Is homosexuality a paraphilia? The evidence for and against

Psychometric Evidence That Paraphilia Is a Natural Kind

Is the category paraphilia a natural kind? That is, do different paraphilias share anything scientifically interesting or are they classified together because they are unusual and sometimes problematic? We investigated this question systematically in 11 samples of paraphilic males (N = 4,617) and 11 samples of control males (N = 1,494). Primary data consisted of responses to the 11-item Paraphilic Interests Scale. Contrary to our initial hypothesis, the scale mean was similar for paraphilic and control samples. Using logistic regression and the same items, we derived three highly correlated measures that robustly discriminated paraphilic and control samples (ds ranging from 0.86 to 0.92). These successful measures capitalized on the unanticipated fact that some items (especially those assessing transvestism and masochistic humiliation) were positively associated with membership in paraphilic samples, while others (especially those assessing voyeurism) were negatively associated with such membership. Subsequent analyses focused on one of the measures, the Paraphilic Interests Scale Contrast (PISC). Consistent with prior findings distinguishing paraphilias and homosexual orientation, PISC was not elevated among homosexual males compared with heterosexual males among the control groups. Within four paraphilic samples, PISC was positively associated with additional paraphilic phenomena. Results provide tentative support for both the proposition that paraphilia is a natural kind and the usefulness of PISC as a measure of paraphilia.

Pedophilia: social, legal and medical aspects

Sexual abuse against children causes a real public response that supports active discussions on the problem of sexual actions against minors both in the legislation, where new legal norms are proposed to regulate and prevent such offensive behavior, and in the medical community, since in some cases the mechanisms of such offenses are associated with specific forms of mental pathology. The aim of this article was the evaluation of the medical, legal and social aspects associated with pedophilia and its role in criminal sexual behavior. Materials and methods. This review included the most influential works in the field of sexology and sexual pathology, official materials of the World Health Organization and the American Psychiatric Association, legal and medical statistical reports. In the result this review reveals the place of pedophilia in mental disorders, the necessity of taking into account current data on the prevalence of abnormal sexual interests in population for work with it, as well as the importance of considering sexual crimes against minors in a broader context, the need to develop psychotherapeutic and preventive approaches.

Identifying the Coping Strategies of Nonoffending Pedophilic and Hebephilic Individuals From Their Online Forum Posts

Individuals who identify as pedophilic or hebephilic, and who do not offend, are increasingly visible in online discourse and as a focus of research. Developing knowledge about this population will offer insights into their psychological needs and, potentially, into the mechanisms and strategies individuals use to live offense-free lives. This study examined coping strategies among members of an online forum supporting pedohebephilic individuals who do not wish to offend. Forum users' posts were analyzed using thematic analysis. Eleven themes emerged, which were classifiable into three superordinate themes around (a) the acceptance of pedophilia, (b) strategies to stay safe, and (c) dealing with sexual arousal. These themes offer insight into the varying strategies used by these individuals to cope with stress and/or to remain offense-free. Understanding whether these strategies are adaptive or maladaptive may help develop better support services for those who have not offended and may inform prevention efforts.

A Brief Report on Fetishism in Romania: An Approach Based on Gender and Sexual Orientation

Objectives: With this research, we aimed to assess the level of fetishism in Romania, to explore the gender and sexual orientation differences and to inspect its relationship with sexual satisfaction and well-being. Methods: This study analyses data from 525 participants from the non-clinical population. Results: The analyses showed that some levels of fetishism are present in almost 70 % of the sample, that queer participants report higher scores and that it does not impact sexual satisfaction and well-being. Conclusion: These findings can be used for a better understanding of fetishism and its impact by both clinicians and individuals with fetishes.

Rates of Injury and Healthcare Utilization for Kink-Identified Patients

BACKGROUND

Kink-involved people engage in atypical erotic activities such as bondage, rough sex, and other fetish activities that might risk injury or medical complication. To date, however, no one has examined the rate of injury or healthcare utilization for people who engage in these activities.

AIM

To describe the type and rate of injuries from kink activities, and the use of healthcare by kink-involved people, including how many people disclose their involvement in kink when seeking care.

METHODS

A survey of 1,398 kink-involved or kink-identified people, using a convenience sampling method.

OUTCOMES

The study is the first to report on rates of injury and disclosure of kink involvement to care providers using a large community sample of kink-involved people.

RESULTS

A high number of participants did not disclose their kink behavior to their physical healthcare clinician (58.3%) or to their mental healthcare clinician (49.6%). Past experiences of kink-related injuries were relatively common (13.5%), as was the number of people who reported delaying or avoiding healthcare because of anticipated or perceived stigma for kink involvement (19.0%).

CLINICAL TRANSLATION

The findings of the current study point to the need for clinicians to address barriers to culturally competent care for kink-involved people. Anticipated stigma leads to non-disclosure of kink involvement and delay in seeking care, thereby creating barriers to health and well-being.

STRENGTHS & LIMITATIONS

Strengths include a sample size large enough to examine regression models to predict disclosure to care providers, and lifetime rates of injury from kink activities overall. Limitations include the use of a convenience sampling method and self-report survey design, which affect the generalizability of the results.

CONCLUSION

The patterns of anticipated stigma, delay or avoidance of care, and concealment of kink and/or BDSM involvement fit the Minority Stress Model, and we argue that kink-identified people should be considered a sexual minority for the purposes of healthcare. Sprott RA, Randall A, Smith K et al. Rates of Injury and Healthcare Utilization for Kink-Identified Patients. J Sex Med 2021;18:1721-1734.

The Prevalence of Paraphilic Interests in the Czech Population: Preference, Arousal, the Use of Pornography, Fantasy, and Behavior

The number of population-based studies focused on the prevalence of paraphilic sexual interests in men is very low and for women, the subject remains largely unexplored. The two main aims of this study are to investigate the prevalence of paraphilias and to explore sex differences in an online representative sample of Czech men and women using various dimensions of sexual experience. We collected data about sexual motivations and behavior from a representative online sample of 10,044 Czechs (5,023 men and 5,021 women). In a standardized online interview, participants answered questions about selected dimensions of sexual experience within specific paraphilic patterns: sexual preferences, sexual arousal, sexual fantasies in the past 6 months, pornography use in the past 6 months, and experience with paraphilic behaviors. Our results show that 31.3% of men (n = 1,571) and 13.6% of women (n = 683) admitted to at least one paraphilic preference. Moreover, 15.5% of men and 5% of women reported more than one paraphilic preference. Except for beating/torture and humiliation/submission, in terms of real experience with such behaviors almost all paraphilias were more common among men than among women. Our results indicate that the high prevalence of some paraphilic patterns might render their pathologization problematic.

Age of Onset and Its Correlates in Men with Sexual Interest in Children

INTRODUCTION

Current discussions in the field of sex research concern the age at which sexual interest in children occurred or awareness emerged.

AIM

To investigate the age of onset (AOO) and its correlates in men with sexual interest in children.

METHODS

Using 2 samples (study 1, patients from an outpatient treatment center, n = 26; study 2, an online survey using 3 recruitment paths, n = 94), we assessed self-reported AOO of sexual interest in children, its flexibility, its exclusiveness, and individuals' motivation to change it. We further examined the interrelation between these variables.

MAIN OUTCOME MEASURE

AOO as the self-reported age at which participants retrospectively felt sexually attracted to children for the first time.

RESULTS

We found broad ranges in AOO (study 1: mean 20.0 ± 10.7; study 2: mean 17.0 ± 8.7), flexibility, and exclusiveness (in studies 1 and 2, 7.7% and 22.3%, respectively, reported that their sexual interest is exclusively in children). The earlier participants felt sexually attracted to children for the first time, the more they were attracted exclusively in children and the less they perceived it to be flexible. Participants who reported rather exclusive sexual interest in children were less likely to perceive it as flexible. The more participants reported on flexibility, the more they were motivated to change it. The earlier participants of study 2 felt sexually attracted to children for the first time, the less they were motivated to change.

CLINICAL IMPLICATIONS

The variety of our results indicates the contradiction of overall rules for individuals with sexual interest in children.

STRENGTH & LIMITATIONS

We included individuals with sexual interest in children from different contexts (eg, forensic vs non-forensic). Our results are in line with previous findings. However, both studies included rather small samples, limiting generalizability. There is not yet consent about how to operationalize AOO.

CONCLUSION

We recommend a differentiated perspective on individuals with sexual interest in children and on different forms of pedophilia in the diagnostic construct. Tozdan S, Briken P. Age of Onset and Its Correlates in Men with Sexual Interest in Children.Sex Med 2019;7:61-71.

Contemporary understanding of zoophilia - A multinational survey study

INTRODUCTION

People with paraphilias have sexual interests that are unusual, including inanimate objects, places, or individuals (children, corpses). This study explores zoophiles (=PSA, people who have sex with animals) recruited from the Internet.

METHOD

We administered a survey of own design via the Internet on popular discussion forums targeting the communities of PSA. All responses were quantified as the percentage of agreeing with one of the possible answer choices, plus the interpretation of qualitative data that may have been supplied in additional space.

RESULTS

Survey questions were thematically categorized into four groups - worldview, personal space, sex life, and online space. PSA are remarkably self-aware of their sexuality and recognize that their behavior is illegal (even though they perceive it as an expression of love); they often relate their struggles with finding social acceptance to homosexuality, believing that one way of de-stigmatizing them would be to remove zoophilia from the list of disorders listed in the DSM. Concerning sex life, PSA believe that the quality of sex with animals is much higher than with humans, and physical features, such as the presence of a fur, can be sexually arousing to PSA, especially when seeing animals in public. PSA utilize the Internet to network and connect with other PSA; these Internet-based friendships usually do not extend beyond online conversations, given that PSA tend to be mistrustful of other zoophiles particularly in the area of personal safety.

CONCLUSIONS

One of the most essential basis of zoophilia is relationship seeking behavior as well as interest in forming a long-term relationship with an animal partner.

Why Information Matters: Examining the Consequences of Suggesting That Pedophilia Is Immutable

In this study, the impact of suggesting that pedophilia is immutable on a man's specific self-efficacy for modifying his sexual interest in children was examined in 94 men with a sexual interest in children. The participants were selected from differing contexts and included non-forensic patients, forensic patients, and participants from the Internet. Randomly distributed to two conditions, the mutable condition group received the information that experts consider pedophilia to be modifiable, whereas the immutable condition group received the information that experts consider pedophilia to be stable. Afterward, the participants' levels of specific self-efficacy for modifying their sexual interest in children were assessed. Non-forensic participants in the mutable condition reported higher levels of specific self-efficacy than those in the immutable condition. No differences in specific self-efficacy were revealed for the forensic and Internet participants when comparing the mutable and immutable conditions. It would appear appropriate to avoid generalized and absolute statements about the (im)mutability of sexual interest in children, as scientific research on this topic remains insufficient. Furthermore, given the present results, such statements might have serious consequences for an individual's belief in being able to change his sexual interest in children.

Keep Faith in Yourself! A Pilot Study on the Relevance of Specific Self-Efficacy for Modifying Sexual Interest in Children Among Men With a Risk to Sexually Abuse Children

Among 26 pedophilic/hebephilic men, we investigated (1) the relationship between "specific self-efficacy for modifying a sexual interest in children" (SSIC) and actual sexual interest in children and (2) whether changes in SSIC are associated with changes in sexual interest in children. Results showed that the more clients believe they are able to influence their sexual interest in children, the less strong they perceive their sexual interest in children to be. Furthermore, an increase in SSIC is associated with a decrease in sexual interest in children. We suggest avoiding generalized statements about the immutability of sexual interest in children.

Paraphilic Thoughts, Behaviors and Sex Addiction in a Sample of Persons Who Use Drugs: A Cross-Sectional Study

OBJECTIVE

The aim of this study was to evaluate the prevalence of paraphilic thoughts/behaviors (including paraphilic disorders) with and without sexual addiction and sexual-related conditions in a sample of substance disorder patients.

METHODS

This was a cross-sectional study of substance-dependent individuals who sought outpatient treatment in São Paulo, Brazil. Data included sociodemographic information, drug of choice, responses to questions about sexual behavior, and to the following standardized questionnaires: (a) Sexual Addiction Screening Test, and (b) Childhood Trauma Questionnaire.

RESULTS

The sample comprised 134 persons who use drug, predominantly men (76.1%), 39.6% were aged between 18 and 29 years, and 54.9% were single. Most were persons who use polydrug, 73.9% were alcohol and cocaine users, 63.4% marijuana users, 81.1% tobacco users, and 5.2% steroid users. Prevalence of paraphilic thoughts/behaviors (including paraphilic disorders) with and without sexual addiction was 47%. The HPV/herpes and hepatitis B rates were 7.9% (P = 0.021) and 6.3% (P = 0.046) respectively. Paraphilic and nonparaphilic thoughts/behaviors were associated to the presence of childhood physical neglect (odds ratios [OR] = 4.7, 95% confidence interval [CI] 1.0 to 21.9), low educational level (OR = 7.2, 95% CI 1.4 to 36), heterosexuality (OR = 3.8, 95% CI 1.1 to 12.8) and youth (age 18 to 20 years) (OR = 5.6, 95% CI 1.4 to 11.8).

CONCLUSIONS

The high prevalence of paraphilic thoughts/behaviors with or without sex addiction in persons who use drugs may be related to the experience of physical and emotional neglect during childhood and this possibility should routinely be investigated in clinical practice.

Role of Sexuality in Body Integrity Identity Disorder (BIID): A Cross-Sectional Internet-Based Survey Study

BACKGROUND

Body integrity identity disorder (BIID)-a strong desire for amputation or paralysis-is often accompanied by feelings and cognitions of sexual arousal, although this sexual component has been largely neglected in the recent literature.

AIM

To examine the presence of BIID-related sexual arousal in subjects with BIID and explore clinical and demographic variables of subjects with BIID who do and do not possess this sexual arousal.

METHODS

Eighty individuals with BIID responded to an internet-based survey we created. For all subjects, restoring identity was the primary motivation for preferred body modification. We collected data about respondents' demographic, clinical, and sexual characteristics. Based on responses to questions about BIID-specific sexual desires, subjects were assigned to the group with BIID-related sexual feelings (S-BIID; n = 57) or the group without such feelings (NS-BIID; n = 23).

OUTCOMES

Differences in clinical, demographic, and sexual characteristics between S-BIID and NS-BIID groups.

RESULTS

Of the respondents, 71.3% endorsed S-BIID. Subjects with S-BIID were significantly more often men, religious, and of a homosexual identity compared with the NS-BIID group. Subjects with S-BIID also significantly more often reported a change in localization and/or intensity of their BIID feelings over time. Furthermore, 66.7% of subjects with S-BIID reported S-BIID as an additional motivation for body modification. Seven of the 57 subjects with S-BIID achieved their preferred body modification through (self)-amputation, whereas none of the subjects with NS-BIID did.

CLINICAL IMPLICATIONS

BIID is a heterogeneous disorder in which subjects who self-reported comorbid sexual arousal more often resorted to (self-induced) amputation.

STRENGTHS AND LIMITATIONS

This study contains the largest BIID cohort presented in the literature and is the first to genuinely research sexuality in BIID. The first limitation is the lack of face-to-face interviews with the subjects, so no clinical diagnoses could be made. Moreover, there is an ascertainment bias because subjects were collected through the internet and in English, which excluded those who spoke other languages or subjects without an internet connection.

CONCLUSION

The present study provides preliminary evidence for a subpopulation or distinct group of individuals with BIID based on the presence of S-BIID. Blom RM, van der Wal SJ, Vulink NC, Denys D. Role of Sexuality in Body Integrity Identity Disorder (BIID): A Cross-Sectional Internet-Based Survey Study. J Sex Med 2017;14:1028-1035.

Karl Heinrich Ulrichs: First Theorist of Erotic Age Orientation

The nomination of Karl Heinrich Ulrichs (1825-1895) as the first theorist of homosexuality may be placed in the oblique light of his eligibility for the nomination as the first theorist of erotic age orientation. In Ulrichs's pamphlets, "man-manly" homosexuality emerged as a particular age orientation, with a subsequent typological breakdown that, importantly, blended gender orientation and age orientation. Into the early 20th century, erotic age orientation remained bound up with the classification and emancipation of what here was demarcated as Urningsliebe. Ulrichs's pioneering and shifting comments on age eventually fed into his legal model of consenting adults in private. They also provide a starting point for the historical understanding of the trope of "grooming pedophile" as it, arguably, crossfaded with that of the "seducing homosexual" after the latter's depsychiatricization across the Western world.

Regression to the Mean Mimicking Changes in Sexual Arousal to Child Stimuli in Pedophiles

The sexual preference for prepubertal children (pedophilia) is generally assumed to be a lifelong condition. Müller et al. (2014) challenged the notion that pedophilia was stable. Using data from phallometric testing, they found that almost half of 40 adult pedophilic men did not show a corresponding arousal pattern at retest. Critics pointed out that regression to the mean and measurement error might account for these results. Müller et al. contested these explanations. The present study shows that regression to the mean in combination with low reliability does indeed provide an exhaustive explanation for the results. Using a statistical model and an estimate of the retest correlation derived from the data, the relative frequency of cases with an allegedly non-pedophilic arousal pattern was shown to be consistent with chance expectation. A bootstrap simulation showed that this outcome was to be expected under a wide range of retest correlations. A re-analysis of the original data from the study by Müller et al. corroborated the assumption of considerable measurement error. Therefore, the original data do not challenge the view that pedophilic sexual preference is stable.

Paraphilic Interests: An Examination of Sex Differences in a Nonclinical Sample

Little research has been conducted to examine paraphilic sexual interests in nonclinical samples. The little that exists suggests that atypical sexual interests are more common in men than in women, but the reasons for this difference are unknown. In this study, we explored the prevalence of paraphilic interests in a nonclinical sample of men and women. We expected that men would report greater arousal (or less repulsion) toward various paraphilic acts than women. We also examined putative correlates of paraphilias in an attempt to explain the sex difference. In all, 305 men and 710 women completed an online survey assessing sexual experiences, sexual interests, as well as indicators of neurodevelopmental stress, sex drive, mating effort, impulsivity, masculinity/femininity, and socially desirable responding. As expected, significant sex differences were found, with men reporting significantly less repulsion (or more arousal) to the majority of paraphilic acts than women. Using mediation analysis, sex drive was the only correlate to significantly and fully mediate the sex difference in paraphilic interests. In other words, sex drive fully accounted for the sex difference in paraphilic interests. The implications of these findings for understanding the etiology of atypical sexual interests are discussed.

The Neurobiology and Psychology of Pedophilia: Recent Advances and Challenges

A pedophilic disorder is recognized for its impairment to the individual and for the harm it may cause to others. Pedophilia is often considered a side issue and research into the nature of pedophilia is delayed in comparison to research into other psychiatric disorders. However, with the increasing use of neuroimaging techniques, such as functional and structural magnetic resonance imaging (sMRI, fMRI), together with neuropsychological studies, we are increasing our knowledge of predisposing and accompanying factors contributing to pedophilia development. At the same time, we are faced with methodological challenges, such as group differences between studies, including age, intelligence, and comorbidities, together with a lack of careful assessment and control of child sexual abuse. Having this in mind, this review highlights the most important studies investigating pedophilia, with a strong emphasis on (neuro-) biological studies, combined with a brief explanation of research into normal human sexuality. We focus on some of the recent theories on the etiology of pedophilia such as the concept of a general neurodevelopmental disorder and/or alterations of structure and function in frontal, temporal, and limbic brain areas. With this approach, we aim to not only provide an update and overview but also a framework for future research and to address one of the most significant questions of how pedophilia may be explained by neurobiological and developmental alterations.

Homosexual inclinations and the passions: A Thomistic theory of the psychogenesis of same-sex attraction disorder

The Catholic Church has held that every human being is a child of God, and every person deserves to be treated with dignity and love regardless of their actions. The phrase "love the sinner, hate the sin" is a simple summary of the approach the Church takes to loving all human beings. The Church has also held firmly that both homosexual acts and homosexual inclinations are disordered, although the origins or contributing factors of homosexual inclinations are not entirely understood. In this paper, I apply principles from St. Thomas Aquinas's treatise on the passions to show that habitual mis-identification of the cause of pleasure associated with the apprehension of beauty, or misjudgments, may be involved in the psychogenesis of same-sex attraction disorder.

Biological markers of asexuality: Handedness, birth order, and finger length ratios in self-identified asexual men and women

Human asexuality is defined as a lack of sexual attraction to anyone or anything and it has been suggested that it may be best conceptualized as a sexual orientation. Non-right-handedness, fraternal birth order, and finger length ratio (2D:4D) are early neurodevelopmental markers associated with sexual orientation. We conducted an Internet study investigating the relationship between self-identification as asexual, handedness, number of older siblings, and self-measured finger-lengths in comparison to individuals of other sexual orientation groups. A total of 325 asexuals (60 men and 265 women; M age, 24.8 years), 690 heterosexuals (190 men and 500 women; M age, 23.5 years), and 268 non-heterosexuals (homosexual and bisexual; 64 men and 204 women; M age, 29.0 years) completed online questionnaires. Asexual men and women were 2.4 and 2.5 times, respectively, more likely to be non-right-handed than their heterosexual counterparts and there were significant differences between sexual orientation groups in number of older brothers and older sisters, and this depended on handedness. Asexual and non-heterosexual men were more likely to be later-born than heterosexual men, and asexual women were more likely to be earlier-born than non-heterosexual women. We found no significant differences between sexual orientation groups on measurements of 2D:4D ratio. This is one of the first studies to test and provide preliminary empirical support for an underlying neurodevelopmental basis to account for the lack of sexual attraction characteristic of asexuality.

Paraphilias: definition, diagnosis and treatment

There is a great deal of controversy concerning paraphilia, and defining what is normal versus deviant or disordered, given that this is to some degree dependent on cultural views of acceptability. In this article, we outline these issues and describe recent progress in diagnosing and treating paraphilias.

A treatment-oriented typology of self-identified hypersexuality referrals

Men and women have been seeking professional assistance to help control hypersexual urges and behaviors since the nineteenth century. Despite that the literature emphasizes that cases of hypersexuality are highly diverse with regard to clinical presentation and comorbid features, the major models for understanding and treating hypersexuality employ a "one size fits all" approach. That is, rather than identify which problematic behaviors might respond best to which interventions, existing approaches presume or assert without evidence that all cases of hypersexuality (however termed or defined) represent the same underlying problem and merit the same approach to intervention. The present article instead provides a typology of hypersexuality referrals that links individual clinical profiles or symptom clusters to individual treatment suggestions. Case vignettes are provided to illustrate the most common profiles of hypersexuality referral that presented to a large, hospital-based sexual behaviors clinic, including: (1) Paraphilic Hypersexuality, (2) Avoidant Masturbation, (3) Chronic Adultery, (4) Sexual Guilt, (5) the Designated Patient, and (6) better accounted for as a symptom of another condition.

Pathologizing sexual deviance: a history

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.