Controversies in the diagnosis and treatment of paraphilias

A Qualitative Study Into the Relative Stigmatization of Mental Illness by Mental Health Professionals

Mental health professionals stigmatize mental illness, which has significant ramifications for public health and policy. Within this domain, there is a lack of comprehensive research on relative stigma, emotions, and behaviors and an absence of literature that can guide research on these topics. The current study sought to address these limitations. Unstructured interviews were conducted with 22 mental health professionals, and data were analyzed using a grounded theory approach. The current study identified a collection of mental disorders (e.g., borderline personality disorder), stereotypes (e.g., dangerousness), emotion-related responses (e.g., fear), and behaviors (e.g., helping) as being key to the relative stigmatization of mental illness by mental health professionals. The results also suggested that professional context and familiarity with mental illness decrease the stigmatization of mental illness by mental health professionals. These variables and constructs were combined to form a grounded theory of mental health professionals stigmatizing mental illness. The current study has implications for the direction of future research on the stigmatization of mental illness by mental health professionals and interventions that strive to mitigate this type of stigmatization.

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.

Narratives of the Origins of Kinky Sexual Desire Held by Users of a Kink-Oriented Social Networking Website

Empirical research on the origins of kinky erotic desires (e.g., sadomasochism, bondage, domination/submission, roleplaying, sexual fetishism, etc.) has been limited and rarely rooted in the narratives of kinky people themselves. Among a sample of 260 self-identified kinky users of a kink-oriented social networking website living in 21 countries, we examined self-reported narratives of the origins of kink desires. An inductive coding process by four independent coders yielded 20 categories of responses, organized into five broad discourses about the origins of kinky desires: identity (e.g., personality, personal taste, and role exploration; 72.7% of responses), nurture (e.g., both traumatic and non-traumatic life experiences; 38.1% of responses), negation (e.g., disavowing or doubting a particular idea about the origins of their kink interests; 24.6% of responses), nature (e.g., biology and genetics; 22.7% of responses), and uncertainty (e.g., not being able to identify an origin of kinky desires; 10.4% of responses). Fewer than 19% of participants mentioned any kind of trauma in their responses. We discuss implications for scientific understandings of kinky sexual desire within the umbrella of sexual diversity.

Exploring the relationship between paraphilic interests, sex, and sexual and life satisfaction in non-clinical samples

Limited research has indicated that paraphilic interests and behaviours do not necessarily decrease sexual and life satisfaction; some research suggests such interests may actually enhance satisfaction. The present study assessed how paraphilic-associated interests and behaviours were related to sexual and life satisfaction in a sample of 173 men and 356 women. Paraphilic interest rates were similar to existing population-based studies. Men reported significantly higher levels of most paraphilic interests than women, apart from masochism. Those with paraphilic interests rarely felt negatively affected. However, those interested in criminal paraphilic interests or both criminal and legally feasible paraphilic interests had lower levels of sexual satisfaction when they did not engage in paraphilia-associated sexual behaviour. The sexual satisfaction of those interested only in legally feasible paraphilic interests was not impacted whether or not they engaged in paraphilia-associated sexual behaviour. Further analyses indicated that those without a paraphilic interest and those who have a paraphilic interest and have disclosed to their partner have higher levels of sexual satisfaction than those who have not disclosed to their partner or who do not have a stable partner. Additionally, among those who had disclosed to a partner, sexual satisfaction was not affected whether the individual engaged in the paraphilic interest with or without their partner. These results suggest a multifaceted relationship that warrants further consideration and examination.

The efficacy, safety and ethics of the use of testosterone-suppressing agents in the management of sex offending

PURPOSE OF REVIEW

The use of endocrine medications to reduce sexual offending recidivism is established and may involve clinicians from diverse specialities. The present review aims to outline relevant background information and note a Medical Ethics framework upon which to facilitate decision-making.

RECENT FINDINGS

There have been several systematic reviews in recent years. A number of problems with research in the area of the medical treatment of sex offenders have been highlighted. There remains scope for improvement in the research to answer a number of relevant clinical issues. Nonetheless, some very useful indicators of relevance to clinical practice have emerged.

SUMMARY

The use of medication to manage the risk of sex offending in males is appropriate under the right circumstances. These include, for example, hypersexuality with sexual deviance and psychological-treatment interfering sexual preoccupation.

Assessment methods and management of hypersexuality and paraphilic disorders

PURPOSE OF REVIEW

The recent implementation of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition introduced some important changes in the conceptualization of hypersexuality and paraphilic disorders. The destigmatization of nonnormative sexual behaviors could be viewed as positive, However, other changes are more controversial. In order to stimulate new research approaches and provide mental healthcare providers with appropriate treatment regimes, validated assessment and treatment methods are needed. The purpose of this article is to review the studies published between January 2013 and July 2014 that aimed at assessing the psychometric properties of the currently applied assessment instruments and treatment approaches for hypersexuality and hypersexual disorders or paraphilias and paraphilic disorder.

RECENT FINDINGS

Currently existing instruments can validly assess hypersexual behaviors in different populations (e.g. college students, gay and bisexual men, and patients with neurodegenerative disorders) and cultural backgrounds (e.g. Germany, Spain, and USA). Concerning the assessment of paraphilias, it was shown that combining different assessment methods show a better performance in distinguishing between patients with paraphilias and control groups. In addition to psychotherapeutic treatment, pharmacological agents aiming at a reduction of serum testosterone levels are used for hypersexual behaviors as well as paraphilic disorders.

SUMMARY

Although the currently applied assessment and treatment methods seem to perform quite well, more research about the assessment and evidence-based treatment is needed. This would help to overcome the existing unresolved issues concerning the conceptualization of hypersexual and paraphilic disorders.

Philosophical issues in the paraphilias

PURPOSE OF REVIEW

Controversies surrounded the development of paraphilias in the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5. This review examines the philosophical issues that emerge from an analysis of those debates and current literature.

RECENT FINDINGS

The resolution of controversies in the publication of the DSM 5 drew upon the available evidence, theories of mental disorder, and normative assumptions. The rise of the Internet presents difficult challenges in this field.

SUMMARY

Numerous philosophical assumptions underlie the psychiatric understandings of paraphilias. The focus here is on the nosological issues such as boundary justification for the determinations of normative and nonnormative human sexuality; the importance of not collapsing the distinction between mental disorder and crime, and the relationship between fantasy and action; epistemological questions of perspectivity, reasons-giving, and relationship of communication to truth claims; and sex differences not only in the paraphilias but also in the social context in which sex is formed and given expression.