetishism, and sexual sadism, including rape, sexual assault, mutilation)."[25] Originally coded as 000-x63, homosexuality was the top of the classification list (Code 302.0) until the American Psychiatric Association removed homosexuality from the DSM in 1973. Other organizations followed suit, including the American Psychological Association in 1975, and the National Association of Social Workers.[26] Martin Kafka writes, "Sexual disorders once considered paraphilias (e.g., homosexuality) are now regarded as variants of normal sexuality."[16]

A 2012 literature study comparing homosexuality with paraphilias confirmed that homosexuality was sufficiently dissimilar from the paraphilias as to be considered an unrelated construct.[27]

Clinical views

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Neurodevelopmental correlates in men

The causes of paraphilic sexual preferences in men are unclear, although a growing body of research points to a possible prenatal neurodevelopmental correlation. A 2008 study analyzing the sexual fantasies of 200 heterosexual men by using the Wilson Sex Fantasy Questionnaire exam, determined that males with a pronounced degree of fetish interest had a greater number of older brothers, a high 2D:4D digit ratio (which would indicate excessive prenatal estrogen exposure), and an elevated probability of being left-handed, suggesting that disturbed hemispheric brain lateralization may play a role in deviant attractions.[28]

Classifications and theories

Albert Eulenburg (1914) noted a commonality across the paraphilias, using the terminology of his time, "All the forms of sexual perversion...have one thing in common: their roots reach down into the matrix of natural and normal sex life; there they are somehow closely connected with the feelings and expressions of our physiological erotism. They are...hyperbolic intensifications, distortions, monstrous fruits of certain partial and secondary expressions of this erotism which is considered 'normal' or at least within the limits of healthy sex feeling."[29]

The clinical literature contains reports of many paraphilias, only some of which receive their own entries in the diagnostic taxonomies of the American Psychiatric Association or the World Health Organization.[30][31] There is disagreement regarding which sexual interests should be deemed paraphilic disorders versus normal variants of sexual interest. For example, as of May 2000, per DSM-IV-TR, "Because some cases of Sexual Sadism may not involve harm to a victim (e.g., inflicting humiliation on a consenting partner), the wording for sexual sadism involves a hybrid of the DSM-III-R and DSM-IV wording (i.e., “the person has acted on these urges with a non-consenting person, or the urges, sexual fantasies, or behaviors cause marked distress or interpersonal difficulty”)".[32]

Diagnostic and Statistical Manual of Mental Disorders

DSM-I and DSM-II

In American psychiatry, prior to the publication of the DSM-I, paraphilias were classified as cases of "psychopathic personality with pathologic sexuality". The DSM-I (1952) included sexual deviation as a personality disorder of sociopathic subtype. The only diagnostic guidance was that sexual deviation should have been "reserved for deviant sexuality which [was] not symptomatic of more extensive syndromes, such as schizophrenic or obsessional reactions". The specifics of the disorder were to be provided by the clinician as a "supplementary term" to the sexual deviation diagnosis; examples of this supplementary term provided in the DSM-I included homosexuality, transvestism, pedophilia, fetishism, and sexual sadism, including rape. There were no restrictions in the DSM-I on what this supplementary term could be.[33]

The DSM-II (1968) continued to use the term "sexual deviations", but no longer ascribed them under personality disorders, but rather them alongside them in a broad category titled "personality disorders and certain other nonpsychotic mental disorders". The types of sexual deviations listed in the DSM-II were: sexual orientation disturbance (homosexuality), fetishism, pedophilia, transvestitism (sic), exhibitionism, voyeurism, sadism, masochism, and "other sexual deviation". No definition or examples were provided for "other sexual deviation", but the general category of sexual deviation was meant to describe the sexual preference of individuals that was "directed primarily toward objects other than people of opposite sex, toward sexual acts not usually associated with coitus, or toward coitus performed under bizarre circumstances, as in necrophilia, pedophilia, sexual sadism, and fetishism."[34] Except for the removal of homosexuality from the DSM-III onwards, this definition provided a general standard that has guided specific definitions of paraphilias in subsequent DSM editions, up to DSM-IV-TR.[35]

DSM-III through DSM-IV-TR

The term "paraphilia" was introduced in the DSM-III (1980) as a subset of the new category of "psychosexual disorders". The types of paraphlias listed were: fetishism, transvestism, zoophilia, pedophilia, exhibitionism, voyeurism, sexual masochism, sexual sadism, and "atypical paraphilia". The DSM-III-R (1987) renamed the broad category to sexual disorders, renamed atypical paraphilia to paraphilia NOS (not otherwise specified), finessed transvestism as transvestic fetishism, added frotteurism, and removed zoophilia, relegating it to the NOS category. It also provided seven nonexhaustive examples of NOS paraphilias, which besides zoophilia included telephone scatologia, necrophilia, partialism, coprophilia, klismaphilia, and urophilia.[36]

The DSM-IV (1994) retained the sexual disorders classification for paraphlias, but added an even broader category, "sexual and gender identity disorders", which includes them. The DSM-IV retained the same types of paraphilias listed in DSM-III-R, including the NOS examples, but introduced some changes to the definitions of some specific types.[35]

Paraphilias are defined by DSM-IV-TR as sexual disorders characterized by "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 nonconsenting persons that occur over a period of 6 months" (Criterion A), which "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" (Criterion B). DSM-IV-TR describes 8 specific disorders of this type (exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, voyeurism, and transvestic fetishism) along with a ninth residual category, paraphilia not otherwise specified (NOS).[37] Criterion B differs for exhibitionism, frotteurism, and pedophilia to include acting on these urges, and for sadism, acting on these urges with a nonconsenting person.[12]

Some paraphilias may interfere with the capacity for sexual activity with consenting adult partners.[12] According to the DSM, "Paraphilias are almost never diagnosed in females,"[12] but some case studies of females with paraphilias have been published.[38]

The DSM provides clinical criteria for these paraphilias:

  • Exhibitionism: the recurrent urge or behavior to expose one's genitals to an unsuspecting person, or to perform sexual acts that can be watched by others.
  • Fetishism: the use of inanimate objects to gain sexual excitement. Partialism refers to fetishes specifically involving nonsexual parts of the body.
  • Frotteurism: recurrent urges of behavior of touching or rubbing against a nonconsenting person.
  • Pedophilia: strong sexual attraction to prepubescent children.[39]
  • Sexual Masochism: the recurrent urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made to suffer for sexual pleasure.
  • Sexual Sadism: the recurrent urge or behavior involving acts in which the pain or humiliation of a person is sexually exciting.
  • Transvestic fetishism: arousal from wearing "clothing associated with members of the opposite sex."[12][40]
  • Voyeurism: the recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing, or engaging in sexual activities, or who is engaging in activities usually considered to be of a private nature.[41][42]

Under Paraphilia NOS, the DSM mentions telephone scatalogia (obscene phone calls), necrophilia (corpses), partialism (exclusive focus on one part of the body), zoophilia (animals), coprophilia (feces), klismaphilia (enemas), urophilia (urine), emetophilia (vomit). The DSM's Paraphilia NOS is equivalent to the ICD-9's Sexual Disorder NOS.

Sexual arousal in association with objects that were designed for sexual purposes is not diagnosable in DSM-IV (DSM, p. 570).[12]

DSM-5 draft

The DSM-5 Paraphilias Subworkgroup reached a "consensus that paraphilias are not ipso facto psychiatric disorders", and proposed "that the DSM-V make a distinction between paraphilias and paraphilic disorders. A paraphilia by itself would not automatically justify or require psychiatric intervention. A paraphilic disorder is a paraphilia that causes distress or impairment to the individual or harm to others. One would ascertain a paraphilia (according to the nature of the urges, fantasies, or behaviors) but diagnose a paraphilic disorder (on the basis of distress and impairment). In this conception, having a paraphilia would be a necessary but not a sufficient condition for having a paraphilic disorder." The 'Rationale' page of any paraphilia in the electronic DSM-5 draft continues: "This approach leaves intact the distinction between normative and non-normative sexual behavior, which could be important to researchers, but without automatically labeling non-normative sexual behavior as psychopathological. It also eliminates certain logical absurdities in the DSM-IV-TR. In that version, for example, a man cannot be classified as a transvestite—however much he cross-dresses and however sexually exciting that is to him—unless he is unhappy about this activity or impaired by it. This change in viewpoint would be reflected in the diagnostic criteria sets by the addition of the word “Disorder” to all the paraphilias. Thus, Sexual Sadism would become Sexual Sadism Disorder; Sexual Masochism would become Sexual Masochism Disorder, and so on."[19]

Bioethics professor Alice Dreger interpreted these changes as "a subtle way of saying sexual kinks are basically okay – so okay, the sub-work group doesn’t actually bother to define paraphilia. But a paraphilic disorder is defined: that’s when an atypical sexual interest causes distress or impairment to the individual or harm to others." Interviewed by Dreger, Ray Blanchard, the Chair of the Paraphilias Sub-Work Group, explained: "We tried to go as far as we could in depathologizing mild and harmless paraphilias, while recognizing that severe paraphilias that distress or impair people or cause them to do harm to others are validly regarded as disorders."[43]

Charles Allen Moser pointed out that this change is not really substantive as DSM-IV already acknowledged a difference between paraphilias and non-pathological but unusual sexual interests, a distinction that is virtually identical to what is being proposed for DSM-5, and it is a distinction that, in practice, has often been ignored.[44] Linguist A. C. Hinderliter argued that "Including some sexual interests—but not others—in the DSM creates a fundamental asymmetry and communicates a negative value judgment against the sexual interests included," and leaves the paraphilias in a situation similar to ego-dystonic homosexuality, which was removed from the DSM because it did not meet the DSM's definition of mental disorder.[45]

Historian and philosopher of science Patrick Singy claims that the DSM-5 is about to drastically loosen the criteria for paraphilias and to make them directly dependent on cultural values. The DSM-5 will then be closer to the DSM-I and DSM-II than to their successors, which all were at least trying to separate the concept of "mental disorder" from cultural norms, and which made "harm" or "distress" a necessary condition for having a mental disorder.[46]

Intensity and specificity

Clinicians distinguish between optional, preferred and exclusive paraphilias,[12] though the terminology is not completely standardized. An "optional" paraphilia is an alternative route to sexual arousal. For example, a man with otherwise unremarkable sexual interests might sometimes seek or enhance sexual arousal by wearing women's underwear. In preferred paraphilias, a person prefers the paraphilia to conventional sexual activities, but also engages in conventional sexual activities. For example, a man might prefer to wear women's underwear during sexual activity, whenever possible. In exclusive paraphilias, a person is unable to become sexually aroused in the absence of the paraphilia.[citation needed]

The literature includes single-case studies of exceedingly rare and idiosyncratic paraphilias. These include an adolescent male who had a strong fetishistic interest in the exhaust pipes of cars, a young man with a similar interest in a specific type of car, and a man who had a paraphilic interest in sneezing (both his own and the sneezing of others).[47][48] See also List of paraphilias.

Drug treatments

The treatment of paraphilias and related disorders has been challenging for patients and clinicians. In the past, surgical castration was advocated as a therapy for men with pedophilia, but has been abandoned for the time being because most governments consider it a cruel punishment where the express willingness and consent of the patient is not objectively indicated. Psychotherapy, self-help groups, and pharmacotherapy (including anti-androgen hormone therapy sometimes referred to as "chemical castration") have all been used. Other drug treatments for these disorders do exist, however.[49]

Hormonal

Antiandrogenic drugs such as medroxyprogesterone (also known as the long-acting contraceptive Depo Provera) have been widely used as therapy in these men to reduce sex drive. However, their efficacy is limited and they have many side effects, including breast growth, headaches, weight gain, and reduction in bone density. Even if compliance is good, only 60 to 80 percent of men benefit from this type of drug. Long-acting gonadotropin-releasing hormones, such as Triptorelin (Trelstar) which reduces the release of gonadotropin hormones, are also used. This drug is a synthetic hormone which may also lead to reduced sex drive.[49]

Psychoactive

Psychostimulants have been used recently to augment the effects of serotonergic drugs in paraphiliacs. In theory, the prescription of a psychostimulant without pretreatment with an SSRI might further disinhibit sexual behavior, but when taken together, the psychostimulant may actually reduce impulsive tendencies. Methylphenidate (Ritalin) is an amphetamine-like stimulant used primarily to manage the symptoms of attention deficit hyperactivity disorder (ADHD). Recent studies imply that methylphenidate may also act on serotonergic systems; this may be important in explaining the paradoxical calming effect of stimulants on ADHD patients. Amphetamine is also used medically as an adjunct to antidepressants in refractory cases of depression.[49]

United States legal cases

In the United States, following a series of landmark cases in the Supreme Court of the United States, persons diagnosed with paraphilias and a history of anti-social behavior, particularly pedophilia (Kansas v. Hendricks, 1997) and exhibitionism (Kansas v. Crane, 2002), can be held indefinitely in civil confinement under various state legislation generically known as Sexually violent predator laws[50][51] and the federal Adam Walsh Act (United States v. Comstock, 2010).[52][53]

See also

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References

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Bibliography
Further reading

External links

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Translations:

Perversion

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Home > Library > Literature & Language > Translations

Dansk (Danish)
n. - forvrængning, unaturlighed

Nederlands (Dutch)
perversiteit, perversie

Français (French)
n. - perversion, travestissement

Deutsch (German)
n. - Perversion, Mißbrauch, Verzerrung, Verdrehung

Ελληνική (Greek)
n. - διαστροφή, ανωμαλία, βίτσιο

Italiano (Italian)
perversione, deformazione

Português (Portuguese)
n. - perversão (f), corrupção (f), desvio (m)

Русский (Russian)
извращение, искажение

Español (Spanish)
n. - perversión, desnaturalización

Svenska (Swedish)
n. - förvrängning, onaturlighet, framhärdande

中文（简体）(Chinese (Simplified))
颠倒, 曲解

中文（繁體）(Chinese (Traditional))
n. - 顛倒, 曲解

한국어 (Korean)
n. - 곡해, 남용, 타락, 성도착

日本語 (Japanese)
n. - 曲解, 濫用, 悪用, 倒錯, 悪化

العربيه (Arabic)
‏(الاسم) إنحراف, فساد‏

עברית (Hebrew)
n. - ‮סטייה, נלוזות, עיוות, סילוף, שימוש שלילי בדבר, פעילות מינית לא-נורמלית‬

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