Transcript 3730L2.html.ppt

Problems with the DSM-IV Definition of
Sexual Paraphilia:
Criterion A:
(1) Lumps together disparate categories of sexual
behaviour when there is no evidence that these
behaviours are related.
(2) Fails to distinguish between consensual sexual activity
and non-consensual activity.
(3) Fails to distinguish between sexual activity with
inanimate objects versus animals
(4) Fails to distinguish between fantasies versus behaviour.
In particular, there is no distinction between fantasies
involving non-consensual sexual activity versus behaviour
involving non-consensual sexual activity
- reinforces the notion that someone with an unusual
sexual fantasy is automatically impaired in their ability
to negotiate the difference between fantasy and reality
- the underlying assumption is that unusual sexual
fantasy takes over our lives, shuts down ability to make
intelligent decisions and threatens our relationships and
our jobs
(5) Assumes children are always non-consenting sexual
partners
(6) Provides no consistent guidelines with regards to who
counts as a “child”
(7) Lack of clarity regarding whether sexual arousal in
response to “an atypical focus involving humans (self or
other)” is a paraphilia (e.g., sexual arousal in response to
non-covert viewing of partner engaging in sexual activity)
Criterion B:
(1) Unusual sexual urges, or fantasies, or behaviour,
may not cause clinically significant distress or
impairment, yet they may be considered paraphilias by
many clinicians, nonetheless.
(2) Opens up the possibility that paraphiliac sexual
behaviours aid the individual in functioning (i.e., if they
function to reduce stress)
- The ambiguity inherent in much of the DSM-IV’s
treatment of sexual paraphilias opens it up to
the cultural biases of the moment
- Homosexuality was considered a sexual paraphilia up
until 1980 when it was officially removed from the
DSM (DSM-III).
- Clinicians developed theories about homosexuality based
on homophobia and bad scientific practice that reflected
and reinforced societal notions of homosexuals as neurotic,
compulsive and narcissistic.
-The DSM-IV’s treatment of sexual paraphilias is
entirely conceptualized from the perspective of
Euro-American society
- As such, the manner in which Euro-American society
conceptualizes sexuality is characterized as “normal”
and mentally healthy
-There is no recognition that sexual activity is
conceptualized and enacted differently in non-EuroAmerican societies
- There is a lack of recognition that what counts as
acceptable sexual activity vary within cultures
- There tends to be more tolerance for unusual sexual
activities in large urban environments compared to
elsewhere
- There is a lack of recognition that what counts as
acceptable sexual activity varies historically
-What is considered mentally healthy in the present,
might have been a sign of mental illness in the past
- Variation in unusual sexual activities across time and
space suggests that these behaviours are universally
indicative of mental disorders, but rather are
conceptualized as mental disorders by particular
(sub)cultures at particular moments in time.
- The DSM-IV’s treatment reinforces the notion that
there is such a thing as “normal” sexual behaviour
- Two ways of thinking about sexual behaviour:
(1) Means
(2) Ranges
- When we think about sexual activity in terms of means,
deviations from the mean tend to be thought of as
“abnormal”
- Abnormal behaviours are problematic and demand
solutions that will render the individual “normal”
- When we think about sexual behaviour in terms of
ranges, atypical consensual sexual behaviours are no
longer problematic because they are not seen as deviating
from a norm
- The DSM-IV encourage diagnosis of sexual paraphilias
based the content of sexual fantasy, as opposed to the
individual’s relationship to their fantasy
Turkey Man Sexual Fantasy