Sexual disorders not otherwise specified: compulsive, addictive, or impulsive?

Paraphilias are recurrent and intense sexually arousing fantasies, sexual urges, or behaviors generally involving nonhuman objects. These paraphilias cause the suffering or humiliation of the patient or patient's partner, or children, or other nonconsenting persons. However, in many patients symptoms involve more culturally acceptable patterns (eg, repetitive masturbation, Internet pornography); such hypersexual symptoms have been labeled as compulsive, addictive, or impulsive. Growing evidence supports the existence of a discrete syndrome characterized by recurrent and intense sexually arousing fantasies, sexual urges, or behaviors involving patterns that fall outside the definition of paraphilia. There is, however, high comorbidity with paraphilia. While such symptoms have been labeled as sexual compulsion or addiction, these terms are problematic in this context. Modern nosology has neglected this entity, although the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), category of sexual disorders not otherwise specified includes hypersexual behaviors as an example. We suggest that the DSM-IV category of sexual disorders be modified to include explicitly diagnostic criteria for a disorder characterized by hypersexual symptoms involving patterns that fall outside of the current definition of paraphilia. The disorder might be classified as one of the paraphilias, or as paraphilia-related. In the absence of a comprehensive understanding of the pathogenesis of this disorder, we suggest that it simply be termed hypersexual disorder.     

Child pornography offenses are a valid diagnostic indicator of pedophilia

This study investigated whether being charged with a child pornography offense is a valid diagnostic indicator of pedophilia, as represented by an index of phallometrically assessed sexual arousal to children. The sample of 685 male patients was referred between 1995 and 2004 for a sexological assessment of their sexual interests and behavior. As a group, child pornography offenders showed greater sexual arousal to children than to adults and differed from groups of sex offenders against children, sex offenders against adults, and general sexology patients. The results suggest child pornography offending is a stronger diagnostic indicator of pedophilia than is sexually offending against child victims. Theoretical and clinical implications are discussed.     

Sensitivity and specificity of the phallometric test for pedophilia in nonadmitting sex offenders

The specificity of phallometric testing for pedophilia has been calculated using sex offenders against adult women. Does the offender's actual number of prior sexual contacts with women affect such estimates? To answer this, the authors' studied 82 male sex offenders against adult women, 172 offenders against unrelated children, and 70 offenders against their own biological children or stepchildren. Phallometric testing included visual and auditory depictions of prepubescent, pubescent, and adult males and females. The results for offenders against women showed that those who had had sexual contact with the greatest number of women (consenting or nonconsenting) had the lowest probability of being diagnosed as pedophilic. Specificity, calculated for those who had sexual contact with the most women and thus the most evidence of attraction to them, was 96%. Sensitivity, calculated analogously for men with the most offenses against children, was 61%.     

Psychological treatment of pedophiles

The main treatment problem of pedophilia is motivating the offender to change. Reasons for the perpetrator's resistance to therapy and strategies for motivating them to change are discussed. Current assumptions about the etiology of this sexual anomaly are examined. Results from a databank of sex offenders are reviewed to show that it is uncommon for pedophiles to be victims of sexual abuse, including incest, and few need pornography as stimulants. Therapeutic difficulties include the egocentric, egosyntonic, and erotically gratifying nature of pedophilia to the perpetrator, his unwillingness to give up his behavior, his tendency to rationalize his acts, and to see the child as consenting. Group therapy and a variety of clinical imagery procedures with case examples are discussed as ways of overcoming the poor motivational state of pedophiles for treatment.     

Victims of Abuse by Priests: Some Preliminary Observations

This paper describes the results of psychological assessments of 25 adult males who were victims of sexual abuse by Catholic priests as children or early adolescents. Preliminary data suggest that premorbid personality patterns in these victims put them at greater risk for abuse and also exacerbated the effects of their victimization. These observations are considered in the context of prevalent explanatory models of the traumagenic effects of child sexual abuse.     

Multigenerational Sexual Abuse: A Cognitive Developmental Approach to Understanding Mothers in Treatment

This paper takes a cognitive developmental perspective in the qualitative analysis of 9 interviews of women who were sexually abused as children and whose children were also sexually abused. It discusses ways in which the development of cognitive self-understanding can by stymied by childhood sexual abuse and how this, in turn, can affect a woman's ability to parent her children and take full advantage of psychotherapy. It studies the recovery process that participants describe at various stages of a social cognitive developmental model of self-understanding. Finally, it promotes the use of a cognitive developmental perspective in clinical work and offers suggestions for counselors addressing issues of childhood sexual victimization.     

Antecedents of Physical and Sexual Victimization Among Homeless Women: A Comparison to Homeless Men

Homeless women experience extensive health risks including physical and sexual victimization. Few studies that have gathered information on homeless persons have reported results separately for women or have compared them directly with men. Research that both investigates antecedents of victimization among homeless women and compares them to those for men is necessary to determine whether prevention efforts must be different for each group. We investigated potential antecedents of recent (past 30 days) physical and sexual victimization in a probability sample of 394 homeless women and compared findings to those for 1159 homeless men. As hypothesized, mental disorder, substance dependence, and engaging in economic survival strategies significantly predicted victimization among homeless women. With few dissimilarities, these characteristics also predicted victimization among homeless men. Although differences in the needs and experiences of homeless women and men must be recognized, both women and men require assistance to establish and maintain safe residences, treatment of any substance use and mental disorder, and alternatives to economic survival strategies that place them at risk for victimization.     

A relational model of workplace victimization: social roles and patterns of victimization in dyadic relationships

This article proposes a model of the ways in which dyadic interactions between employees who occupy 1 of 4 archetypal social roles in organizations can lead to either episodic or institutionalized patterns of victimization. The model shows how the occurrence of victimization involving these 4 role types is influenced by organizational variables such as power differences, culture, and access to social capital. The model integrates behavioral and social structural antecedents of victimization to develop a relational perspective on the dynamics of harmful behavior in the workplace.     

Reactivity to Exclusion Prospectively Predicts Social Anxiety Symptoms in Young Adults

Peer victimization leads to negative outcomes such as increased anxiety and depression. The prospective relationship between peer victimization and social anxiety in children and adolescents is well established, and adults with social anxiety disorder (SAD) are more likely than individuals with other anxiety disorders to report a history of teasing. However, a crucial bridge between these findings (peer victimization in young adults) is missing. We manipulated perceptions of peer exclusion in a young adult sample (N = 108) using the Cyberball Ostracism Task. Reactivity to exclusion prospectively predicted social anxiety symptoms at a 2-month follow-up, whereas self-reported teasing during high school and current relational victimization did not. This research suggests that reactions to peer victimization may be a worthwhile target for clinical interventions in young adults. Targeting how young adults react to stressful social interactions such as exclusion may help prevent the development of SAD. Future research should test if reactivity to exclusion plays a role in the relationship between other disorders (e.g., depression) and peer victimization.     

A narrative review of research on clinical responses to the problem of sexual offenses in the last decade

Research on the treatment and programs for people who have committed sexual offenses has greatly increased in the past decade. The aim of this review is to discuss research that has been published over that period (2010–2019) that is relevant for treatment providers. The articles included in this review were found through PsycINFO and PubMed (Medline) using the keywords “treatment or therapy” and “sex offen*”. The inclusion criteria were publications that discuss treatment of persons who have committed sexual offenses (written in the English language only). Any articles that examined only special populations were excluded, such as those that examined persons who committed sexual offenses who were female, had intellectual disabilities, deafness, juveniles, etc., because these groups will likely have needs and responsivity factors that differ from the “average” natal-born male sex offender. Results showed that several meta-analyses indicate that treatment is effective in reducing sexual recidivism. The most frequently used treatment for sex offenders is cognitive behavioral therapy, which is often provided in conjunction with pharmacological treatment to reduce sexual impulsivity and/or sex drive. This review is limited to the specific key search terms. The findings of this review support the use of treatment and a community reintegration approach when treating persons who have committed sexual crimes to prevent sexual recidivism.     

Recognizing the Threat Posed by an Incestuous Parent to the Victim's Siblings. Part II: Improving Legal Responses

Many courts refuse to protect the siblings of an incest victim even when faced with unmistakable evidence that they are at risk, arguing that no one can predict what will happen. For instance, some courts believe that a parent who molests his stepchild is unlikely to victimize biological offspring, while others believe that a father who violates a daughter will not also victimize sons. Although judges have relied principally on intuition, a substantial body of empirical studies can help them to better assess a sibling's risk. In Part I, I argued that once a parent establishes the first sexual relationship, other children in the family should be considered at risk. Nonetheless, not all children in the household face identical risks of molestation. In this paper, I continue this theme and argue that a legal presumption should arise that other children are endangered. Further, I maintain that offenders should have an opportunity to rebut this presumption. Without this opportunity, a child who never faced a significant risk of abuse may be removed from his home or unnecessarily lose his ties to a parent. In order to better protect children, I outline how legal decisions can better reflect what is known about child victimization.     

Born This Way? A Qualitative Examination of Public Perceptions of the Causes of Pedophilia and Sexual Offending against Children

Understanding public opinion about the causes of pedophilia and/or child sex offending is vital, as the views of the public influence how governments respond to sexual offenders. However, little research has been undertaken on this topic. This study addresses this gap by examining the causes that members of the public ascribe to pedophilia and/or child sexual abuse using qualitative data from online forums. The etiological accounts that the public gave provide important information for those developing public prevention policies and/or education campaigns about child sexual abuse. Key implications of these etiological explanations are analyzed in this regard.     

Alcohol and human sexual behavior.

Despite the potential clinical significance of the relationship between alcohol consumption and human sexual responsiveness. the subject has received little systematic research attention. Clinical observations have suggested that alcohol abuse can lead to impotency disorders in males and sexual dysfunction in women. Alcohol has been associated with sex offences such as rape and pedophilia, increased sexual activity and extramarital affairs. However, correlation has been confused with cause, and unequivocal evidence of alcohol as the causal agent is lacking. Recent research using penile tumescence and vaginal pressure pulse as measures of sexual arousal has shown a significant negative linear relation between alcohol and sexual responsiveness in both men and women social drinkers. Findings that cognitive rather than pharmacological factors decisively influence alcohol's effects on sexual arousal, together with other psychosocial analyses, dispute the disinhibition hypothesis of alcohol's effects. A social learning analysis of alcohol's influence on sex is proposed.     

societal reaction to sex offenders: a review of the origins and results of the myths surrounding their crimes and treatment amenability

Examination of societal reaction to sexual offenders reveals a history of harshness exemplified by the sexual psychopath laws of the 1930s. The latest round of legal attempts to control sex offenders uses Severe sentencing laws, civil commitment procedures and community notification statutes to confine and shame sex offenders. This paper shows these laws to be based on popular beliefs about the predatory nature of these men, the probability of their re-offense and their amenability to treatment rather than the facts about the sex offenses and offenders. The severe reaction to sexual offenders is a vindictive one based on myth and misunderstanding that serves many interests. The paper exposes the contradictory myths and skewed emotions that guide our view of sex crimes and compares these with the facts about re-offense rates and the effects of treatment.     

An Examination of Disclosure,Mental Health Treatment use,and Posttraumatic Growth Among College Women Who Experienced Sexual Victimization

Few investigations have sought to identify factors associated with posttraumatic growth among survivors of sexual victimization. The present study examined the relationship between posttraumatic growth, disclosure, and mental health treatment use following sexual assault. Undergraduate female psychology students (N = 85), who reported a prior history of sexual victimization, completed measures assessing trauma exposure, posttraumatic growth, disclosure, and mental health treatment use. Results revealed that degree of disclosure of the assault to support sources and mental health treatment use following sexual assault was related to increased posttraumatic growth. Findings have valuable implications for treatment interventions for survivors of sexual trauma.     

Sexual deviations as conditioned behaviour: A hypothesis

While it has been frequently suggested that sexual deviations are learned, the learning has usually been thought of as taking place during one traumatic experience. From a study of 45 sexual deviants, the authors believe that it is often a much more gradual process occurring during masturbation to a memory, which need not have been sexually stimulating at the time of the initial experience and which often alters with the passage of time. The hypothesis is illustrated from case histories of pedophilia, exhibitionism, homosexuality, voyeurism and transvestism. The implications for both aversive treatment of deviations and positive conditioning to normal sex are considered.     

Blame attribution in sexual victimization

The current study explored how victims and third-parties attribute blame and perpetrator motivation for actual sexual victimization experiences. Although we do not assert that victims are responsible for perpetrators’ behavior, we found that some victims do not allocate all blame to their perpetrator. We sought to examine how victims and third-parties allocate blame in instances of actual completed and attempted sexual victimization and how they perceived perpetrator motivations. Victims of completed rape (n = 49) and attempted sexual assault (n = 91), and third-parties who knew a victim of sexual assault (n = 152) allocated blame across multiple targets: perpetrator, self/victim, friends, family, and the situation. Participants also described their perceptions of perpetrator’s motivation for the sexual assault. Victims tended to assign more blame to themselves than third-parties assigned to victims. Furthermore, victims perceived perpetrators as being more sexually-motivated than third-parties did, who viewed perpetrators as more power-motivated. Results suggest that perceptions of rape and sexual assault significantly differ between victims and third-party individuals who have never directly experienced such a trauma.     

The fear of confession? High Catholic collective narcissism and low secure identification with Catholics predict increased pedophilia myth acceptance

Over the past 30 years, the Catholic Church has been rocked by a series of child sexual abuse scandals worldwide. Some of the religious officials suggested that the children are partly to blame for being sexually abused by priests. We assumed that such convictions (i.e., pedophilia myth acceptance) should be associated with a defensive commitment to one's religious group, captured by religious collective narcissism. In two studies conducted among Polish participants (Study 1, longitudinal, n = 719; Study 2, cross-sectional, n = 357), we found that pedophilia myth acceptance was positively predicted by Catholic narcissism but negatively by secure identification with Catholics. We additionally demonstrated that the effect of Catholic narcissism on pedophilia myth acceptance was mediated by a siege mentality with respect to the religious in-group. We discuss the role of different types of group commitment in predicting in-group criticism and prejudice against underaged victims of sexual abuse.