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Arnone JM, Conti RP, Preckajlo JH. Coprophilia and Coprophagia: A Literature Review. J Am Psychiatr Nurses Assoc 2024; 30:8-16. [PMID: 38050323 DOI: 10.1177/10783903231214265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
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.
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Affiliation(s)
| | | | - Joseph H Preckajlo
- Joseph H. Preckajlo, MA, Florida Institute of Technology, Melbourne, FL, USA
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Liu A, Zhang E, Leroux EJ, Benassi P. Sexual Sadism Disorder and Coercive Paraphilic Disorder: A Scoping Review. J Sex Med 2022; 19:496-506. [PMID: 35153163 DOI: 10.1016/j.jsxm.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Valid and reliable diagnostic criteria are essential in forensic psychiatry and sexual medicine due to the severe implications of potential misdiagnoses. One challenge in this field is the poor operationalization of sexual sadism disorder (SSD) and coercive paraphilic disorder (CP+) definitions. AIM The aim of this scoping literature review is to provide a comprehensive overview of the key conceptual differences between SSD and CP+, as well as consider pragmatic and clinically useful approaches to their diagnostic formulation. METHODS Arksey and O'Malley's methodological framework was followed. A literature search of Medline, PsychInfo, Web of Science, and Cumulative Index to Nursing and Allied Health Literature electronic databases was conducted. Publications in English describing the construct and/or operational definition of SSD or CP+ were included. Full-text studies were reviewed by 2 authors and data was charted and synthesized qualitatively. RESULTS The initial search provided 1,271 records, after which 120 full-text papers were considered for eligibility and 48 studies were ultimately included. The most common sources of definitions for SSD and CP+ were the Diagnostic and Statistical Manual of Mental Disorders (n = 53) and the International Classification of Disease (n = 12). There was more variation of terms used for CP+ than SSD. Both CP+ and SSD are critiqued by reviewed literature for having low validity, reliability, and consistency, as well as being conflated with sexual crime. SSD is better described due to having diagnostic criteria and validated diagnostic tools. CLINICAL IMPLICATIONS Currently, clinicians rely mostly on the DSM to diagnose SSD or CP+. As applications of SSD and CP+ definitions vary, interpretations may not be generalizable between clinicians. Furthermore, specific diagnoses may be practically unhelpful and unreliable. It may therefore be beneficial for treatment to be determined by risk of harm. In addition to these concerns, the stigma associated with SSD and CP+ may also impact treatment. STRENGTHS & LIMITATIONS Strengths of this study include duplicate review and charting to increase methodological rigor, transparent reporting to minimize publication bias, and encompassing a comprehensive scope. Limitations include the weaknesses of low strength of reviewed literature and risk of publication bias. CONCLUSION Despite their significant implications, the definitions of SSD and CP+ are inconsistent and lack reliability. Future research is necessary to develop stronger diagnostic criteria and tools. Liu A, Zhang E, Leroux EJ et al. Sexual Sadism Disorder and Coercive Paraphilic Disorder: A Scoping Review. J Sex Med 2022;000:1-11.
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Affiliation(s)
- Alissa Liu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Emma Zhang
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Elisabeth J Leroux
- Sexual Behaviours Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Paul Benassi
- Sexual Behaviours Clinic, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry & Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Cranstoun LM, Moser C. The Paraphilias and Medical Licensure in the United States. J Sex Med 2021; 18:1130-1133. [PMID: 37057470 DOI: 10.1016/j.jsxm.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND As part of their mission to protect the public from exploitation, state medical boards query physicians about a wide range of topics prior to licensure, including in some cases whether the applicant has been diagnosed with or been treated for paraphilias or paraphilic disorders. AIM We investigated the prevalence of questions inquiring about the applicants' history of paraphilias and paraphilic disorders on applications for medical licensure. METHODS The allopathic medical licensure application forms for each of the 50 United States and the District of Columbia were reviewed. Medical boards with questions pertaining to paraphilias or paraphilic disorders were asked how many affirmative responses had been obtained in the prior 5 years and how they would treat an affirmative response. OUTCOMES Eight medical boards inquired about paraphilias or paraphilic disorders, however there was no evidence of an affirmative response to these questions in the prior 5 years. RESULTS Of the 51 applications reviewed, 8 (16%) inquired whether the applicant had, was diagnosed with, or had been treated for a paraphilia or paraphilic disorder. The wording of the questions was variable and often failed to distinguish between paraphilias and paraphilic disorders. All but one medical board responded to requests for further information. The medical board staff members stated that an affirmative response would result in case-by-case review, including request for further information and possibly an in-person appearance before the board. None of the medical boards were willing or able to provide a formal count of affirmative responses in the last 5 years. CLINICAL IMPLICATIONS Medical boards may be contributing to the stigma experienced by both physicians and patients with diverse sexual interests. The benefit of retaining these questions is not clear. STRENGTHS AND LIMITATIONS This study is the first to investigate the use of paraphilias and paraphilic disorders as screening questions for medical licensure. Data regarding the number of affirmative responses were limited by the medical boards' inability or unwillingness to respond to share the information. CONCLUSIONS Eliminating or modifying physician licensing application questions pertaining to paraphilias and paraphilic disorders may decrease the stigma encountered by persons with diverse sexual interests. Removal also may diminish the barriers to accessing health care services for both physicians and patients with diverse sexualities. If the questions are retained, they should conform to the current DSM-5 nosology, which distinguishes between the mere presence of a paraphilia and a diagnosis of a paraphilic disorder. Cranstoun LM, Moser C. The Paraphilias and Medical Licensure in the United States. J Sex Med 2021;18:1130-1133.
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Affiliation(s)
| | - Charles Moser
- Diverse Sexualities Research and Education Institute, San Francisco, CA, USA
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4
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Dunkley CR, Brotto LA. The Role of Consent in the Context of BDSM. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2020; 32:657-678. [PMID: 31010393 DOI: 10.1177/1079063219842847] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Consent represents a central focus in the controversial realm of BDSM-an overlapping acronym referring to the practices of Bondage and Discipline, Dominance and Submission, and Sadism and Masochism. Many authors have argued that the hallmark feature that distinguishes BDSM activity from abuse and psychopathology is the presence of mutual informed consent of all those involved. This review examines the relevant literature on consent in BDSM, including discussions on safety precautions, consent violations, North American laws pertaining to BDSM practice, and the role of the BDSM community with respect to education and etiquette surrounding consent. Practical information relevant to professionals who work toward the prevention of sexual exploitation and abuse is provided. The explicit approach to consent practiced by those in the BDSM community is proposed as a model for discussions around consent in clinical and educational contexts. Criteria for distinguishing abuse from BDSM and identifying abuse within BDSM relationships are outlined. It is our hope to demystify the consent process and add to the growing body of literature that destigmatizes consensual BDSM practices.
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Affiliation(s)
| | - Lori A Brotto
- The University of British Columbia, Vancouver, Canada
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5
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Abstract
There is no accepted definition of the term paraphilia despite its being listed as an essential feature of a class of mental disorders known as the paraphilic disorders. The origin of the term, history of its inclusion as a diagnosis, and logical flaws inherent in the various definitions are discussed in this review. We examine the basis for pathologizing individuals with paraphilias, consider what paraphilias can tell us about how humans develop their sexual interests, and question the usefulness of dividing sexual interests into paraphilias and normophilias. The construct of the paraphilias appears to be poorly conceived and has outlived its usefulness.
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Affiliation(s)
- Charles Moser
- Diverse Sexualities Research and Education Institute, San Francisco, California 94109, USA;
| | - Peggy J Kleinplatz
- Department of Family Medicine and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K2P 0X4, Canada;
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Oswald P, Ducro C, Alvarez L, Pham T. Évaluation du sadisme sexuel sévère dans un population médico-légale. Validation francophone de la Sexual Sadism Scale (SESAS). ANNALES MEDICO-PSYCHOLOGIQUES 2019. [DOI: 10.1016/j.amp.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Min H, Pavisic I, Howald N, Highhouse S, Zickar MJ. A systematic comparison of three sadism measures and their ability to explain workplace mistreatment over and above the dark triad. JOURNAL OF RESEARCH IN PERSONALITY 2019. [DOI: 10.1016/j.jrp.2019.103862] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Moser C. Sexual Harassment: "I Just Do Not Feel Safe". ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:681-689. [PMID: 31041732 DOI: 10.1007/s10508-018-1356-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/20/2018] [Indexed: 05/12/2023]
Affiliation(s)
- Charles Moser
- Diverse Sexualities Research and Education Institute, 2261 Market Street, #622, San Francisco, CA, 94114, USA.
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9
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Hughes SD, Hammack PL. Affirmation, compartmentalization, and isolation: narratives of identity sentiment among kinky people. PSYCHOLOGY & SEXUALITY 2019. [DOI: 10.1080/19419899.2019.1575896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sam D. Hughes
- Department of Psychology, University of California, Santa Cruz, CA, USA
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10
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Chester DS, DeWall CN, Enjaian B. Sadism and Aggressive Behavior: Inflicting Pain to Feel Pleasure. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2018; 45:1252-1268. [PMID: 30571456 DOI: 10.1177/0146167218816327] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Sadism is a “dark” trait that involves the experience of pleasure from others’ pain, yet much is unknown about its link to aggression. Across eight studies (total N = 2,255), sadism predicted greater aggression against both innocent targets and provocateurs. These associations occurred above-and-beyond general aggressiveness, impulsivity, and other “dark” traits. Sadism was associated with greater positive affect during aggression, which accounted for much of the variance in the sadism–aggression link. This aggressive pleasure was contingent on sadists’ perceptions that their target suffered due to their aggressive act. After aggression, sadism was associated with increases in negative affect. Sadism thus appears to be a potent predictor of aggression that is motivated by the pleasure of causing pain. Such sadistic aggression ultimately backfires, resulting in greater negative affect. More generally, our results support the crucial role of anticipated and positive forms of affect in motivating aggression.
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11
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Longpré N, Proulx J, Brouillette-Alarie S. Convergent Validity of Three Measures of Sexual Sadism: Value of a Dimensional Measure. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2018; 30:192-208. [PMID: 27229922 DOI: 10.1177/1079063216649592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sexual sadism can be described as the sexual pleasure produced by acts of cruelty and bodily punishment. The most common method for evaluating sexual sadism is clinical evaluation, that is, evaluation based on the diagnostic criteria of nosological instruments such as the Diagnostic and Statistical Manual of Mental Disorders ( DSM) or the International Classification of Diseases (ICD). It is also possible to evaluate sadistic sexual preferences by phallometry, which provides a physiological measure of sexual excitation by deviant and nondeviant scenarios. The most recently developed evaluation method is the Severe Sexual Sadism Scale (SESAS), a dimensional instrument that has been empirically validated. Despite the availability of all these measurement techniques, very little research has been conducted on their degree of convergence. Consequently, the aim of the current study was to assess the relationship between these three measures of sexual sadism. Our analyses were conducted on a sample of rapists ( N = 72), assessed in a maximum-security penitentiary. There was no significant relation between phallometric scores and other measures of sexual sadism. There was, however, an important correlation between SESAS scores and Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) sexual sadism diagnosis. Our results are consistent with other phallometric studies, which reported no difference in the penile responses of individuals diagnosed as sadists and those not diagnosed as sadists. Results and implications for future research are discussed.
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12
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Longpré N, Guay JP, Knight RA. MTC Sadism Scale: Toward a Dimensional Assessment of Severe Sexual Sadism With Behavioral Markers. Assessment 2017; 26:70-84. [DOI: 10.1177/1073191117737377] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sadism was initially described as the experience of sexual pleasure produced by acts of cruelty and bodily punishment. Sadism was conceptualized as if sadists were fundamentally different from nonsadists. Recent studies have suggested that sadism is distributed as a dimension rather than as a category. The aim of the current study was to assess the psychometric properties the MTC Sexual Sadism Scale. Our analyses were conducted on a sample of 486 sexual offenders assessed at a correctional institution in Massachusetts. In summary, the results indicate that the MTC Sexual Sadism Scale possesses good psychometric properties for the dimensional assessment of severe sexual sadism with behavioral markers. Moreover, the scale captures a wide range of intensity of sadism among sexual offenders. These results are consistent with prior research and support the current consensus to move toward a dimensional interpretation of sadism. Implications both for clinical assessment and for research on the development of sadism are discussed.
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13
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Abstract
Aggressive behavior hurts us all and is studied across psychology’s subdisciplines. Classical theories discuss the causes of aggression in the context of negative affect (e.g., frustration, pain). However, more recent research implicates positive affect as an important correlate and cause of aggression. Such aggressive pleasure likely evolved from ancient predatory tendencies that later yielded reproductive benefits, holds across reactive and proactive forms of aggression, and is used strategically as an item in many people’s emotion-regulation toolkit. Findings from psychological and neural sciences have converged to detail aggression’s hedonically pleasant qualities and the motivational and biological mechanisms through which they occur. This new approach generates novel hypotheses and might lead to effective interventions that mollify mankind’s aggressive tendencies.
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15
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Krueger RB, Reed GM, First MB, Marais A, Kismodi E, Briken P. Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11). ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1529-1545. [PMID: 28210933 PMCID: PMC5487931 DOI: 10.1007/s10508-017-0944-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 05/12/2023]
Abstract
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.
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Affiliation(s)
- Richard B Krueger
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
- Department of Psychiatry, New York Presbyterian Hospital, New York, NY, USA.
- Sexual Behavior Clinic, New York State Psychiatric Institute, 1051 Riverside Drive, Unit #45, New York, NY, 10032, USA.
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
- Global Mental Health Program, Columbia University Medical Center, New York, NY, USA
| | - Michael B First
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Adele Marais
- Department of Psychiatry and Mental Health, Groote Schur Hospital, University of Cape Town, Observatory, South Africa
| | - Eszter Kismodi
- , Geneva, Switzerland
- Global Health Justice Partnership, Yale Law School, New Haven, CT, USA
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Weierstall R, Giebel G. The Sadomasochism Checklist: A Tool for the Assessment of Sadomasochistic Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:735-745. [PMID: 27488306 DOI: 10.1007/s10508-016-0789-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/19/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
Various scientific disciplines devoted to the study of sexual behavior are concerned with the understanding of sadomasochistic (SM) practices. However, only a fragmented body of theories, opinions, and studies is available, which limits the systematic study of this field. Empirical studies and tools for the assessment of SM tendencies are particularly sparse. Our aim was to develop a comprehensive tool for the assessment of an individual's engagement in SM practices. A comprehensive 24-item checklist of different types of SM play was generated with the assistance of members of the German SM community, covering both a dominance scale and a submission scale. The sadomasochism checklist was administered in an online study to a sample of 652 adults (345 female, 307 male), with 527 participants being active members in the SM community. Both the frequency of SM behavior and the attraction to the types of SM practices were assessed. Results revealed a one-factor structure for the dominance as well as the submission scale. The distinction between different types of practices (soft play, domination/submission, beating, toys, breath and bodily fluids) was confirmed using principal component analysis. Cronbach's alpha was appropriate. The total scores for the dominance and the submission scale distinguish between participants with different preferences for dominant and submissive practices. The newly developed scale is a reliable and valid tool for the assessment of the frequency of and attraction to SM behavior. It aims to provide the basis for future systematic studies on sadomasochism.
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Affiliation(s)
- Roland Weierstall
- Department of Psychology, University of Konstanz, 78457, Constance, Germany.
| | - Gilda Giebel
- Department of Psychology, University of Konstanz, 78457, Constance, Germany
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17
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Moser C. DSM-5 and the Paraphilic Disorders: Conceptual Issues. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:2181-2186. [PMID: 27658918 DOI: 10.1007/s10508-016-0861-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Charles Moser
- Department of Sexual Medicine, Institute for Advanced Study of Human Sexuality and Sutter Pacific Medical Foundation, 45 Castro Street, #125, San Francisco, CA, 94114, USA.
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Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, Cohen‐Kettenis PT, Arango‐de Montis I, Parish SJ, Cottler S, Briken P, Saxena S. Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations. World Psychiatry 2016; 15:205-221. [PMID: 27717275 PMCID: PMC5032510 DOI: 10.1002/wps.20354] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings: F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation. Changes have been proposed based on advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards. This paper describes the main recommended changes, the rationale and evidence considered, and important differences from the DSM-5. An integrated classification of sexual dysfunctions has been proposed for a new chapter on Conditions Related to Sexual Health, overcoming the mind/body separation that is inherent in ICD-10. Gender identity disorders in ICD-10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health. The proposed classification of Paraphilic disorders distinguishes between conditions that are relevant to public health and clinical psychopathology and those that merely reflect private behaviour. ICD-10 categories related to sexual orientation have been recommended for deletion from the ICD-11.
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Affiliation(s)
- Geoffrey M. Reed
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland,School of PsychologyUniversidad Nacional Autónoma de MéxicoMexico CityMexico
| | - Jack Drescher
- Department of PsychiatryNew York Medical CollegeNew YorkNYUSA
| | - Richard B. Krueger
- Department of PsychiatryColumbia University, College of Physicians and Surgeons, New York State Psychiatric Institute and New York Presbyterian HospitalNew YorkNYUSA
| | - Elham Atalla
- Primary Care and Public Health Directorate, Ministry of HealthManamaBahrain
| | - Susan D. Cochran
- Fielding School of Public HealthUniversity of CaliforniaLos AngelesCAUSA
| | - Michael B. First
- Department of PsychiatryColumbia University, College of Physicians and Surgeons, New York State Psychiatric Institute and New York Presbyterian HospitalNew YorkNYUSA
| | - Peggy T. Cohen‐Kettenis
- Department of Medical PsychologyVU University Medical Centre, and Center of Expertise on Gender DysphoriaAmsterdamThe Netherlands
| | | | - Sharon J. Parish
- Departments of Medicine and PsychiatryWeill Cornell Medical College and New York Presbyterian Hospital/Westchester DivisionWhite PlainsNYUSA
| | - Sara Cottler
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg‐EppendorfHamburgGermany
| | - Shekhar Saxena
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
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Baur E, Forsman M, Santtila P, Johansson A, Sandnabba K, Långström N. Paraphilic Sexual Interests and Sexually Coercive Behavior: A Population-Based Twin Study. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1163-1172. [PMID: 26754158 DOI: 10.1007/s10508-015-0674-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/22/2015] [Accepted: 11/26/2015] [Indexed: 06/05/2023]
Abstract
Prior research with selected clinical and forensic samples suggests associations between paraphilic sexual interests (e.g., exhibitionism and sexual sadism) and sexually coercive behavior. However, no study to date used a large, representative and genetically informative population sample to address the potential causal nature of this association. We used self-report data on paraphilic and sexually coercive behavior from 5990 18- to 32-year-old male and female twins from a contemporary Finnish population cohort. Logistic regression and co-twin control models were employed to examine if paraphilic behaviors were causally related to coercive behavior or if suggested links were confounded by familial (genetic or common family environment) risk factors. Results indicated that associations between four out of five tested paraphilic behaviors (exhibitionism, masochism, sadism, and voyeurism, respectively) and sexually coercive behavior were moderate to strong. Transvestic fetishism was not independently associated with sexual coercion. Comparisons of twins reporting paraphilic behavior with their paraphilic behavior-discordant twin further suggested that associations were largely independent of shared genetic and environmental confounds, consistent with a causal association. In conclusion, similar to previously reported predictive effects of paraphilias on sexual crime recidivism, paraphilic behavior among young adults in the general population increases sexual offending risk. Further, early identification of paraphilic interest and preventive interventions with at-risk individuals might also reduce perpetration of first-time sexual violence.
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Affiliation(s)
- Elena Baur
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- LWL-Maßregelvollzugsklinik, Herne, Germany
| | - Mats Forsman
- Swedish Prison and Probation Service, R&D Unit, PO Box 12055, 102 22, Stockholm, Sweden.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Pekka Santtila
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland
| | - Ada Johansson
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Sandnabba
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland
| | - Niklas Långström
- Swedish Prison and Probation Service, R&D Unit, PO Box 12055, 102 22, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Schumpe BM, Lafrenière MAK. Malicious joy: Sadism moderates the relationship between schadenfreude and the severity of others' misfortune. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Eher R, Schilling F, Hansmann B, Pumberger T, Nitschke J, Habermeyer E, Mokros A. Sadism and Violent Reoffending in Sexual Offenders. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2016; 28:46-72. [PMID: 25567533 DOI: 10.1177/1079063214566715] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A diagnosis of sadism in sexual offenders is commonly regarded as indicative of high risk for violent reoffending. The purpose of the current two studies was to evaluate whether sadism is indeed associated with higher rates of violent (including sexual) reoffending. In Study 1 (meta-analysis), the rate of violent and sexual recidivism was assessed across seven samples of male sex offenders (total N = 2,169) as a function of diagnoses of sexual sadism. In Study 2 (N = 768) the outcome (violent recidivism yes/no) was regressed on sadism, along with behavioral indicators of sexually sadistic offending, and scores from violence risk assessment instruments. In Study 1 (meta-analysis), the overall risk of sadists compared with nonsadists with respect to violent (including sexual contact) reoffending was slightly elevated (by a factor of 1.18), yet not significantly increased. Similarly, the risk of sexual reoffending among sadists was slightly, but not significantly, higher than among nonsadists (factor 1.38). According to Study 2, only a measure of sadistic behavior, not the clinical diagnosis, was associated with violent reoffending. This association, however, was not present once age and customary risk assessment instruments for violence risk were included in the regression. A clinical diagnosis of sexual sadism and behavioral measures of sadism are related to the risk of violent reoffending in sexual offenders. These associations, however, are weak and do not hold once variables relevant for the prediction of violence are controlled for. At the individual level, the risk for future violence in sadists can therefore be adequately described by customary risk assessment instruments.
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Affiliation(s)
- Reinhard Eher
- Federal Evaluation Center for Violent and Sexual Offenders, Vienna, Austria Department of Forensic Psychiatry, University of Ulm, Germany
| | - Frank Schilling
- Federal Evaluation Center for Violent and Sexual Offenders, Vienna, Austria
| | - Brigitte Hansmann
- Federal Evaluation Center for Violent and Sexual Offenders, Vienna, Austria
| | - Tanja Pumberger
- Federal Evaluation Center for Violent and Sexual Offenders, Vienna, Austria
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Hopkins TA, Brawner CA, Meyer M, Zawilinski L, Carnes PJ, Green BA. MMPI-2 Correlates of Sadomasochism in a Sexual Addiction Sample: Contrasting and Men and Women. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/10720162.2015.1095137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Giami A. Between DSM and ICD: Paraphilias and the Transformation of Sexual Norms. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1127-38. [PMID: 25933671 DOI: 10.1007/s10508-015-0549-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The simultaneous revision of the two major international classifications of disease, the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, serves as an opportunity to observe the dynamic processes through which social norms of sexuality are constructed and are subject to change in relation to social, political, and historical context. This article argues that the classifications of sexual disorders, which define pathological aspects of "sexually arousing fantasies, sexual urges or behaviors" are representations of contemporary sexual norms, gender identifications, and gender relations. It aims to demonstrate how changes in the medical treatment of sexual perversions/paraphilias passed, over the course of the 20th century, from a model of pathologization (and sometimes criminalization) of non-reproductive sexual behaviors to a model that reflects and privileges sexual well-being and responsibility, and pathologizes the absence or the limitation of consent in sexual relations.
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Affiliation(s)
- Alain Giami
- Inserm, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018-Team 7: Gender, Sexuality, Health, 82 rue du Général Leclerc, 94276, Le Kremlin Bicêtre, Cedex, France,
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Harviainen JT. Information literacies of self-identified sadomasochists: an ethnographic case study. JOURNAL OF DOCUMENTATION 2015. [DOI: 10.1108/jd-02-2014-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to present findings on the way in which self-identified sadomasochist apply their information literacy skills, and to analyse those applications in the context of existing research on information literacies (IL).
Design/methodology/approach
– The paper is based on the author’s two decades of ethnographic work within a national-level sadomasochist community, supplemented by interviews with 30 practitioners and an extensive literature survey.
Findings
– Sadomasochists avoid the social stigma associated with their activities by developing highly refined ILs. Central among these is the ability to learn from other practitioners by reading and interpreting their actions as “texts.” They furthermore stockpile potentially useful information for later use. Their ILs not only make sadomasochists more skilled in their practices, but also provide them with safety.
Originality/value
– By examining its subject community, the paper develops the ideas of embodied information literacy, currently strongly associated with workplace learning, to the hobby and lifestyle sectors, as it deals with a particularly corporeal set of ILs. This radical example allows scholars to conduct research on the ILs other communities of practice, in which the activities may be less obviously corporeal, but the literacies just as based on embodied interpretation and the reading of others’ activities as texts.
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Monteiro Pascoal P, Cardoso D, Henriques R. Sexual Satisfaction and Distress in Sexual Functioning in a Sample of the BDSM Community: A Comparison Study Between BDSM and Non-BDSM Contexts. J Sex Med 2015; 12:1052-61. [DOI: 10.1111/jsm.12835] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Defrin R, Arad M, Ben-Sasson M, Ginzburg K. Attitudes and emotions towards pain and sensitivity to painful stimuli among people routinely engaging in masochistic behaviour. Eur J Pain 2015; 19:1321-30. [DOI: 10.1002/ejp.662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2014] [Indexed: 11/07/2022]
Affiliation(s)
- R. Defrin
- Department of Physical Therapy; School of Allied Health Professions; Sackler Faculty of Medicine; Tel-Aviv University; Israel
- Sagol School of Neurosciences; Tel-Aviv University; Israel
| | - M. Arad
- Department of Physical Therapy; School of Allied Health Professions; Sackler Faculty of Medicine; Tel-Aviv University; Israel
| | - M.P. Ben-Sasson
- Department of Physical Therapy; School of Allied Health Professions; Sackler Faculty of Medicine; Tel-Aviv University; Israel
| | - K. Ginzburg
- Bob Shapell School of Social work; Tel-Aviv University; Israel
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27
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Sadomasochism in Sickness and in Health: Competing Claims from Science, Social Science, and Culture. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-014-0039-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
This article gives a clinically oriented overview of forensically relevant forms of sexual sadism disorder and its specific relationship to sexual homicide. In sexual homicide perpetrators, peculiar patterns of sexual sadism may be a motivational pathway to kill. Sexual sadism increases the risk for reoffending in sexual offenders. Through psychotherapy and pharmacological interventions, treatment of sadistic sex offenders has to consider special characteristics that may be different from those of nonsadistic sex offenders. Many of these offenders share a combination of sexual sadistic motives and an intact self-regulation, sometimes combined with a high level of sexual preoccupation.
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Affiliation(s)
- Peer Briken
- Institute for Sex Research & Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Martinistrasse 52, Hamburg D-20246, Germany.
| | - Dominique Bourget
- Forensic Program, Department of Psychiatry, The Royal Ottawa Hospital, University of Ottawa, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada
| | - Mathieu Dufour
- Forensic Program, Department of Psychiatry, The Royal Ottawa Hospital, University of Ottawa, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada
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Robertson CA, Knight RA. Relating sexual sadism and psychopathy to one another, non-sexual violence, and sexual crime behaviors. Aggress Behav 2014; 40:12-23. [PMID: 24019144 DOI: 10.1002/ab.21505] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/05/2013] [Indexed: 11/08/2022]
Abstract
Sexual sadism and psychopathy have been theoretically, clinically, and empirically linked to violence. Although both constructs are linked to predatory violence, few studies have sought to explore the covariation of the two constructs, and even fewer have sought to conceptualize the similarities of violence prediction in each. The current study considered all four Psychopathy Checklist-Revised (PCL-R) facets and employed well-defined, validated measures of sadism to elucidate the relation between sadism and psychopathy, as well as to determine the role of each in the prediction of non-sexual violence and sexual crime behaviors. Study 1 assessed 314 adult, male sex offenders using archival ratings, as well as the self-report Multidimensional Inventory of Development, Sex, and Aggression (the MIDSA). Study 2 used archival ratings to assess 599 adult, male sex offenders. Exploratory and confirmatory factor analyses of crime scene descriptions yielded four sexual crime behavior factors: Violence, Physical Control, Sexual Behavior, and Paraphilic. Sadism and psychopathy covaried, but were not coextensive; sadism correlated with Total PCL-R, Facet 1, and Facet 4 scores. The constructs predicted all non-sexual violence measures, but predicted different sexual crime behavior factors. The PCL-R facets collectively predicted the Violence and Paraphilic factors, whereas sadism only predicted the Violence factor.
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Kelsey K, Stiles BL, Spiller L, Diekhoff GM. Assessment of therapists’ attitudes towards BDSM. PSYCHOLOGY & SEXUALITY 2013. [DOI: 10.1080/19419899.2012.655255] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Zucker KJ. DSM-5: call for commentaries on gender dysphoria, sexual dysfunctions, and paraphilic disorders. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:669-674. [PMID: 23797860 DOI: 10.1007/s10508-013-0148-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Duschinsky R, Chachamu N. Sexual dysfunction and paraphilias in the DSM-5: Pathology, heterogeneity, and gender. FEMINISM & PSYCHOLOGY 2013. [DOI: 10.1177/0959353512467966] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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33
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Abstract
This article provides a historical perspective on how both American and European psychiatrists have conceptualized and categorized sexual deviance throughout the past 150 years. During this time, quite a number of sexual preferences, desires, and behaviors have been pathologized and depathologized at will, thus revealing psychiatry's constant struggle to distinguish mental disorder--in other words, the "perversions," "sexual deviations," or "paraphilias"--from immoral, unethical, or illegal behavior. This struggle is apparent in the works of 19th- and early-20th-century psychiatrists and sexologists, but it is also present in the more recent psychiatric textbooks and diagnostic manuals, such as the consecutive editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). While much of the historical literature revolves around the controversy over homosexuality, this article also reviews the recent medicohistorical and sociohistorical work on other forms of sexual deviance, including the diagnostic categories listed in the latest edition, the DSM-IV-TR: exhibitionism, voyeurism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, and transvestic fetishism.
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Abstract
In this article, I discuss the question of the pathological nature of various sexual orientations and paraphilias and provide arguments for and against the inclusion of various paraphilias in future versions of the DSM. Practically, it is proposed that most of the paraphilias can be usefully conceptualized as involving sexual behaviors directed toward non-consenting individuals. From a Darwinian standpoint, it seems clear that at least some of the paraphilias should not be considered to be pathological because they are potentially associated with enhanced fitness.
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Affiliation(s)
- Vernon L Quinsey
- Department of Psychology, Queen's University, Kingston, ON, K7L 3S9, Canada.
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Wright S. Depathologizing consensual sexual sadism, sexual masochism, transvestic fetishism, and fetishism. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:1229-1230. [PMID: 20632078 DOI: 10.1007/s10508-010-9651-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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First MB. DSM-5 proposals for paraphilias: suggestions for reducing false positives related to use of behavioral manifestations. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:1239-44; author reply 1245-1252. [PMID: 20697936 DOI: 10.1007/s10508-010-9657-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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38
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Sexueller Sadismus und Sexualkriminalität. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2010. [DOI: 10.1007/s11757-010-0048-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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39
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Långström N. The DSM diagnostic criteria for exhibitionism, voyeurism, and frotteurism. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:317-324. [PMID: 19924524 DOI: 10.1007/s10508-009-9577-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
I reviewed the empirical literature for 1980-2008 on exhibitionism, voyeurism, and frotteurism for the American Psychiatric Association's Sexual and Gender Identity Disorders Work Group in preparation for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Very limited empirical support was found for major changes of the current DSM-IV-TR criteria sets for these paraphilias. Some of the criticism of current criteria and the balancing of false negatives and false positive diagnoses are examined. The report concludes with suggestions for possible diagnostic criteria changes for the DSM-V.
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Affiliation(s)
- Niklas Långström
- Centre for Violence Prevention, Karolinska Institutet, POB 23000, 104 35, Stockholm, Sweden.
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40
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Abstract
I reviewed the empirical literature for 1900-2008 on the paraphilia of Sexual Masochism for the Sexual and Gender Identity Disorders Work Group for the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The results of this review were tabulated into a general summary of the criticisms relevant to the DSM diagnosis of Sexual Masochism, the assessment of Sexual Masochism utilizing the DSM in samples drawn from forensic populations, and the assessment of Sexual Masochism using the DSM in non-forensic populations. I concluded that the diagnosis of Sexual Masochism should be retained, that minimal modifications of the wording of this diagnosis were warranted, and that there was a need for the development of dimensional and structured diagnostic instruments. It should be noted that this summary reflects my original literature review. Subsequently, interactions with other members of the workgroup and advisors have resulted in modification of these initial suggestions.
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Affiliation(s)
- Richard B Krueger
- Sexual Behavior Clinic, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 45, New York, NY 10032, USA.
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