Sexual Disorders

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Transcript Sexual Disorders

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Sexual Disorders
Dysfunction & Paraphilias
Professor Craig A. Jackson
Head of Psychology
Overview
Understanding sexual disorders
Paraphilias
The role of Fantasy
Prevalence
Spaces
COS model
Paedophilia
Causes
Treatments
Other Paraphilias
Two types of Sexual Disorders
Sexual Dysfunction
Problem of sexual response
Desire
Aversion
Drive
Orgasm
Sexual Disorders
Paraphilias
Abnormal sexual activity
Illegal & legal
Not necessarily distressing
No desire to change
At extreme of sexual spectrum rather than disordered
Paraphilias caveat
DSM-IV
Must result in distress
Or not considered disorder
Paraphilias
Fetishism
Intense sexual urges
Sexually arousing fantasies
Behaviours
Living or inanimate objects
Paraphilias
Exhibitionism
Urges to expose genitalia
Sometimes to others
Concomitant with sexual fantasies
Paraphilias
Sadomasochism / Sadism / Masochism
Sexual stimulation
Through acts of humiliation
Beating / being beaten
Binding / constriction / airway
reduction / unconsciousness
Suffering
UK Serial Murderers and their Paraphilias
Colin Ireland
Unemployed
Gay men
Peter Sutcliffe
Driver
Peter Manuel
Unemployed
Steve Wright
Driver
Sex workers
Stephen Griffiths
Student
Sex workers
Wests
Builder / Prostitute
Brady & Hindley
Unemployed
Children
Dennis Nilsen
Civil Servant
Gay men
Harold Shipman
GP
Robert Black
Driver
Children
Beverley Allit
Nurse
Children
Bible John
?
Peter Tobin
Handyman
Colin Norriss
Nurse
David Copeland
Unemployed
Gay men / immigrants
Donald Neilson
Unemployed
Older people /child
Sex workers (mostly)
Young women
Runaways / strays
Older people
Young women
Women / immigrants
Olde people
The Crimes of the BTK
Serial killer in Kansas active from 1974 to 2005
Murdered 10 people from 1974 – 1991 (caught in 2005)
Victims
1974
Mr Joe Otero, Mrs Julie Otero, and children Jo jr & Josephine
1974
Kathryn Bright and wounded her brother Kevin
1977
Killed Shirley Vian
1977
Killed Nancy Fox
1985
Marine Hedge, was murdered
1986
Vicki Wegerle was killed
1991
The last confirmed victim of BTK was Dolores Davis
Shirley Vian murder scene
Kathryn Bright murder scene
Who was BTK?
Dennis Lyn Rader
Married father of two
Heterosexual
ADT home security installer (1980s)
Scout Leader
Church Minister
City dog warden (1990s)
Who was BTK?
Bondage
BDSM
Violent sexual fantasist
Who was BTK?
Paraphilias
Paedophilia
Intense sexual urges
Sexually arousing fantasies
Involving children
DSM IV & Paedophilia
Recurrent sexual urges and sexually arousing fantasies
involving sexual activity (nt necessarily) with a pubescent
child or children
Offender must be 16yrs or older AND at least 5 yrs older
than victim
Genital touching, oral sex, or undressing
Pedophiliac relationships rely on persuasion, guilt and
friendship (Murray 2000)
Exploring Erotic Fantasies
Represent our own world
Psychological realm
Thinking, dreaming, imagining occurs
Without fear of reprimand
Without social constraints
Exploring Erotic Fantasies
Serve to sexually arouse
Mental images
Over long periods or Fleeting
moments
Hicks & Leitenberg 2001
Not culturally constrained or limited by
age and gender
Erotic Fantasy Prevalence
Males fantasise about sex 7 times per day
Females: about sex 4 times per day
Doskoch 1995
Fantasies important - enable to be free to
indulge primitive lusts and brutish
impulses that are unacceptable in reality
Wilson 1997
Do fantasies remain in the fantasy realm?
Fantasy Spaces
Fantasies don't always stay in fantasy realm
Facilitated by:
Socially acceptable physical environments (retail)
Acceptable virtual environments (online)
Consenting adults - fear of reprimand possible (Green 2001)
Fantasies not static
Cog rehearsal, transformation, maintenance, abandonment,
reinforcement
The Virtual Space
Pseudo reality space
Hybrid twixt psychological & physical space
Fantasy blended with reality
Pornography - virtual space
Voyeurs rather than active participants
A gateway to sexual offending? No (Taylor & Quayle 2002)
Porn may reinforce, update & strengthen erotic fantasy
Ready-Made Fantasies. Vanilla
Three Fantasy Spaces
Fantasies co-exist between Psychological, Physical, and
Virtual spaces
Each space provides unique opportunity for
Motivation
Access
Opportunity
Fantasy & Reality inextricably linked
"Doing" is dangerous when fantasy is non-consensual,
unwanted, violent & illegal
Aetiology of Paedophilia
Offenders frequently report disruptive early parent-child
relationships, or childhood sex abuse (Hanson& Slater 1988)
60% offenders report childhood abuse (Cohen et al 2000)
Many offenders try to justify / rationalise their abuse
Cycle of abuse misappropriated
Some offenders highly skilled and use their victimology
Behavioural Theories of Paedophilia
Offenders develop sexual attraction to children
Follows pairing of sexual arousal and child images
Pairings often occur in adolescence
Reinforced by masturbation (Barbaree 1990)
Many offenders report isolation & loneliness
Arising from inadequate childhood attachments (Ward 1996)
Children as alternatives to adult connections
Preconditions Theory of Offending
Finkelhor 1984
Sex with children emotionally & sexually satisfying
Unable to meet sex needs / fantasies in appropriate ways
Disinhibited behaviour at times of stress
Paedophilia triggered by periods of low mood / depression
as result of stress / distress / conflict (Pithers 1990)
Offenders enter high risk behaviours to decrease negative
feelings. Feelings return once rush has passed
Self-loathing --> More offences --> Self-loathing
Combined Offending Space Model
Wilson & Jones 2007
Important role of Internet in supporting, nurturing and
normalising sexual fantasies
Even extreme violent & illegal
Assess if thinking leads to doing
When does thinking lead to doing?
Understand why offenders use children
Combined Offending Space Model
Offending
Psychological
Fantasy Space
Motivation
Norms
Space
Conversations with Sexual Offenders
I guess fantasy is where I want it to go, what I can do for getting
aroused to this thought
As my fantasies grew my offending grew
The Internet is designed purely for sexual thoughts
I think your fantasies stay with what you've done and you revisit
A male may be abusing the hell out of a child... It's almost the
very best of the actual fantasy on screen
I think it (the internet) made me fantasise more. I don't think it
made me offend more, but I suppose it made me do different
things in the offences
Conversations with Sexual Offenders
Paedophilia Treatments
Secure forensic units or prison
Rehab programme
Not compulsory. 25% uptake in prison
Chemical castration for high testosterone offenders
15% of offenders on androgen programmes re-offend
(Meinecke 1981)
Poor compliance with medication in offenders
(Barbaree & Seto 1997)
Behavioural Paedophilia Treatments
Aversion Therapy
Child sexual stimulus paired with aversive event
Masturbatory Reconditioning
Initiates sexual response to child material / thoughts.
Once aroused, switch to appropriate image, continue
until orgasm
Really thinking of appropriate image???
Fewer ethical issues than version therapy
Relapse Prevention
Offender taught a behavioural modification programme
ID situations at high risk of offending
Get out of high risk situation
Learn from lapses
ID factors that lead to relapses
2% success rate against relapse (Marques et al 2000)
Additional Paraphilias
302.4 Exhibitionism
302.81 Fetishism
302.89 Frotteurism
302.2 Paedophilia
302.83 Sexual masochism
302.84 Sexual sadism
302.3 Transvestic fetishism
302.82 Voyeurism
302.9 Paraphilia NOS (not otherwise specified) e.g copraphilia, necrophilia,
acrotomophilia,
Gender identity disorder