Are rapists differentially aroused by coercive sex in phallometric assessments?

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.

Use of sexual stimuli in research and clinical settings: expert opinion and recommendations

Background

Sexual stimuli, such as sexual videos, images, and narratives describing sexual interactions, are one of many tools used by clinicians and researchers to elicit or augment sexual response. Given the wide variability within sexual stimuli and their effects on sexual response, we provide guidance on when and how to use sexual stimuli, selecting sexual stimuli, and standardizing the use and reporting of sexual stimuli in research and clinical practice.

Aim

This expert opinion review article discusses standard operating procedures when using sexual stimuli in clinical and research applications, addressing 3 broad areas: settings in which sexual stimuli are used, characteristics and contexts of the stimuli, and practical and ethical considerations when using the stimuli.

Methods

This article is based on an expert opinion review of the sexual psychophysiology literature.

Results

First, we discuss the settings in which sexual stimuli are typically used and evaluate the ecological validity of each setting. Second, we review the types of sexual stimuli used in sexual response research, including physical characteristics, depicted sexual activity, and context, and the impacts of these characteristics on sexual response. Last, we discuss the practical and ethical considerations that come with the choice and use of sexual stimuli in clinical and research settings. We address potential limitations of certain sexual stimuli, including practical and ethical considerations such as participant vs experimenter choice, diversity and representation, and proper sourcing of sexual stimuli for use in clinical and research applications. Discussions on the future applications of sexual stimuli, such as the use of virtual reality, and ethical considerations in terms of user-generated Internet sexual stimuli are also explored.

Conclusion

We provide an expert opinion review of the literature regarding use of sexual stimuli for clinical and research applications and offer best use practices and recommendations.

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.

Effect of a Condom Cover on Vaginal Photoplethysmographic Responses

INTRODUCTION

The vaginal photoplethysmograph (VPP) is a reusable intravaginal device often employed in sexual psychophysiology studies to assess changes in vaginal blood flow, an indicator of sexual arousal.

AIM

To test whether placing a disposable cover on the VPP probe impacts the acquired data. A condom cover would reduce risk of disease transmission and likely increase participant comfort but may negatively impact the VPP signal.

METHOD

The genital responses of 25 cisgender women (mean age = 21.3 years, standard deviation = 2.6) were assessed with VPP in a within-subjects design with 2 conditions-with and without a polyisoprene condom cover. Sexual responses were elicited by audiovisual film clips that varied in erotic intensity: nonsexual (nonsexual male-female interaction), low-intensity sexual (nude exercise), and high-intensity sexual (male-female intercourse). Women continuously rated their sexual arousal during stimulus presentations.

MAIN OUTCOME MEASURE

Change in vaginal pulse amplitude and also self-reported sexual arousal.

RESULTS

The magnitude of sexual response to each stimulus category and the overall pattern of results were found to be highly similar in the cover-off and cover-on conditions. The high-intensity sexual stimulus category elicited a greater sexual response than all other categories. The low-intensity sexual category elicited a (small) genital response in only the cover-on condition, although we suspect this is a spurious finding. There was no difference in the average number of edited movement artifacts across conditions.

CLINICAL IMPLICATIONS

Potential benefits of encasing the VPP probe with a protective cover include enhanced participant safety and comfort, especially if assessing genital responses of high-risk or immunocompromised samples. The use of a cover complies with current guidelines for reprocessing semi-critical medical devices (eg, vaginal ultrasound probes) in many regions.

STRENGTHS & LIMITATIONS

Although the idea of a VPP probe cover had been discussed among sexual psychophysiology researchers, this is the first study to empirically test whether a cover could jeopardize VPP data. Potential limitations include the use of a 10-Hz VPP sampling rate and a cover that was not tailored to the size of the VPP probe.

CONCLUSION

Placing a protective cover on the VPP probe did not appear to meaningfully impact sexual arousal or the VPP data. Based on these results and the potential advantages of a protective cover, researchers may wish to integrate the use a condom cover in their experiment protocols and clinical applications. Sawatsky ML, Lalumière ML. Effect of a Condom Cover on Vaginal Photoplethysmographic Responses. J Sex Med 2020; 17:702-715.

Mixed Emotions: An Incentive Motivational Model of Sexual Deviance

Sexual offending behavior is a complex and multifaceted phenomenon. Most existing etiological models describe sexual offending behavior as a variant of offending behavior and mostly include factors referring to disinhibition and sexual deviance. In this article, we argue that there is additional value in describing sexual offending behavior as sexual behavior in terms of an incentive model of sexual motivation. The model describes sexual arousal as an emotion, triggered by a competent stimulus signaling potential reward, and comparable to other emotions coupled with strong bodily reactions. Consequently, we describe sexual offending behavior in terms of this new model with emphasis on the development of deviant sexual interests and preferences. Summarized, the model states that because sexual arousal itself is an emotion, there is a bidirectional relationship between sexual self-regulation and emotional self-regulation. Not only can sex be used to regulate emotional states (i.e., sexual coping), emotions can also be used, consciously or automatically, to regulate sexual arousal (i.e., sexual deviance). Preliminary support for the model is drawn from studies in the field of sex offender research as well as sexology and motivation research.

Sexual Arousal and Sexually Explicit Media (SEM): Comparing Patterns of Sexual Arousal to SEM and Sexual Self-Evaluations and Satisfaction Across Gender and Sexual Orientation

Introduction

Investigations of patterns of sexual arousal to certain groups of sexually explicit media (SEM) in the general population in non-laboratory settings are rare. Such knowledge could be important to understand more about the relative specificity of sexual arousal in different SEM users.

Aims

(i) To investigate whether sexual arousal to non-mainstream vs mainstream SEM contents could be categorized across gender and sexual orientation, (ii) to compare levels of SEM-induced sexual arousal, sexual satisfaction, and self-evaluated sexual interests and fantasies between non-mainstream and mainstream SEM groups, and (iii) to explore the validity and predictive accuracy of the Non-Mainstream Pornography Arousal Scale (NPAS).

Methods

Online cross-sectional survey of 2,035 regular SEM users in Croatia.

Main Outcomes Measures

Patterns of sexual arousal to 27 different SEM themes, sexual satisfaction, and self-evaluations of sexual interests and sexual fantasies.

Results

Groups characterized by sexual arousal to non-mainstream SEM could be identified across gender and sexual orientation. These non-mainstream SEM groups reported more SEM use and higher average levels of sexual arousal across the 27 SEM themes assessed compared with mainstream SEM groups. Only few differences were found between non-mainstream and mainstream SEM groups in self-evaluative judgements of sexual interests, sexual fantasies, and sexual satisfaction. The internal validity and predictive accuracy of the NPAS was good across most user groups investigated.

Conclusions

The findings suggest that in classified non-mainstream SEM groups, patterns of sexual arousal might be less fixated and category specific than previously assumed. Further, these groups are not more judgmental of their SEM-related sexual arousal patterns than groups characterized by patterns of sexual arousal to more mainstream SEM content. Moreover, accurate identification of non-mainstream SEM group membership is generally possible across gender and sexual orientation using the NPAS.

Hald GM, Stulhofer A, Lange T, et al. Sexual Arousal and Sexually Explicit Media (SEM): Comparing Patterns of Sexual Arousal to SEM and Sexual Self-Evaluations and Satisfaction Across Gender and Sexual Orientation. Sex Med 2018;6:30–38.

Genital Responses to Rape Vignettes Among Young Men: The Influence of Mood and Directed Attention

Although it is clear that men with a history of sexual assaults against women produce higher relative genital responses to rape vignettes in the laboratory than do men without such a history, it remains unclear what aspects of the vignettes are eliciting these responses, and whether the genital responses are affected by situational factors. The antisocial tendencies hypothesis states that many men are inhibited by cues of violence, suffering, and coercion in rape vignettes, but other men, particularly antisocial and sexually aggressive men, are not so inhibited. In this study, we investigated whether the hypothesized inhibition to rape vignettes among nonoffenders could be affected by manipulation of mood and directed attention. A total of 48 young men were exposed to audio-recorded vignettes describing mutually consenting and nonviolent sexual interactions, mutually consenting and violent sexual interactions, nonconsenting and violent sexual interactions, and nonsexual and nonviolent social interactions (within-subjects). Participants were randomly assigned to a mood manipulation designed to induce a happy, neutral, or sad mood (between-subjects). All were asked to pay attention to either sex words or violent words while listening to the vignettes (within-subjects). As is typically observed, genital responses were lower (inhibited) when vignettes included cues of violence or nonconsent. Both happy and sad mood inductions reduced this inhibition, so that men induced into a happy or sad mood showed greater relative responding to cues of violence or nonconsent compared with men in a neutral mood. The attention manipulation had no significant effect. Results suggest that genital responses to rape cues can be situationally influenced, but not necessarily as predicted by the antisocial tendencies hypothesis.

Discriminating Coercive from Sadomasochistic Sexuality

Sadomasochistic (SM) sexual interest is reported by a wide range of individuals. Within the sex offender literature, the presence of SM interest is often viewed as a herald of criminal sexual behavior; however, research indicates that SM interests are not predictive of coercive sexual behavior. In the current study, we measured a range of sexual fantasies and behaviors, and then applied cluster analyses to determine (1) if individuals endorsed elevated SM interests also endorsed coercive fantasies and, (2) to explore cluster membership correlates using measures of sensation seeking, externalizing and antisocial behaviors, attitudes toward rape, and empathic capacity. A total of 550 participants were recruited through a variety of on-line discussion areas. A four cluster solution best fit the data with distinct clusters observed for those endorsing SM behaviors and those reporting coercive sexual behavior. Additional analyses revealed greater endorsement of victim blaming attitudes and lower empathic concern among members of the coercive sexual behavior cluster. Elevated sensation seeking and externalizing behaviors were reported by members of clusters marked by SM and coercive sexual behavior. Results provide further support for the differentiation between SM and coercive sexual behaviors as representative of individuals with divergent attitudes, traits, and behaviors.

Nudity as a Disinhibiting Cue in a Date Rape Analogue

Situational factors likely play a role in date rape. The sexual inhibition hypothesis suggests that men are typically sexually inhibited by violence and non-consent, but that inhibition can also be disrupted. We attempted to determine if female nudity reduces inhibition of sexual arousal to non-consensual cues in sexually non-aggressive men. In two studies, heterosexual men (aged 18-25) were presented with six 2-min audiotaped narratives depicting consensual sexual interactions, non-consensual sexual interactions (rape), and non-sexual interactions (neutral) involving a man and a woman. In the first study, 20 participants saw pictures depicting nude or clothed women while listening to the stories. In the second study, 20 other participants saw videos depicting nude or clothed women exercising, also while listening to the stories. Genital responses and subjective sexual arousal were measured. Results suggested that nudity may have a disinhibitory effect on sexual arousal to non-consensual cues, but only when presented in the form of moving images.

Experimental effects of exposure to pornography: the moderating effect of personality and mediating effect of sexual arousal

Using a randomly selected community sample of 200 Danish young adult men and women in a randomized experimental design, the study investigated the effects of a personality trait (agreeableness), past pornography consumption, and experimental exposure to non-violent pornography on attitudes supporting violence against women (ASV). We found that lower levels of agreeableness and higher levels of past pornography consumption significantly predicted ASV. In addition, experimental exposure to pornography increased ASV but only among men low in agreeableness. This relationship was found to be significantly mediated by sexual arousal with sexual arousal referring to the subjective assessment of feeling sexually excited, ready for sexual activities, and/or bodily sensations associated with being sexually aroused. In underscoring the importance of individual differences, the results supported the hierarchical confluence model of sexual aggression and the media literature on affective engagement and priming effects.

A systematic qualitative review of risk and protective factors for sexual violence perpetration

The current review summarized results of 191 published empirical studies that examined the risk and protective factors for sexual violence perpetration. Studies in the review examined factors for perpetration by and against adolescents and adults, by male and female perpetrators, and by those who offended against individuals of the same sex or opposite sex. Factors associated with child sexual abuse (CSA) perpetration were not included. In all, 2 societal and community factors, 23 relationship factors, and 42 individual-level factors were identified. Of these 67 factors, consistent significant support for their association with SV was found for 35, nonsignificant effects were found for 10, 7 factors had limited or sample-specific evidence that they were associated with SV but were in need of further study, and 15 demonstrated mixed results. The factors identified in the review underscore the need for comprehensive prevention programs that target multiple risk and protective factors as well as factors that occur across the social ecology. Moreover, we identified two domains of factors--the presence and acceptance of violence and unhealthy sexual behaviors, experiences, or attitudes--that had consistent significant associations with SV but are not typically addressed in prevention programs. Therefore, SV prevention may also benefit from learning from effective strategies in other areas of public health, namely sexual health and youth violence prevention.

Explaining the erectile responses of rapists to rape stories: the contributions of sexual activity, non-consent, and violence with injury

In phallometric research, rapists have a unique pattern of erectile responses to stimuli depicting sexual activities involving coercion and violence. In this study, we attempted to determine the cues that control rapists' erectile responses to rape stories in the laboratory. A total of 12 rapists and 14 non-rapists were exposed to recorded audio scenarios that systematically varied with regard to the presence or absence of three orthogonally varied elements: sexual activity and nudity, violence and injury, and expression of non-consent. As expected from prior research, an index computed by subtracting participants' greatest mean responses to stories describing mutually consenting sexual activity from their greatest mean responses to stories describing rape was much higher among rapists than non-rapists. Both groups showed larger responses when stories involved sexual activity and nudity, but neither group exhibited a preference for cues of violence and serious injury, or for cues of non-consent. The element that produced the larger group difference, however, was the presence or absence of active consent. The results indicated that a sexual interest in (or indifference to) non-consent is at least as central to accounting for the unique sexual orientation of rapists as is sexual responding to violence and injury.

Psychopathy and sexual sadism

Psychopathic personality disorder and sexual sadism share several common characteristics, such as emotional detachment from the suffering of others or the preparedness to inflict pain or injuries. Based on a sample of 100 male forensic patients (all of them sex offenders, half of them sadistic), the concept of psychopathy and sexual sadism as a unified construct was tested empirically. Pooling indicator variables for psychopathic and sexually sadistic disorders showed that a two-factorial solution yielded a better fit than a single-factor model. The two factors identified psychopathy and sexual sadism as separate latent variables. More specifically, the data were compatible with a path model in which affective deficits and behavioral disinhibition of the psychopathy domain are precursors to sexually sadistic conduct.

Prepared for Anything?

Men’s genital arousal occurs in response to a limited number of sexual stimuli, whereas women’s genital arousal occurs in response to a wide range of sexual stimuli, including those depicting nonpreferred cues. Researchers have hypothesized that women’s nonspecific pattern of genital arousal prepares the body for sexual activity, thus functioning to protect the genital organs against injury. If this hypothesis is correct, women should show genital responses to any cues suggesting sexual activity, even unappealing cues that involve nonconsensual sex and extreme violence. Fifteen men and 15 women listened to fourteen 2-min audiotaped narratives that depicted an interaction between a man and a woman and that varied factorially according to the presence of consent, violence, and sexual activity. The results support the preparation hypothesis: Men showed the greatest genital arousal in response to narratives depicting consensual, nonviolent sex, whereas women showed similar responses to all the narratives involving sexual activities, including those describing a sexual assault.

Assessment of pedophilic sexual interest with an attentional choice reaction time task

Choice-reaction time (CRT) is an experimental information-processing paradigm. Based on an interference effect in visual attention, the CRT method has been shown to be suitable for measuring sexual orientation in men and women. The present study assessed the potential of the CRT to identify deviant (i.e., pedophilic) sexual interest. Participants were patients from forensic-psychiatric hospitals: 21 child molesters and 21 non-sex offenders. The dependent variable was reaction time in an ostensible seek-and-locate task (i.e., identifying the position of a dot superimposed on a picture of a person). There was an interaction effect between stimulus age category and participant group status: Child molesters took longer to respond to pictures of children relative to pictures of adults. Non-sex offenders showed an opposite pattern (i.e., longer reaction times with pictures of adults than with pictures of children). In addition, the data supported the notion of sexual content induced delay: Subjects took longer for the task with nude stimuli than with clothed ones. A subtractive preference index, derived from the reaction times for child and adult stimulus material, allowed distinguishing participants from both groups almost perfectly (ROC-AUC = .998). We conclude that a match of sexual interest with properties of visual stimuli led to a cognitive interference effect: Attentional resources were drawn from the ostensible task of locating the dot towards exploring the picture. This opens up the possibility of using this interference effect (i.e., the delay of response times) for diagnostic purposes.

Coercive paraphilic disorder

Sexual coercion is a manifestation of sexual conflict that is not in itself pathological according to Wakefield's (1992) criteria because sexual coercion can increase a man's Darwinian fitness. There are, however, differences among men in their propensity to commit rape and this propensity is linked to antisocial personality characteristics and relatively more sexual interest in brutal rape depictions. If highly rape-prone men were to be considered pathological, it would be possible to develop diagnostic criteria to identify them.

Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis

The assessment of sexual arousal in men and women informs theoretical studies of human sexuality and provides a method to assess and evaluate the treatment of sexual dysfunctions and paraphilias. Understanding measures of arousal is, therefore, paramount to further theoretical and practical advances in the study of human sexuality. In this meta-analysis, we review research to quantify the extent of agreement between self-reported and genital measures of sexual arousal, to determine if there is a gender difference in this agreement, and to identify theoretical and methodological moderators of subjective-genital agreement. We identified 132 peer- or academically-reviewed laboratory studies published between 1969 and 2007 reporting a correlation between self-reported and genital measures of sexual arousal, with total sample sizes of 2,505 women and 1,918 men. There was a statistically significant gender difference in the agreement between self-reported and genital measures, with men (r = .66) showing a greater degree of agreement than women (r = .26). Two methodological moderators of the gender difference in subjective-genital agreement were identified: stimulus variability and timing of the assessment of self-reported sexual arousal. The results have implications for assessment of sexual arousal, the nature of gender differences in sexual arousal, and models of sexual response.

Sexual preferences and recidivism of sex offenders with mental retardation

By some accounts, sex offenders with mental retardation commit sex offenses against children because the offenders lack sexual knowledge or are socially and intellectually immature rather than because of sexually deviant interests. By other accounts, these offenders exhibit pedophilic sexual interests. In this study, phallometrically determined sexual interests, recidivism, and choices of victims of 69 sex offenders with mental retardation are examined and compared with those of 69 sex offenders of average or higher IQ. Consistent with hypotheses, sex offenders with mental retardation exhibit more deviant preferences for prepubertal children, male children, and young children than do the comparison offenders. They are also more likely to have had a prepubertal victim, a prepubertal male victim, and a very young victim. They are no more likely than the comparison offenders to exhibit preferences for extremely coercive sex with children or to exhibit deviant adult activity preferences, nor are they more likely to recidivate violently. Results support the idea that pedophilia is a disorder of neurodevelopment and point to the importance of risk assessments that include assessing sexual preferences among sex offenders with mental retardation.

Through evolution's eyes: extracting mate preferences by linking visual attention to adaptive design

Information is crucial to decision-making, including mate choice decisions. Perceptual systems, such as attention, evolved in part to forage for reproductive information; consequently, these systems can be used to reveal mate preferences. Here, I consider the place of visual information in human mate choice and provide a rationale for pressing into service methods drawn from the attention literature for the study of mate choice decisions. Because visual attention is allocated automatically and selectively, it may be used to complement common methods of mate preference assessment, such as self-report questionnaires and measures of genital arousal, while avoiding some of the pitfalls of these methods. Beyond the utility of increasing confidence in extant research findings by employing relatively unobtrusive methods, visual attention paradigms can also allow researchers to explore a variety of questions that are rarely asked, such as those concerned with signal efficiency and tradeoffs in the assessment of mate value.

The validity of phallometric assessment with rapists: comments on Looman & Marshall (2005)

In a recent article Looman and Marshall (2005) questioned the validity of phallometric assessment of rapists based on the results of a study of incarcerated rapists and child molesters. In this commentary we offer (1) a critique of the methods used and conclusions reached by Looman and Marshall and (2) a discussion of important methodological issues relevant to phallometry. We conclude that the correct inference from Looman and Marshall's study is that rapists, as a group, show a pattern of sexual arousal to audiotaped scenarios of coercive and non-coercive sex that significantly differs from the pattern of groups of non-sex offenders, in agreement with the general literature on this question.

A sex difference in features that elicit genital response

Previous research suggests that women's genital arousal is an automatic response to sexual stimuli, whereas men's genital arousal is dependent upon stimulus features specific to their sexual interests. In this study, we tested the hypothesis that a nonhuman sexual stimulus would elicit a genital response in women but not in men. Eighteen heterosexual women and 18 heterosexual men viewed seven sexual film stimuli, six human films and one nonhuman primate film, while measurements of genital and subjective sexual arousal were recorded. Women showed small increases in genital arousal to the nonhuman stimulus and large increases in genital arousal to both human male and female stimuli. Men did not show any genital arousal to the nonhuman stimulus and demonstrated a category-specific pattern of arousal to the human stimuli that corresponded to their stated sexual orientation. These results suggest that stimulus features necessary to evoke genital arousal are much less specific in women than in men.