The DSM diagnostic criteria for paraphilia not otherwise specified

Coprophilia and Coprophagia: A Literature Review

BACKGROUND

Coprophilia and coprophagia are distinct paraphilias that fall under the category of other specified paraphilic disorders in the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Coprophilia refers to sexual excitement from viewing, smelling, or handling feces, as well as fantasizing about another person engaging in these activities. Coprophagia, or eating one's own or another person's excrement, has also been observed in some patients with coprophilia.

AIMS

The purposes of this review are to examine the current literature on the etiology, symptoms, interviewing techniques, pharmacotherapy, and psychotherapy used for each disorder and to elicit best practice guidelines in the treatment of patients with coprophila and coprophagia.

METHODS

Electronic and hand searches were initiated using CINAHL, EBSCOhost, SAGEpub, and MEDLINE databases between 1990 and 2022 using the terms "coprophilia," "coprophagia," "paraphilia NOS," and "other specified paraphilic disorder" restricted to English.

RESULTS

Individual case reports and limited studies were found in this literature. Reported treatment protocols included individual and tandem use of pharmacotherapy and psychotherapy, with mixed outcomes. Future studies are needed to explore the factors that mitigate the paraphilias, therapeutic management, and treatment outcomes, to produce evidence-based practice treatment guidelines.

CONCLUSIONS

Understanding the psychological and biological factors that may contribute to these disorders' manifestations may portend a greater understanding and insight into the genesis of the paraphilias. Having specific evidence-based treatment protocols will afford the psychiatric nurse practitioner to render patient-centered, safe, and culturally competent care and effect better patient outcomes among this understudied population.

The impact of androgen deprivation therapy on bone mineral density in men treated for paraphilic disorder: A retrospective cohort study

BACKGROUND

Guidelines suggest treating men with paraphilic disorder with androgen-deprivation therapy (ADT). However, little evidence is available about the long-term impact on bone loss and how to manage this adverse event.

OBJECTIVES

The aim of this study is to assess the impact of ADT on bone mineral density (BMD) in men treated for paraphilic disorder with the androgen receptor blocker cyproterone acetate (CPA) and/or GnRH agonist triptoreline (GnRHa) and to evaluate the effect of treatment with bisphosphonates.

METHODS

Baseline and follow-up dual-energy X-ray absorptiometry scan (DXA-scan) data (lumbar and femoral T-scores) were retrospectively extracted from electronic medical files of paraphilic men who received CPA and/or GnRHa.

RESULTS

A total of 53 patients with a mean age of 39.1 years (range 17.5-74.6) were included. Lumbar (-0.39 ± 0.17, Mean ± SEM, p = 0.046), femoral neck (-0.34 ± 0.09, p = 0.002) and total femur (-0.33 ± 0.12, p = 0.014) T-scores decreased significantly in the CPA-only group (n = 13) during a mean follow-up of 6.0 ± 5.3 years. In the GnRHa group (n = 29), T-scores at all sites decreased significantly over 6.6 ± 4.4 years (lumbar: -0.55 ± 0.12, p < 0.001, femoral neck: -0.53 ± 0.09, total femur: -0.44 ± 0.09, p < 0.001). In the group, who received bisphosphonates (n = 11), no significant T-score change was observed (lumbar: -0.25 ± 0.14, p = 0.106, femoral neck -0.15 ± 0.17, p = 0.402, total femur -0.25 ± 0.14, p = 0.106) during 5.0 ± 2.8 years of follow-up.

DISCUSSION AND CONCLUSION

Following a mean duration of 6 years of ADT, we observed a significant decline in BMD of approximately half a standard deviation in T-score at lumbar and femoral site. Although the number of patients who received bisphosphonates was limited, this treatment seems to have a positive stabilizing effect on bone density.

Stigmatization of Paraphilias and Psychological Conditions Linked to Sexual Offending

Except for pedophilia, little is known about public attitudes toward paraphilias and psychological conditions that are considered risk factors for sexual offending. In the present study we sought to compare the stigma attached to pedophilia with attitudes toward sexual sadism and antisocial tendencies (Study 1, N = 720) and with attitudes toward necrophilia and zoophilia (Study 2, N = 210) in convenience samples of community individuals. When investigating social distance intentions both studies explicitly referred to people with paraphilic sexual interests or antisocial tendencies who had not committed any crimes. In both studies, people with pedophilia emerged as highly stigmatized even though most participants showed awareness that pedophilic interests cannot be chosen or changed at will. The present studies solidify the evidence that pedophilia occupies a place in the public consciousness as less deserving of acceptance than most other sexual offending risk-relevant conditions, including ones that compare in terms of rarity.

Critical evaluation of arguments opposing male circumcision: A systematic review

OBJECTIVE

To systematically evaluate evidence against male circumcision (MC).

METHODS

We searched PubMed, Google Scholar, EMBASE and Cochrane databases.

RESULTS

Database searches retrieved 297 publications for inclusion. Bibliographies of these yielded 101 more. After evaluation we found: Claims that MC carries high risk were contradicted by low frequency of adverse events that were virtually all minor and easily treated with complete resolution. Claims that MC causes psychological harm were contradicted by studies finding no such harm. Claims that MC impairs sexual function and pleasure were contradicted by high-quality studies finding no adverse effect. Claims disputing the medical benefits of MC were contradicted by a large body of high-quality evidence indicating protection against a wide range of infections, dermatological conditions, and genital cancers in males and the female sexual partners of men. Risk-benefit analyses reported that benefits exceed risks by 100-200 to 1. To maximize benefits and minimize risks, the evidence supported early infant MC rather than arguments that the procedure should be delayed until males are old enough to decide for themselves. Claims that MC of minors is unethical were contradicted by balanced evaluations of ethical issues supporting the rights of children to be provided with low-risk, high-benefit interventions such as MC for better health. Expert evaluations of case-law supported the legality of MC of minors. Other data demonstrated that early infant MC is cost-saving to health systems.

CONCLUSIONS

Arguments opposing MC are supported mostly by low-quality evidence and opinion, and are contradicted by strong scientific evidence.

A Qualitative Exploration of Adult Baby/Diaper Lover Behavior From an Online Community Sample

This study examined qualitative data on 1,795 male, 139 female, and 78 transgender members of the adult baby/diaper lover (ABDL) online community. Using grounded theory, the analyses examined a description of ABDL practices, explored evidence of subgroups within the ABDL community, and examined the degree to which ABDL behavior involves sexual motivations. Overall, the data suggest there is a fair amount of diversity within the ABDL community. Most participants enjoy wearing diapers or engaging in age regression (as babies or children), and the importance of incontinence may vary. ABDL practices can reflect bondage play for some individuals and a way to cope with medical problems for others. Overall, there is modest evidence of more than two ABDL subgroups. Although a large number of individuals do not see their ABDL practices as sexual in nature, there is a clear contingent that describes sexual motivations. For some, sex during ABDL activity violates conceptions of baby play. Nonsexual motivations include a desire to relax or be carefree as well as a desire to be nurtured. Some diaper lovers and adult babies have the same goals but achieve them in different ways. ABDL practices may be as diverse as seemingly typical sexual behaviors.

Personality Disorder Features and Paraphilic Interests Among Undergraduates: Differential Relations and Potential Antecedents

We examined the relations between: (1) narcissism, psychopathy, DSM-5 personality disorder symptom counts; and (2) paraphilic interests among undergraduates (N = 608). Base rates of paraphilic interests were appreciable. The disinhibition and meanness features of psychopathy and the entitlement and exploitativeness features of narcissism were robustly associated with paraphilic interests, particularly sexual sadism, whereas the boldness features of narcissism and psychopathy were essentially unrelated to these interests. Narcissism and psychopathy features typically manifested the most pronounced relations with paraphilic interests, although antisocial personality disorder features were also strong predictors. By and large, these relations were comparable across gender. Lastly, there was no evidence that erotophilia mediated the relations between the narcissism and psychopathy features and paraphilic interests, most likely because erotophilia was generally unrelated to paraphilic interests. Relative to other dimensions of personality disorders, facets of meanness and disinhibition from psychopathy and entitlement/exploitativeness facets from narcissism were most associated with paraphilic interests.

Disinhibited Exposing Behavior, Hypersexuality, and Erectile Dysfunction as a Consequence of Posttraumatic Stress in a 42-Year-Old Male Patient

Research into sexual dysfunction and its explanations within a cognitive behavioral framework in patients with posttraumatic stress is sparse. In this report, we present the case of a 42-year-old male with severe posttraumatic stress symptoms who displayed apparent exhibitionistic behavior, hypersexual behavior in the form of excessive masturbation, and erectile dysfunction. Differential diagnostics showed that the presented exhibitionistic behavior could be more accurately classified as non-paraphilic disinhibited exposing behavior. Functional behavioral analysis of his sexual behavior suggested that disinhibited exposing and hypersexual behavior served as dysfunctional coping strategies for trauma-associated negative emotions. Erectile dysfunction seemed to be the result of trauma-associated hyperarousal and excessive masturbation. Within the context of operant learning processes, we propose that his sexual behaviors became highly automated and were used as the main strategies to regulate trauma-associated negative emotions. Implications for the diagnoses and suggestions for the conceptualization and incorporation into a cognitive behavioral therapy treatment of posttraumatic stress disorder are made.

Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11)

The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH's proposals for Paraphilic Disorders in ICD-11 are based on the WHO's role as a global public health agency and the ICD's function as a public health reporting tool.

Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy

We evaluate recent claims opposing infant male circumcision, a procedure now supported by the evidence-based policy of the American Academy of Pediatrics. We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development. An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological, scheduling and financial burdens later circumcision entails, so reducing the likelihood that it will occur. In contrast, early infant circumcision is convenient, safer, quicker, lower risk, healing is faster, cosmetic outcome is routinely good and the lifetime benefits accrue immediately. Benefits include reduction in urinary tract infections, inflammatory skin conditions, foreskin problems, and, when older, substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners. Some authorities regard the failure to offer parents early infant circumcision as unethical, just as it would be unethical to fail to encourage the vaccination of children. In conclusion, the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing.

A Preliminary Model of Motivation for Pornography Consumption Among Men Participating in Zoophilic Virtual Environments

Although zoophilic blogs and websites attract the attention of zoophiles and others who are curious about this sexual activity, the motivations for consuming this type of pornography are not clear. This study aimed to confirm the factorial validity of the Pornography Consumption Inventory in an online sample of men with sexual interest in animals, and to construct an association model between motivations for pornography consumption and the following psychological variables: depression, sexual impulsiveness, and strength of sexual interest in animals. In this cross-sectional study, we located a website that catered to a network of people with a sexual interest in animals. Subsequently, a questionnaire was made available online to members of this network. Results support the 4-factor model of the Pornography Consumption Inventory. Depression and strength of sexual interest in animals were negatively and positively correlated with the sexual curiosity factor, respectively. Sexual impulsiveness was positively associated with the emotional avoidance, excitement seeking, and sexual pleasure factors. Depression and sexual impulsiveness were positively correlated. Psychological factors can differently motivate the consumption of pornography among men who visit zoophilic blogs and websites. With these preliminary data, we can identify some characteristics of this population.

Splitting hairs: differentiating between entomological activity, taphonomy, and sharp force trauma on hair

PURPOSE

The analysis of hair can provide useful information for the correct evaluation of forensic cases, but studies of trauma on hair are extremely rare. Hair may present lesions caused by traumatic events or by animals: in fact, signs of sharp force weapons on hair may provide important information for the reconstruction of the manner of death, and, for example, may suggest fetishist practice. This study stemmed from a judicial case where it was fundamental to distinguish between sharp force lesions and insect activity on hair.

METHODS

In order to highlight differences between sharp force lesions and insect feeding activity, different experiments were performed with high power microscopy: hair samples were subjected to several lesions by blunt and sharp force trauma; then samples were used as pabulum for two taxa of insects: the common clothes moth (Tineola bisselliella Lepidoptera, Tineidae) and the carpet beetle (Anthrenus sp., Coleoptera, Dermestidae). Hairs were examined from a macroscopic and microscopic point of view by stereomicroscopy and scanning electron microscopy (SEM): the morphological characteristics of the lesions obtained from the different experimental samples were compared.

RESULTS

Results show that sharp force trauma produces lesions with regular edges, whereas insects leave concave lesions caused by their "gnawing" activity. These two types of lesions are easily distinguishable from breaking and tearing using SEM.

CONCLUSIONS

This study demonstrates that insect activity leaves very specific indications on hair and sheds some light on different hair lesions that may be found in forensic cases.

Adult baby/diaper lovers: an exploratory study of an online community sample

This internet-based study provided descriptive information and exploratory analyses on 1,795 male and 139 female members of the Adult Baby/Diaper Lover (ABDL) community. Based on prior research, some research questions focused on the degree to which ABDL behavior was associated with negative mood states, parental relationships, and attachment style. Based on clinical experience, a second research question focused on discerning two possible subgroups within the ABDL community: persons focused on role play behavior and persons who were primarily interested in sexual arousal in their ABDL behavior. The results showed modest support for the former research questions, but notable support for the last research question. Because of some overlap between the two hypothesized subgroups, additional subgroups may exist. Males in the ABDL community identified their ABDL interests earlier than females and these males may be more focused on sexual aspects of ABDL practices. Both males and females perceived being dominated as important in their ABDL behavior. Most participants were comfortable with their ABDL behavior and reported few problems. ABDL behavior may represent a sexual subculture that is not problematic for most of its participants.

[Deviant sexual behaviors, paraphilias, perversions]

OBJECTIVE

To know the new concept of paraphilias, their clinical presentation and their link with a personality disorder as perversion, the French legislation concerning them and the different therapeutic options.

MATERIAL AND METHODS

Review of guidelines published on this subject in the Medline database and a reflexion from our own clinical experience, especially in the judicial expertise.

RESULTS

Deviant sexual behavior is, in current classifications, known as paraphilia. This clinical entity corresponds to any sexual behavior considered "abnormal" compared with sexual acts in the society where the person lives. It means precisely, firstly, suffering caused by this disorder or deterioration of social, professional, or family life. Paraphilia such as pedophilia have strict age limits. The victim must be aged below 16 years, with an age difference of at least 5 years with the author of the act. Sexual acts which are illegal are crimes or offences according to the degree, and are sanctioned by the law. In ordinary terms, they are known as perverts, committing perversions. This concept is different from that of paraphilia, a pervert can have, or not have, paraphiliac behavior. In order to diagnose a personality disorder such as perversion, all the criteria must be included: narcissism, use of a person as an object for pleasure, with, primarily, mechanisms of denial and a split personality which removes any feeling of guilt from the perpetrator.

CONCLUSION

Medical treatment of paraphilia alone is not satisfactory for the denial mechanism is such that only the sex drive is affected with a high risk of recurrence. Only psychotherapy can modify the pathological element of a perverted personality.