The Prevalence of Paraphilic Interests and Behaviors in the General Population: A Provincial Survey

Inadequate Coping Strategies of Men who Have Committed Sexual Aggression Against Women: A Study of Their Developmental Antecedents

Several researchers have found that men who have committed sexual aggression have inadequate coping strategies (e.g., paraphilic sexual fantasies, substance abuse). However, very few researchers have empirically examined the factors potentially associated with the development of these strategies. In 2011, Maniglio hypothesized that the inadequate coping strategies of men who have committed sexual aggression are the result of childhood victimization, mediated by internalized psychological problems. The present study therefore empirically tested this hypothesis in a Canadian sample of 205 men who had committed sexual aggression against women, of whom 37 committed sexual murder. Structural equation modeling (SEM) resulted in the identification of several direct and indirect trajectories leading from childhood victimization (psychological, physical, sexual) to the development of inadequate coping strategies (paraphilic sexual fantasies, alcohol and drug use) mediated by internalized psychological problems (e.g., anxiety, depression, social isolation). The theoretical and clinical implications of these developmental trajectories are discussed.

Mistrust and missed opportunities: BDSM practitioner experiences in healthcare

BACKGROUND

Stigma and discrimination have been shown to be significant barriers to healthcare utilization and provider trust among sexual minority groups including BDSM and kink communities.

AIM

This exploratory study sought to better understand medical mistrust and experiences of discrimination in primary care settings and how these factors predict hiding kink-related injuries from healthcare providers.

METHODS

A total of 301 individuals who self-identified as being a member of the BDSM community and engaged in BDSM-play activities completed an online survey.

OUTCOMES

Participants completed measures including experiences with BDSM-play-related injuries, disclosure of BDSM activity to healthcare providers, measures addressing mistrust in in healthcare providers (such as avoidance of questions about sexual health or STI testing), and experiences with discrimination in healthcare settings because of BDSM group membership (such as perceptions of being insulted or receiving poor care).

RESULTS

Nearly, 40% of participants indicated at least one experience with discrimination in the healthcare system because they identified as a member of the kink community. Over 20% of participants indicated there were BDSM-related concerns they would have liked to discuss with their primary care provider but did not. Participants who hid injuries from their primary care provider had higher levels of medical mistrust and more experiences with medical discrimination than those who disclosed their injuries. A stepwise logistic regression determined that medical mistrust served as a significant predictor of hiding injuries from healthcare providers.

CLINICAL IMPLICATIONS

Patients who are members of the BDSM community are likely to have had negative healthcare experiences, and these experiences impact their communication with and trust in future medical encounters.

STRENGTHS AND LIMITATIONS

Strengths of the study include addressing diverse components of stigma in healthcare including both experiences with discrimination as well as perceptions of the medical field. Furthermore, potential direct consequences of past negative experiences such as hiding injuries from healthcare providers were examined. Given the likely impact of race, gender, and BDSM group membership on experiences with discrimination, a limitation includes the limited representations of BDSM participants from minoritized racial and ethnic groups. Furthermore, in addressing injuries, the survey did not differentiate intended or expected injuries obtained in BDSM play from unintentional or unwanted injuries.

CONCLUSION

Mistrust in the medical system impacts members of the BDSM community's willingness to disclose injuries to their healthcare provider.

The Propensity for Deviant Sexual Behavior in the General Population: An Empirical Examination of the Motivation-Facilitation Model

In their influential paper Wurtele et al. (2014) investigated the degree to which individuals within the general population (N = 435) express sexual interest in children. In the male population of their study (n = 173), about 6% showed a propensity to engage in sexual activity with a child. Based on a German general population sample consisting of women and men (N = 911, n = 206 males), we were able to replicate most of the results of Wurtele and colleagues (e.g., 6% of men indicated some likelihood of having sex with a child). To explain sexual offending, Seto (2019) developed the motivation-facilitation model (MFM). In our study, we were interested whether this model also translates to explaining the propensity for deviant sexual behavior in the general population. Moderated hierarchical logistic regression analyses revealed that hypersexuality and sexual fantasies had significant effects as motivating factors for deviant sexual behavior (e.g., sexually assaulting an adult), whereas we found no significant effect of psychopathy as a facilitator. For the prediction of child sexual abuse, only hypersexuality had a significant effect. Notably, after including gender in both models the effect of hypersexuality was no longer significant. Accordingly, we were able to show that the MFM is useful in explaining the propensity for deviant sexual behavior foremost in the male general population. Thus, in clinical practice an assessment of hypersexuality seems to be most relevant for the male population.

Group Comparisons of the Sexual Interests and Behaviors of Assigned Males and Their Association with Genital Ablation Fantasies

We describe here the sexual histories and characteristics of 338 individuals with interests in castration (orchiectomy) and, more broadly, genital ablation (i.e., orchiectomy, penectomy, and/or nullification), recruited from the Eunuch Archive. We compared four groups: those who only fantasize about castration (Fantasy, n = 66), those who wish to be castrated in the future (Aspiring, n = 166), and those who have been castrated (Eunuchs) both with (n = 42) or without (n = 64) androgen replacement therapy (ART). In our sample, 35.6-53.8% had sexual fantasies of castrating someone, 83.3-90.8% had fantasies of being castrated, 20.6-33.3% had fantasies of removing someone's penis, and 45.3-61.9% had fantasies of having a penectomy. The four groups had similar arousal by high-risk sex behaviors, anal sex play, attraction to people under 18, common sex behaviors, and fetishistic behaviors. Fantasy of being castrated by someone was associated with elevated high-risk sexual behaviors and attraction to individuals aged 18 to 49 after controlling for age, groups, and sexual attraction. In addition, after adjusting for age, groups, and sexual attraction, fantasy of castrating someone was associated with more attraction to individuals under the age of 18 and being aroused by interaction with a stranger, whereas fantasy of cutting off someone's penis was associated with less tendency for common sexual behaviors and digital sex communication. Fantasy of being penectomized was associated with high risk and fetishistic sexual behaviors. These results support screening for high-risk behaviors in individuals who endorse an interest in genital ablation, with treatments focused on harm reduction.

What do you fantasize about? An exploratory factor analysis of minor attracted person's sexual fantasies

Current knowledge on the sexual fantasies of minor attracted persons (MAPs) is primarily focused on these individuals' attraction to minors. Furthermore, MAPs' sexual fantasies are often perceived as revolving systematically around scenarios involving a minor. However, this raises the question of whether their sexual fantasies extend beyond minors. To explore this, we analyzed data from 403 MAPs (364 men and 39 women), using a modified Joyal Sexual Fantasy Questionnaire (JSFQ). Our exploratory factor analysis (EFA) revealed 5 factors: Male Partner Focused Fantasies (α = 0.905), Female Partner Focused Fantasies (α = 0.882), Coercing Focused Fantasies (α = 0.867), Promiscuous/Unattached Focused Fantasies (α = 0.848), and Romantic/Relational Sexual Fantasies (α = 0.650). These results not only highlight the diversity of MAPs' sexual interests of beyond their attraction to minors, paving the way for further research, but also suggest new perspectives for practitioners.

Theories on the Etiology of Deviant Sexual Interests: A Systematic Review

Not much is known about the etiology, or development, of deviant sexual interests. The aim of this systematic review was to provide a broad overview of current theories on the etiology of sexual deviance. We conducted a systematic search of the databases PubMed and APA PsycInfo (EBSCO). Studies were included when they discussed a theory regarding the etiology or development of sexual deviance. Included studies were assessed on quality criteria for good theories. Common etiological themes were extracted using thematic analysis. We included 47 theories explaining sexual deviance in general as well as various specific deviant sexual interests, such as pedophilia and sadism/masochism. Few theories (k = 7) were of acceptable quality as suggested by our systematic assessment of quality criteria for good theories (QUACGOT). These theories indicated that deviant sexual interests may develop as the result of an interplay of various factors: excitation transfer between emotions and sexual arousal, conditioning, problems with "normative" sexuality, and social learning. Neurobiological findings could not be included as no acceptable quality neurobiological theories could be retrieved. The important roles of excitation transfer and conditioning designate that dynamic, changeable processes take part in the etiology of sexual deviance. These same processes could potentially be deployed to diminish unwanted deviant sexual interests.

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.

Explicit measures for emotional congruence with children are related to sexual interests in a male community sample, but not implicit measures

This study sought to disentangle several phenotypic correlates of pedophilic sexual interests, such as emotional congruence with children and lack of empathy. We utilized Implicit Association Tests and self-report questionnaires for emotional congruence with children and analyzed the psychometric properties of these measures. Further, we analyzed the associations between these measures and self-reported pedophilic sexual interests and empathy. The sample consisted of 110 adult community males (prevalence of sexual interest in children at least to some extent: 5.5%) with or without child-related jobs (43.6% vs. 56.4%) recruited online in the general population. Overall, we found equivocal parameters for reliability of the implicit and explicit measures of emotional congruence with children (α = 0.29 to 0.76). The self-reported emotional congruence with children was only weakly linked to the implicit positive evaluations of children (r = 0.170, p = 0.039), not linked to empathy except for distress in social interactions (r = 0.199, p = 0.019), and moderately linked to deviant sexual interests in children (r = 0.321 to 0.404, p < 0.001), especially in men working with children (R2 = 0.04, p = 0.027). Further studies are warranted to expand the sample to the offender population and explore the more complex network of constructs related to pedophilia.

Does the Paraphilia Scale Work for Everyone? Confirmatory Factor Analysis and Measurement Invariance Across Gender and Sexual Orientation Groups

We conducted three studies to examine the factor structure and measurement invariance of the Paraphilia Scale, a measure of paraphilic interests used in multiple studies. In the first study, we conducted a confirmatory factor analysis (CFA) testing different a priori models with a community sample of 1,040 adults previously reported by Seto et al. (2021), and found support for a hierarchical four-factor model: An agonistic continuum involving coercion or physical pain (biastophilia, sexual sadism, masochism), chronophilias (pedophilia, hebephilia), courtship disorders (voyeurism, exhibitionism, and frotteurism), and fetishism (object fetishism, transvestic fetishism, urophilia-coprophilia). This factor structure was replicated in a second study comprising a combined sample of 400 mTurk participants and 870 university students. The third study analyzed the community sample and found evidence of configural invariance but not scalar or metric invariance across gender (man or woman) and sexual orientation for gender (heterosexual or other sexual orientation). This indicates that the factor structure of the Paraphilia Scale is robust for gender and sexual orientation for gender, but factor loadings differ across these groups, as do the loadings of individual items on the four factors. Implications for research on gender and sexual orientation differences in paraphilic interests are discussed.

Factor Analysis With Unusual Sexual Interests: A Replication Study in a Representative Population Sample

A previous study found a variety of unusual sexual interests to cluster in a five-factor structure, namely submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism (Schippers et al., 2021). The current study was an empirical replication to examine whether these findings generalized to a representative population sample. An online, anonymous sample (N = 256) representative of the Dutch adult male population rated 32 unusual sexual interests on a scale from 1 (very unappealing) to 7 (very appealing). An exploratory factor analysis assessed whether similar factors would emerge as in the original study. A subsequent confirmatory factor analysis served to confirm the factor structure. Four slightly different factors of sexual interest were found: extreme, illegal and mysophilic sexual activities; light BDSM without real pain or suffering; heavy BDSM that may include pain or suffering; and illegal but lower-sentenced and fetishistic sexual activities. The model fit was acceptable. The representative replication sample was more sexually conservative and showed less sexual engagement than the original convenience sample. On a fundamental level, sexual interest in light BDSM activities and extreme, forbidden, and mysophilic activities seem to be relatively separate constructs.

An Evolutionary Psychological Approach Toward BDSM Interest and Behavior

Bondage/discipline, Dominance/submission, and Sadism/Masochism (BDSM) have gained increased attention and discussion in recent years. This prevalence is accompanied by a shift in perceptions of BDSM, including the declassification of sadomasochism as a paraphilic disorder. Evolutionary psychology offers a unique perspective of why some individuals are interested in BDSM and why some prefer certain elements of BDSM over others (e.g., dominance versus submission). In this paper, we examine BDSM from an evolutionary standpoint, examining biopsychosocial factors that underlie the BDSM interests and practice. We articulate this perspective via an exploration of: proximate processes, such as the role of childhood experiences, sexual conditioning, and physiological factors; as well as ultimate explanations for power play and pain play dimensions of BDSM, highlighting the potential adaptive advantages of each. While BDSM may not be adaptive in itself, we examine the literature of sex differences in BDSM role preferences and argue that these preferences may stem from the extreme forms of behaviors which enhance reproductive success. In the realm of pain play, we explore the intersection of pain and pleasure from both physiological and psychological perspectives, highlighting the crucial role of psychological and play partner factors in modulating the experience of pain. Finally, we encourage future research in social sciences to utilize evolutionary frameworks to further explore the subject and help alleviate the mystification surrounding BDSM. This multifaceted exploration of BDSM provides valuable insights for clinicians, kink-identified individuals, and scholars seeking to understand the evolutionary perspectives of human sexual behavior and preferences.

Childhood Adversity and Offense-Supportive Cognitions Among Czech Adults with a Sexual Interest in Violence or Children

Individuals with paraphilic interests in sexual violence or children may be more likely to sexually offend if they possess offense-supportive cognitions. These cognitions may develop in response to childhood adversity. However, this idea is largely based on research in men convicted of sexual offenses and may not generalize to non-incarcerated adults with paraphilic interests. In a sample of 178 adults screened for paraphilic interests in violence or children (from the general Czech population), we hypothesized that childhood sexual abuse and emotional neglect would be associated with offense-supportive cognitions about rape and child molestation. Participants came from a nationally representative sample of Czech adults and were selected if they self-reported high levels of sexual interest in violence and/or children. Participants completed an online survey with self-report measures of sexual orientation, offense-supportive cognitions (Bumby RAPE and MOLEST scales), and childhood sexual abuse and emotional neglect (Childhood Trauma Questionnaire). Controlling for gender, age, and sexual orientation, we found that both rape-supportive cognitions and child molestation-supportive cognitions were significantly associated with higher levels of childhood sexual abuse, but not emotional neglect. These findings indicate that childhood sexual abuse may lead to offense-supportive cognitions among men and women with paraphilia.

Dark Tetrad personality traits, paraphilic interests, and the role of impulsivity: an EEG-study using a Go/No-Go paradigm

Maladaptive personality traits, such as 'dark personalities' are found to result in a diverse set of negative outcomes, including paraphilic interests and associated (illegal) behaviors. It is however unclear how these are exactly related, and if related, if then only those individuals higher on dark personality traits and higher impulsivity engage in paraphilic behaviors. In the current study, 50 participants were recruited to investigate the relationship between Dark Tetrad personality traits (i.e., narcissism, psychopathy, Machiavellianism and everyday sadism), paraphilic interests (arousal and behavior) and the moderating role of impulsivity. Personality and paraphilic interests were investigated through self-report questionnaires. Impulsivity was measured both through self-reported dysfunctional impulsivity and the P3 event related potential using electroencephalography during the Go/No-Go task (i.e. response inhibition). The results showed that there was a positive association between psychopathy, sadism and paraphilic interests. Whereas everyday sadism was associated with paraphilic (self-reported) arousal, psychopathy was associated with paraphilic behavior. Although P3 amplitude was not associated with paraphilic interests, self-reported dysfunctional impulsivity was associated with paraphilic behavior specifically. However, there was no moderating role of dysfunctional impulsivity and response inhibition (P3) in the relationship between psychopathy and paraphilic behavior. Findings indicate that the relation between specific dark personalities and paraphilic interests may be more complex than initially thought. Nevertheless, risk assessment and intervention approaches for paraphilia and related behavior both may benefit from incorporating Dark Tetrad and impulsivity measurements.

Paraphilic fantasies and behavior in attention deficit/hyperactivity disorder and their association with hypersexuality

Previous research has found some peculiarities in sexual functioning of adults with attention deficit/hyperactivity disorder (ADHD). Using a set of questionnaires that had to be answered online, we assessed the prevalence of paraphilic fantasies and behaviors in a sample of 160 adults with ADHD in comparison to 75 adults without ADHD and evaluated the association between paraphilias and hypersexuality in the ADHD group. Both groups reported high rates of paraphilic fantasies and behaviors. ADHD individuals were more likely to report about very sexually arousing paraphilic fantasies (ADHD: 58.2% vs. non-ADHD: 40.5%; χ2 = 6.323, p = 0.01) and behaviors (ADHD: 44.9% vs. non-ADHD: 28.4%; χ2 = 5.774, p = 0.02). Furthermore, ADHD individuals reported on average about more very sexually arousing paraphilic behaviors compared to non-ADHD individuals (ADHD: M = 1.28, SD = 0.10 vs. non-ADHD: M = 0.81, SD = 0.09; T = 2.68, p < 0.01). Furthermore, in ADHD individuals both very sexually arousing paraphilic interests in masturbation fantasies (r(158) = 0.17, p = 0.03) and in sexual behaviors (r(158) =0.19, p = 0.02) showed a significant correlation with hypersexuality. In non-ADHD individuals no such significant correlation could be found. Altogether, it can be concluded that individuals with ADHD seem to be more prone to develop and act out paraphilic sexuality than those without ADHD, however, found differences were rather small. The results of the present study add to the current trend to depathologize paraphilic sexuality in the general as well as in clinical populations.

A Preliminary Exploratory Factor Analysis of the BDSM Counselor Competency Scale

BDSM practitioners represent a large sexual minority group often overlooked, misunderstood, and unnecessarily pathologized by mental health clinicians. Although developing cultural competence for diverse and marginalized populations is widely understood to be a core component of delivering efficacious therapeutic services that can counteract these stigmatizing mental healthcare experiences, no measures currently exist that assess clinicians' self-reported competence to work with BDSM practitioners. Previous measurement work has been done to establish self-report competency scales for clinicians working with other sexual and gender minority groups, but no such scales exist for working with BDSM practitioners. In the current study, we adapted a version of the Sexual Orientation Counselor Competency Scale (SOCCS) to measure clinicians' self-reported competence to work with BDSM practitioners and did a preliminary exploratory factor analysis of the new scale (n = 124). After an initial 24-item administration, principal axis factoring of our final 17-item solution revealed two latent factors (attitudes and skills/knowledge) consistent with the 2013 SOCCS and the theoretical constructs of cultural competency. The BDSM Counselor Competency Scale (BDSM-CCS) can help clinicians, practices, agencies, and training programs track self-reported cultural competence with the BDSM population. Future research directions for scale development and clinical and training applications are discussed.

A Descriptive Model of Voyeuristic Behavior

Over the last 50 years, there has been a plethora of research exploring sexual offending with a recent focus on online offending. However, little research has focused on voyeurism despite convictions and media awareness growing rapidly. Currently, there is sparse theoretical or empirical literature to guide research and practice for individuals engaging in voyeuristic behaviors. As such, 17 incarcerated men with a conviction of voyeurism in the UK were interviewed on the cognitive, affective, behavioral, and contextual factors leading up to and surrounding their offense(s). Grounded theory analyses were used to develop a temporal model from background factors to post-offense factors; the Descriptive Model of Voyeuristic Behavior (DMV). The model highlights vulnerability factors for men engaging in voyeuristic behaviors in this sample. Following this, the same 17 men were plotted through the model and three key pathways were identified: Sexual Gratification, Maladaptive Connection Seeking, and Access to Inappropriate Person(s). The characteristics of each pathway are discussed, and treatment implications considered.

The Sexual Grooming Behaviors of Youth Who Engage in Harmful Sexual Behaviors

Little is known about the extent to which youths who commit harmful sexual behaviors (HSBs) against another minor utilize sexual grooming during the offense process. This study examined sexual grooming behaviors reported by adults (n = 250) who experienced HSBs by another minor during their childhood. Participants completed a self-report survey which included the Sexual Grooming Scale - Victim Version (SGS-V). The results showed that most participants (n = 242; 96.9%) reported at least one sexual grooming behavior, with an average of 11.3 behaviors reported. These findings will be discussed as they pertain to the identification and prevention of HSBs among youth.

The correlation between sadomasochists' experience and their sadomasochistic behaviors and fantasies: A qualitative analysis of interviews

Lacking a comprehensive understanding of sadomasochism makes difficulties in judicial dispositions, clinical interventions, and mental health services. This study explores the correlation between sadomasochists' growth experience and their sadomasochistic behaviors and fantasies. We interviewed 51 sadomasochists from a Chinese subcultural website, coded and analyzed the interview records, conducted correlation and cluster analyses on the reference points of the nodes of impressive experience and sadomasochistic behaviors and fantasies, and constructed the model of Experience-Behaviors and Fantasies. We found that sadomasochists' typical impressive experiences are family parenting and sexual experience; sadomasochistic behaviors and fantasies can be classified into five categories: spirit, punishment, sex, canine, and excretion; and sadomasochistic behaviors and fantasies are partially correlated with sadomasochists' impressive experiences, indicating psychoanalytic theory is the leading theory for the driving processes of sadomasochism, while behaviorist and Gestalt theories also contribute.

When Kinks Come to Life: An Exploration of Paraphilic Behaviors and Underlying Predictors

Paraphilia is defined as a condition in which sexual excitement relies on fantasizing about and/or participating in unusual sexual behavior. Although recent studies have assessed the concordance between paraphilic interests and paraphilic behaviors, few studies have studied which individual traits and demographics predict engaging in paraphilic behaviors, or the level of concordance between arousal and behavior. The current study replicated and expanded Joyal and Carpentier's 2022 study. We assessed concordance between paraphilic arousal and behavior. Further, we assessed the impact of Dark Tetrad traits, impulsivity, social desirability and demographic variables on engaging in paraphilic behaviors using self-report questionnaires in a sample from the general population and FetLife. Finally, we were interested in whether these individual differences moderated the concordance between arousal and behavior. Results indicated high concordance between paraphilic arousal and behavior for all paraphilias except pedophilia and hebephilia. Younger, male participants were more likely to engage in various paraphilias than women and older participants. Machiavellianism was linked with lower paraphilic behavior, particularly impulsive or risky ones. Psychopathy predicted engaging in more deviant or illegal paraphilias, whereas sadism only showed an association for engaging in frotteurism and narcissism was not a predictor for engaging in any paraphilia. For several paraphilias, individual traits moderated the effect of arousal on behavior. Implications of these findings and future directions are discussed.

Associations Between Contents of Pornography and Sexual Satisfaction and Function Among Young Adults

Pornography offers a wide variety of sexual contents and has documented potential positive (e.g., higher sexual satisfaction) and negative associations (e.g., lower sexual function) with sexuality. The aims of this study were to describe the proportion of use of five different contents of pornography (i.e. group sex, passion and romance, gender-bending, taboo transgression and forbidden sex, power, control, and rough sex pornography), to examine gender-based differences in the frequency of use of these contents, and to examine the associations between the frequency of use of these contents and sexual satisfaction and function, considering potential differences among genders and individuals with and without a romantic or sexual partner, and controlling for frequency of masturbation. A sample of 827 young adults (503 women; Mage = 23.44) completed online self-report questionnaires. Results of path analysis indicated that, controlling for frequency of masturbation, the use of passion and romance pornography was associated with higher sexual satisfaction, whereas the use of power, control, and rough sex pornography was associated with lower sexual satisfaction. Cisgender men's use of power, control, and rough sex pornography was also associated with lower sexual function. These findings suggest different associations between pornography use and sexual satisfaction and function depending on the pornographic contents used.

A Content Analysis of Reasons for Disclosing Sexual Fantasies and Partner Responses

This study aimed to identify some of the reasons held by participants for either disclosing or concealing a sexual fantasy. Participants were asked to describe either how their partner responded to a disclosure or (for those reporting on an undisclosed sexual fantasy) how they anticipated that their partner was likely to respond. A mixed-methods approach was employed. Two hundred and eighty-seven participants were surveyed about their reasons for disclosing/concealing fantasies and either their actual or anticipated disclosure experiences. The majority of participants (69.3%) indicated having disclosed a sexual fantasy at some point in their relationship. Five categories of reasons for disclosing/not disclosing a sexual fantasy were generated through descriptive content analysis. These categories were sexual gratification, relationship-motivated, partner traits or characteristics, communication patterns, and specific fantasy content. Participant descriptions of their partner's response to the disclosure of their sexual fantasy were frequently coded as positive. For those describing how they believed their partner would be likely to respond to the disclosure of reported sexual fantasy, these anticipated responses were often coded as negative. The findings of the current study deepen our understanding of sexual fantasy disclosure and highlight some of the reasons held for either disclosing or concealing sexual fantasies. More widely, these findings may have implications for sex education, furthering our understanding of sexual dysfunction and sex/relationship therapy.

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.

Psychopathic Personality as a Moderator of the Relationship Between Atypical Sexuality and Sexual Coercion Proclivity in the General Population

Being sexually coerced can have long-lasting psychological impacts on victims; with perpetration strongly predicted by elevated psychopathic traits. Owing to recent legislative developments in the United Kingdom that criminalize coercive control under the Domestic Abuse Act (2021), this study offers a timely investigation into the mechanisms of sexual coercion in domestic abuse across sexual abuse and coercive control. We used moderation analysis (n = 405) to investigate whether sexual coercion proclivity was predicted by facets of atypical sexuality (non-clinical elevated levels of sex drive, sexual sadism, and sexual masochism), and whether this relationship was moderated by psychopathic personality traits specifically the factor one components, which encompasses interpersonal and affective characteristics. Psychopathic personality traits significantly moderated the positive association between sex drive and sexual coercion proclivity, and between sexual sadism and sexual coercion proclivity in males (but not females), but psychopathic personality traits had no such moderating effect in the sexual masochism model. Results are discussed in terms of identifying risk factors of sexual coercion within a general population sample and international application. Open data and a preprint of this paper are available at [https://osf.io/xkcah/?view_only=134ff9c93ad24ba286515b348ce79c0c].

Sexual Orientation, Sexual Motivation, and Erotic Target Identity Inversions in Male Adult Baby/Diaper Lovers

Adult baby/diaper lovers (AB/DLs) enjoy role-playing as babies and/or wearing diapers. They also engage in other related activities, such as urinating or defecating themselves and having an adult care for them. Previous surveys have revealed that AB/DLs commonly report sexual motivation, a finding that is corroborated by case reports in the psychiatric literature and some media interviews. The fact that AB/DLs change their appearance and behavior to become more like babies raises the possibility that they have an erotic target identity inversion (ETII). In ETIIs, a person's external erotic target is inverted into the self, resulting in sexual arousal by the fantasy of being a member of the target class or by imitating one. If AB/DLs are sexually motivated by an ETII, they should experience both sexual attraction to babies and sexual arousal by the fantasy of being a baby. We surveyed 207 male AB/DLs recruited from the Internet about their sexual orientation, sexual motivation, and sexual interests for a primarily quantitative analysis. Consistent with past research, a substantial minority of participants reported non-heterosexual identities (42%), and a large majority reported some degree of sexual motivation for being AB/DLs (93%). Wearing diapers and urinating or defecating oneself were rated as especially sexual. Even though 40% of participants reported sexual arousal by the fantasy of being a baby, only 4% reported sexual attraction to babies. This pattern of results is contrary to predictions from the concept of ETIIs. Instead, participants indicated that physical or mental pain, humiliation, and an adult woman were important to their sexual fantasies of being a baby. Masochism appears to be a promising alternative to an ETII for explaining the sexual motivation of AB/DLs.

The Role of Technology in the Perpetration of Childhood Sexual Abuse: The Importance of Considering Both In-Person and Online Interactions

Child sexual abuse (CSA) is a pervasive global problem. To date, prevention efforts have largely focused on legislative efforts, parent and child education, and environmental protections. Due to the proliferation of the Internet, and especially since the COVID-19 pandemic, recent prevention efforts have focused on online CSA. However, the extent to which technology is being used in the perpetration of in-person, contact CSA remains unclear. This study examined the role of technology in the perpetration of in-person, contact CSA using a sample of 332 adult CSA survivors who completed an anonymous online survey. Overall, we found that only 8.5% of the sample reported that they met the perpetrator online through social media, chatrooms, and other online applications. When looking at the role of technology in the perpetration of the abuse, 35% reported texting with the perpetrator, 27% reported engaging in online chats, and 33% spoke to the perpetrator on the phone. Few participants reported sending (11%) or receiving (13%) photographs or videos that were sexual in nature. Technology use was reported more frequently in CSA involving adolescents than CSA involving children aged 12 and under. There were no differences in the use of technology based on the age of the person who perpetrated the CSA. These findings will be discussed as they pertain to prevention efforts for CSA.

Compulsive sexual behavior and paraphilic interests in adults with chronic tic disorders and Tourette syndrome: a survey-based study

Early research suggested that compulsive sexual behavior (CSB) and paraphilic interests (PI) are more prevalent in adults with primary tic disorders compared to the general population. However, recent data on this topic remain scarce. We conducted an anonymous online survey capturing data on CSB and PI in adult patients with primary tic disorders. We also explored the role of antipsychotic tic medication and the impact of neuropsychiatric comorbidities like attention-deficit hyperactivity disorder and depression. In total, 62 participants (26 females/36 males) completed the survey. The prevalence of CSB and PI were 12.9% and 19.4%, respectively. There was no association with antipsychotic medication nor with symptoms of depression. However, the presence of attention-deficit hyperactivity disorder was associated with a higher prevalence of both CSB and PI. The current results contrast with earlier reports and show that in adults with primary tic disorders, the prevalence of CSB and PI is not overly prominent.

Clinical Guidelines for Working with Clients Involved in Kink

People involved in kink (BDSM or fetish) subcultures often encounter stigma and bias in healthcare settings or when seeking psychotherapy. Such individuals typically encounter well-meaning clinicians who are not prepared to provide culturally competent care or who have not recognized their own biases. Over a two-year period, a team of 20 experienced clinicians and researchers created clinical practice guidelines for working with people involved with kink, incorporating an extensive literature review and documentation of clinical expertise. This article summarizes the guidelines and discusses relevant issues facing clinicians and their clients, as well as implications for clinical practice, research and training.

Elaborating and Testing Erotic Target Identity Inversion Theory in Three Paraphilic Samples

Some men sexually attracted to types of persons (e.g., women) or things (e.g., animals) also have internalized sexual attractions: sexual arousal by the idea of being the type of person or thing to whom they are attracted. Consequently, some of these men develop erotic target identity inversions, in which they imitate, yearn to be, or identify as an instance of their erotic target. Erotic Target Identity Inversion Theory predicts that for every external erotic target to which men are attracted, a subset of men will develop an internalized sexual attraction, which may cause an erotic target identity inversion. We examined these predictions in Internet surveys of three samples of men with paraphilic sexual interests: 322 men attracted to amputees, 1501 men attracted to animals, and 402 men attracted to severely obese persons. All samples included substantial minorities of men reporting internalized sexual attractions and erotic target identity inversions specific to their external sexual attractions (e.g., men attracted to amputees who are also aroused by the fantasy of being amputees and wish to become amputees). The correlation between degree of each internalized sexual attraction and degree of its corresponding erotic target identity inversion was approximately 1.0 after correction for attenuation. In each sample, participants' specific internalized sexual attraction was positively correlated with autogynephilia, likely the most common internalized sexual attraction in men. Erotic Target Identity Inversion Theory can potentially explain a variety of otherwise puzzling phenomena, including transgender identity among female-attracted natal males and men seeking amputations of healthy limbs.

Kink-Oriented People and Exogenous Oppressions: Understanding Mental Health and Related Service Use in a Rural Context

Rural, kink-oriented people experience much exogenous oppression and yet related research is scarce. This study examined the risk and protective factors of kink-oriented rural Tasmanian Australians with preexisting mental health conditions and help-seeking barriers and facilitators. Participants completed either an online survey (n = 42), an interview (n = 10), or both. Thematic analysis and descriptive statistics were used to analyze the qualitative and quantitative data, respectively. Participants aged 18 to 61 were gender and sexually diverse and better educated but had more lifetime suicide attempts than the general public. Despite the increasing normalization of kink, 90.5% of participants have never seen a kink-aware mental health professional (MHP) and nearly 83.0% did not disclose to an MHP for fear of stigma or discrimination. Self-awareness, resilience, social support and kink improved participants' mental health. Tailored support from trained MHP is vital to improve the mental health of kink-oriented people in rural areas.

"Classifying D/s Profiles Without Prior Assumptions: An Application of Cluster Analysis to Social Data"

Dominant/submissive role-play (D/s) is associated with specialized roles including Mistress, Master, Slave, Switch, Sadist, and Masochist. The current study uses cluster analysis to provide empirical evidence that no binary opposition or single spectrum constitutes a workable typology of individuals based on their affinities for these roles. The optimality of a particular choice of clustering scheme, including the number of clusters, is established using a replication technique which is presented in detail. A large number (n = 236,353) of individualized results (profiles) generated by the BDSM Test, a popular anonymous web survey, were analyzed. We hypothesize a two-dimensional typology of D/s profiles as the inferential result of our cluster analyses.

Youth sexual offending in Hong Kong: examining the role of self-control, risky sexual behaviors, and paraphilic interests

Introduction

Little is known about the nature and prevalence of sexual offending among youth in Hong Kong.

Methods

Testing self-control theory and sexual health risk factors (i.e., risky sexual behaviors [general and two subtypes] and paraphilic interests [general and 14 subtypes]), the prevalence of self-reported sexual offending behaviors (i.e., threat of sexual assault, penetrative sexual assault, and nonpenetrative sexual offense) was examined in a community-based sample of 863 young people (aged 17 to 20) in Hong Kong.

Results

In this study, men reported significantly higher levels of threat of sexual assault and of general and 12 subtypes of paraphilic interests than women; and women reported a significantly higher level of a specific paraphilic interest subtype (i.e., transvestic fetishism) than men. Logistic regressions found that, in general, a low level of self-control and high levels of risky sexual behaviors and paraphilic interests were important factors in the participants' likelihood of issuing threats of sexual assault and engaging in penetrative and nonpenetrative sexual assault.

Discussion

Important practical implications for reducing the tendency of young people to engage in sexual offending behavior can be derived from this study.

The effects of bilateral stimulation using eye movements on sexual fantasies with follow-up

BACKGROUND AND OBJECTIVES

Sexual fantasies represent a common aspect of human sexuality that can support sexual well-being but also contribute to psychopathology. The latter warrants intervention and bilateral stimulation with eye movements (EMs) may be a suitable intervention for impairing mental imagery of sexual fantasies. This study aimed to evaluate the effect of multiple rounds of EMs on sexual fantasies, gauge the effect over time with a one-week follow-up, and assess how impaired sexual imagery may influence behaviour and behavioural intention.

METHODS

Twenty-eight participants (14 male, Mage = 44.10, SDage = 9.77) selected a favoured sexual fantasy and engaged in five repeated rounds of an EM task, either face-to-face or via telehealth. Baseline phenomenological characteristics of sexual fantasies were compared against repeated measures after each round of EMs and at one-week follow-up, as well as hypothetical behavioural intention and frequency of fantasy masturbation.

RESULTS

All sexual fantasy characteristics (e.g., vividness, sensations, arousal, believability) diminished progressively between each round of EMs. These characteristics increased from round five to follow-up. However, they remained significantly reduced compared to baseline. Participants' hypothetical behavioural intention and frequency of masturbation associated with their sexual fantasies also reduced post-EM task.

LIMITATIONS

Use of self-report measures; participants' mental imagery could not be measured directly; and no comparison groups were included.

CONCLUSIONS

As an imagery impairing task, bilateral stimulation with EMs is effective for diminishing the phenomenological properties of sexual fantasies, extending upon extant literature. Collectively, the progressive research regarding EMs and sexual fantasies encourages replication in specific populations (e.g., individuals with problematic or harmful sexual fantasies).

Paraphilic Interests Versus Behaviors: Factors that Distinguish Individuals Who Act on Paraphilic Interests From Individuals Who Refrain

Little is known about distinct factors linked with acting on paraphilic interests or refraining from engaging in paraphilic behaviors. Participants from Canada and the United States (N = 744), aged 19-42 years (M = 29.2; SD = 3.18), were recruited through Amazon's Mechanical Turk. Participants completed questionnaires about their paraphilic interests and behaviors, as well as potential key factors linked to behavioral engagement (i.e., perceptions of consent, sexual excitation/inhibition, impulsivity, moral disengagement, empathy). Results indicated that higher moral disengagement and impulsivity, lower sexual control (i.e., high sexual excitation, low sexual inhibition), and maladaptive understandings of consent were best able to differentiate individuals who reported highly stigmatized (e.g., hebephilia, pedophilia, coprophilia) or Bondage and Dicipline, Dominance and Submission, Sadism and Masochism(BDSM)/Fetish paraphilic interests and engagement in the paraphilic behaviours associated with these interests relative to individuals who did not report such paraphilic interests or behaviors. Moreover, higher moral disengagement, impulsivity, and maladaptive perceptions of consent were best able to differentiate non-consensual paraphilic interests and behaviours (e.g., voyeurism, exhibitionism) compared to individuals who did not report these paraphilic interests or behaviours. These results provide future directions for the exploration of mechanisms that may contribute to engagement in paraphilic behaviors and may be targets for intervention aimed at preventing engagement in potentially harmful paraphilias.

Psychological and Developmental Correlates of Paraphilic and Normophilic Sexual Interests

The classification of sexual fantasies and behaviors (here referred to as 'sexual interests') has historically been divided into 'paraphilic' and 'normophilic'. However, studies on paraphilic interests are often limited to clinical or forensic samples and normophilic interests are rarely assessed in tandem. Previous research has found mixed results for psychological and other correlates of sexual interests, potentially due to inconsistency in operationalism and measurement of fantasies and behaviors. The aim of the current study was to quantify correlates of sexual interests via the Sexual Fantasies and Behaviors Inventory, containing factors related to general fantasies/behaviors, normophilia, power dynamics, sadomasochism, and courtship paraphilias, using a large (N = 4280) non-clinical sample. Psychological, developmental, sexual, and demographic correlates were investigated via bivariate correlations, mean difference testing, and multiple regression. Sexual interest domains were largely unrelated to psychopathology and developmental factors. Sociosexuality and more accepting attitudes towards sadomasochism was generally related to more arousal to/engagement in normophilic and paraphilic domains. More autism spectrum disorder traits were related to decreased normophilic interests. Psychopathic traits, sexual sensation seeking, and sexual compulsivity were related to paraphilia dimensions, especially courtship paraphilias and domination/sadism; the former was also associated with negative attitudes about establishing consent. Men, non-monogamous, and non-heterosexual participants indicated greater sexual fantasies and behaviors compared to women (except in the case of submission and masochism), monogamous, and heterosexual participants, respectively.

Sexual Fantasies and Harmful Sexual Interests: Exploring Differences in Sexual Memory Intensity and Sexual Fantasy Characteristics

The perpetration of harmful sexual behavior is a global concern, with deviant sexual fantasies identified as a prominent etiological risk factor. However, the concepts of state sexual fantasy characteristics (e.g., vividness and emotionality) and associated trait sexual memory intensity have received minimal investigation concerning harmful sexual interests, formulating the impetus for this research. Two online surveys were conducted in community populations. Study 1 (N = 414) aimed to validate the psychometric properties of a trait sexual memory intensity scale (SMIS) through principal components analysis, confirmatory factor analysis, and evaluation of concurrent validity. Study 2 (N = 820) endeavored to explore associations between state sexual fantasy characteristics and cognitive-behavior variables (e.g., frequency of masturbation to a reported fantasy), and evaluate differences in fantasy characteristics and SMIS scores between participants with and without harmful sexual interests. Collectively, results supported the factor structure, concurrent validity, and internal consistency of the SMIS, while revealing significant associations between the SMIS, sexual fantasy characteristics, and several variables. Significant differences in sexual fantasy characteristics and SMIS scores were evident but variable among harmful sexual interests. Findings encourage the consideration and research of interventions focused on impairing mental imagery and memory in the management of harmful sexual interests.

An exploration of marks/injuries related to BDSM sexual experiences

Background

Despite its growing prevalence, BDSM practice (bondage, discipline, dominance, submission, and sadomasochism) is still stigmatized, and little is known about the physical marks and injuries that individuals sustain from consensual BDSM-related activities.

Aim

In this exploratory study, we examined BDSM sexual experiences and the physical marks and injuries resulting from these experiences in a convenience sample of 513 US adults.

Methods

We examined the extent to which individuals at various stages of BDSM exploration engage with different types of BDSM and kink behaviors, along with the frequency with which they communicate about, inflict, and receive physical marks from these activities.

Outcomes

Our main outcome measures were intentional and unintentional marks sustained from BDSM-related activities, BDSM experiences, and the use of safe words.

Results

Results revealed that BDSM marks and injuries are common and quite varied (from small scratches to very large bruises) and unintentional and intentional marks differ in terms of typical size, place on body, and severity of injury. Additionally, BDSM experience is positively associated with the use of safe words and marking behaviors.

Clinical Translation

Disclosure of marks and injuries, intentional and unintentional, may be improved if health care providers are aware of, and make efforts to reduce stigma surrounding, BDSM and rough sex activity.

Strengths and Limitations

The findings of this study must be interpreted with acknowledgment of the limitations that it was a survey study with a convenience sample. However, as one of the few studies exploring the marks and injuries sustained from BDSM activities, the exploration of intentional and unintentional marks sustained provides a critical starting point for future examination of BDSM consequences that intersect with health care and the law.

Conclusion

Marks and injuries from BDSM-related activities are common, and despite the greater use of safe words, practitioners with more BDSM experience inflict more marks than those with less BDSM experience.

From Fantasy to Reality: Self-Reported Aggression-Related Sexual Fantasies Predict Sexually Sadistic Behavior beyond Indirect and Direct Measures of Sexual Preference

Aggression-related sexual fantasies (ASF) have been related to various forms of harmful sexual behavior in both sex offender and community samples. However, more research is needed to fully understand this relation, particularly whether ASF is associated with harmful sexual behavior beyond hostile sexism against women and a sexual preference for violence and sexual violence. In the present study, N = 428 participants (61.9% women) between 18 and 83 years of age (M = 28.17, SD = 9.7) reported their ASF and hostile sexism. They rated their sexual arousal by erotic, violent, and sexually violent pictures as a direct measure of sexual preference. Response latencies between stimulus presentation and arousal ratings were used as an indirect measure of sexual preference. ASF and the directly and indirectly assessed sexual preference for violent and sexually violent stimuli were positively correlated. They were unrelated to hostile sexism against women. ASF showed the strongest associations with self-reported sexually sadistic behavior and presumably non-consensual sexual sadism beyond these preferences and hostile sexism in the total group and separately among men and women. The findings indicate that ASF and sexual preference are not equivalent constructs and further underscore the potential relevance of ASF for harmful sexual behavior.

The Development, Content Validation, and Pilot Testing of the Paraphilic Interests and Disorders Scale

The prevalence rates of paraphilic interests and disorders in the general population have been understudied, in large part due to the lack of a standardized assessment measure. As a result, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 provides little information regarding the prevalence of paraphilic disorders. The present study involved the development of a self-report measure, Paraphilic Interests and Disorders Scale (PIDS), that can be used to assess for the eight paraphilic interests/disorders in the DSM-5 for use with general population samples. Study 1 established the content validity of the PIDS using feedback from 22 experts in the field, and recommendations from these experts were utilized to modify the measure. In Study 2, the PIDS was piloted on 100 individuals in the general population, which supported the feasibility of implementation and its limited-efficacy. While the PIDS requires further psychometric support, the current research suggests the PIDS is a promising tool to gather self-report, population-based data on DSM-5 paraphilic interests and disorders.

Risky Sexual Behavior, Paraphilic Interest, and Sexual Offending: The Study of a Community Sample of Young Adults in Hong Kong

Limited information is available on the prevalence and nature of sexual offending in Hong Kong. This cross-sectional study seeks to explore the role of risky sexual behavior (RSB) and paraphilic interests in self-reported sexual offending behavior (i.e., nonpenetrative-only, penetrative-only, and nonpenetrative-plus-penetrative sexual assault) in a community sample of young adults in Hong Kong. Using a large sample (N = 1885) of university students, the lifetime prevalence of self-reported sexual offending was 18% (n = 342; 23% males (n = 166), 15% females (n = 176)). Based on the study subsample of 342 participants who self-reported sexual offending (aged 18-35), the findings indicated that males reported significantly higher levels of general, penetrative-only, nonpenetrative-plus-penetrative sexual assault; and paraphilic interest in voyeurism, frotteurism, biastophilia, scatophilia, and hebephilia than females; while females reported a significantly higher level of transvestic fetishism than males. No significant difference was found in RSB between males and females. Logistic regressions found that the participants who possessed a higher level of RSB, particularly penetrative behaviors, and paraphilic interest in voyeurism and zoophilia were less likely to engage in a nonpenetrative-only sexual offense. Conversely, the participants who possessed higher levels of RSB, especially penetrative behaviors, and paraphilic interest in exhibitionism and zoophilia, were more likely to engage in nonpenetrative-plus-penetrative sexual assault. The implications for practice in areas such as public education and offender rehabilitation are discussed.

Stigmatisation of People with Deviant Sexual Interest: A Comparative Study

Background: Pedophilia is a deviant sexual interest subject to more public stigma and punitive attitudes than others. Pedophilia has received a disproportionate amount of scholarly attention in comparison to other deviant sexual interests. To address this, the present study offers a comparison of the public stigma and punitive attitudes associated with pedophilia, fetishism, and hypersexuality. Methods: Recruited in Australia, one-hundred and twelve individuals participated in an anonymous online survey. Stigmatising and punitive attitudes toward pedophilia, fetishism, and hypersexuality were assessed via sub-scales of perceived dangerousness, deviance, intentionality, and punitive attitudes. Results: Participants held harsher punitive attitudes toward people with pedophilia and thought them to be more deviant and dangerous than people with fetishism and hypersexuality. Participants perceived hypersexuality to be more dangerous and deviant than fetishism. No consistent combination of perceived dangerousness, deviance, and intentionality predicted punitive attitudes toward all conditions. Rather, combinations of punitive attitude predictors were unique across conditions. Conclusions: This research articulates the unparalleled public stigma and punitive attitudes faced by people with pedophilia, compared to people with fetishism and hypersexuality. Findings which suggest that public stigma is stronger for hypersexuality than it is for fetishism are relatively novel, as are the observed predictors of punitive attitudes toward each condition. Knowledge produced by this study contributes to an improved conceptualisation of how the public views individuals who experience deviant sexual interests.

Current biopsychosocial science on understanding kink

The field of kink (or BDSM) studies has grown significantly in recent years, with several areas of study being initiated. This paper summarizes the current state of kink research, including prevalence rates; marginalization and stigma; key biological, psychological, and social research findings; clinical issues; and recommendations for further research. Theoretical frameworks, such as minority stress, serious leisure, sexual orientation, personal growth, and sensation-seeking theories appear to be useful frameworks outside of approaches that assume psychopathology as an etiological factor. Studies find the following results: higher levels of sensation-seeking; kink activities generating states of flow and transient hypofrontality; notable levels of gender, sexual orientation, and relationship style diversity in kink samples; and higher levels of minority stress-related suicidality.

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.

Excitation Transfer Between Sexual Arousal and Other Emotions in a Community Sample

Excitation transfer, the transfer of arousal from one emotion to another, might be a mechanism in the development of unusual sexual interests. In this pilot study, we investigated whether we could induce excitation transfer between various emotions and sexual arousal in a laboratory setting with 30 male volunteers. We induced low-level sexual arousal in four different emotional states (aggression/dominance, endearment, fear, disgust) and a neutral state. Sexual arousal was measured using penile plethysmography and self-report. Although there was no mean group effect, possibly due to large interindividual variations, 60% of the subjects showed more sexual arousal in response to sexual stimulation in at least one of the emotional states than in the neutral state. Excitation transfer was most prominent with aggression/dominance and least prominent with disgust. Genital excitation transfer was strongly related to lower penile reactivity and to higher self-reported erotophilia. This pilot study paves the way for further research into excitation transfer as a mechanism to increase the salience of stimuli that otherwise would not have been sexual in nature.

The Relation Between the Paraphilias and Anxiety in Men: A Case-Control Study

Despite a multitude of theoretical views, it is still unclear how individuals develop and sustain paraphilic interests (e.g., sexual attraction to children, interest in non-consensual violence). It is also not clear from these views why many paraphilic interests, and especially many paraphilias and paraphilic disorders, are much more common in men than in women. One possible factor affecting male's higher rate of paraphilias is anxiety, because anxiety can potentiate sexual arousal in men. We speculated that paraphilic interests could develop when feelings of anxiety are recurrently generated by atypical sexual stimuli, and when that anxiety repeatedly potentiates sexual arousal, reinforcing sexual response to atypical stimuli. It follows that men with paraphilic interests are susceptible to anxiety disorders, because an anxiety disorder would facilitate the hypothesized developmental process. We conducted a retrospective file review of 1048 consecutive patients (944 male patients retained for analysis) referred to an outpatient sexual behavior clinic at a psychiatric hospital to investigate the link between paraphilias and anxiety. Male patients with a paraphilia had 1.64 greater odds than male patients without a paraphilia of having been diagnosed with an anxiety disorder, but they also had elevated rates of many other types of disorders. Therefore, there does not seem to be a specific link between paraphilias and anxiety in this sample. The discovery of a general link between the paraphilias and psychological disorders in men opens new avenues for studying the developmental origins and consequences of male paraphilic interests.

Dark personalities and general masochistic tendencies: Their relationships to giving and receiving sexualized pain

Recent research has shown that a tendency to harm others goes hand in hand with a tendency to harm oneself. The present two studies further supported the notion that the joy of harming others and oneself has a common core by showing positive relationships between dark personality traits (particularly psychopathy) and sexual masochistic preferences and between general masochistic tendencies and sexual sadistic preferences. Despite the overlap between dark personality traits and general masochistic tendencies, they independently predicted the engagement in sexual sadomasochism. These relationships statistically held when controlling for the impact of basic personality (Study 1). Study 2 found that self-enhancement, openness to change, and low conservation values serve as motivators for a person's attraction to sexual sadomasochism and shed some light on the differences between sexual sadomasochism and the Dark Tetrad. Overall, people who score relatively high on dark personalities and masochism are particularly predisposed to engage in sexual sadomasochism, in both the dominant and the submissive roles.

Pornography Use, Offense-Supportive Cognitions, Atypical Sexual Interests, and Sexual Offending against Children

The effects of pornography are hotly debated in the scientific literature, especially its potentially negative influence on sexual offending. While studies do not support direct effects of pornography use on sexual offending, pornography is hypothesized to have a catalytic effect among men who are predisposed to sexually offend due to the presence of other risk factors. Using a sample of 241 men varying in sexual offending history, this study examined the associations of different types of pornography consumption, offense-supportive cognitions, and atypical sexual interests on sexual offending against boys or girls. Bivariate analyses support the idea that people seek pornography that matches their sexual interests. Multivariate analyses revealed that the only type of pornography associated with contact sexual offending against boys or girls was child pornography, as it had incremental validity predicting number of victims beyond offense-supportive cognitions and atypical sexual interests. Moderation analyses suggested that, as hypothesized, child pornography consumption amplifies the effect of sexual interests for boys on sexual offending against boy victims. However, that moderation effect was not found for sexual offending against girls. Clinical and research implications are discussed, focusing on the importance of including measures of pornography consumption within forensic assessment and management protocols.

Castration for Pleasure: Exploring Extreme Castration Ideations in Fiction

The Eunuch Archive (EA) is an online community which includes individuals who read and write sexual fantasies with themes related to castration and eunuchs. Here we analyzed the 100 stories rated highest by EA readers among the >8800 currently posted. Our goal was to gain insights into commonalities within, and specifics of, castration sexual fantasies. Simply stated, we want to know what the authors (and readers) fantasize about and why. The most popular EA stories link sexual gratification and romantic partnership with genital abuse. They are characterized by the absence of consent for genital ablations and multiple SM-related paraphilias. Many stories feature attraction to, and ablation of, the genitals of pubescent or adolescent males. Some EA members have acted on their interests and been voluntarily castrated. Others wish to be. The most popular stories in the EA collection typically link the sacrifice via SM abuse to securing a permanent sexual partnership. The idea of sacrificing one's genitals to build dyadic adhesion has been noted before in individuals with extreme castration ideations. Here we identify the common features of sexualized fantasies that are popular among individuals with exceptional interest in castration.

A Case Report of Rare Paraphilic Interest: Emetophilia

Background: Paraphilic interest is when sexual arousal occurs in response to objects that are not part of normal sexual arousal. One of the rare paraphilic interests is emetophilia, in which an individual experiences sexual pleasure by observing people vomiting.   Case Report: We report a 29 year old, unmarried woman, who came alone to the psychiatrist due to sexual arousal by observing others vomiting since childhood. The patient has never had sexual intercourse, so she does not know whether this condition affects her sexual activities or not. Meanwhile, she experienced job-related distress due to her illness.  Conclusion: Paraphilic interest or anomalous is one paraphilic disorder form which the person experiences less intense and frequent unusual sexual interest without significant distress or impairment in daily life. In this case, further evaluation concerning this patient’s level of distress, including her sexual intercourse behaviour, was still needed.  Keywords: paraphilia, emetophilia, paraphilic disorder 

The Prevalence of Sexual Interest in Children and Sexually Harmful Behavior Self-Reported by Men Recruited Through an Online Crowdsourcing Platform

This study examined the feasibility of using crowdsourcing to recruit men who self-report sexual interest in children or sexually problematic behavior involving children. Crowdsourcing refers to the use of the internet to reach a large number of people to complete a specific task. A nonrepresentative sample of men (N = 997) participated in a brief self-report survey examining age of attraction, sexual interest in children, proclivity toward sexual offenses involving children, and history of sexual offending. Almost a quarter of the sample (23.1%) indicated some degree of sexual interest in children, propensity to sexually offend against children, and/or actual offending behavior. We present our data broken down by type of interest or behavior and examine the frequency of these outcomes. Findings are likely to be of value to those considering the viability of crowdsourcing to overcome the limitations or challenges of face-to-face research on stigmatizing interests and behaviors. Findings also contribute to estimating prevalence of self-reported sexual interest in children, and sexual offending behavior toward children, across different countries.

Concordance and Discordance between Paraphilic Interests and Behaviors: A Follow-Up Study

Although paraphilic interests represent significant risk factors for recidivism among sexual offenders, little is known about the magnitude of concordance between paraphilic interests and behaviors in the general population. The goal of this follow-up study was to conduct secondary analyses based on a sample of 1040 adults (475 men; 565 women) recruited in the general population. Levels of associations and active concordance (having both interest and experience), passive concordance (having neither interest nor experience), active discordance (having experience without interest) and passive discordance (having interest without experience) between paraphilic interest and corresponding behavior were assessed. Concordance and discordance indexes were also computed, as well as regressions and moderation analyses. As expected, paraphilic interests predicted corresponding behaviors, although the mean active concordance rate was only approximately 50%. Concordance rates varied with gender and the criminal nature (legal vs. illegal) of paraphilia. Paraphilic interests in adults from the general population may not have the same predictive value as that observed in medico-legal contexts. The possible role of other moderators in the concordance between paraphilic interest and behavior in non-clinical populations should be assessed. These findings have implications for sexual abuse prevention programs aiming at individuals in the community.