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Practice Guidelines for the Assessment of Risk for Violent Behaviors during the Psychiatric Evaluation
Published in Kunsook S. Bernstein, Robert Kaplan, Psychiatric Mental Health Assessment and Diagnosis of Adults for Advanced Practice Mental Health Nurses, 2023
Kunsook S. Bernstein, Robert Kaplan
Additional risk factors to be considered in EDs and inpatient units:Aggressive attributional style (hostile, suspicious, or believing others intend harm).Command hallucinations to harm others.Poor therapeutic alliance has been implicated.Some paraphilias are risk factors for sexual offending.
Beneath the covers
Published in Lester D. Friedman, Therese Jones, Routledge Handbook of Health and Media, 2022
Sexual deviancy or perversion can be identified as a behavior or desire that departs from conventional standards or is considered abnormal. As suggested by the definition, society establishes models to guide what is or is not acceptable, while the identification of what is or is not deemed “normal” might be best described by medical professionals who are equipped to diagnose and treat abnormal behavior or desire such as Paraphilia Disorder. The most recent Diagnostic and Statistical Manual for Psychiatric Disorders (DSM-5) classifies Paraphilia, previously known as sexual deviation and perversion, under a family of Paraphilic Disorders including Voyeuristic Disorder, Exhibitionistic Disorder, Frotteuristic Disorder, Sexual Masochism Disorder, Sexual Sadism Disorder, Pedophilic Disorder, Fetishistic Disorder, Transvestic Disorder, Unspecified Paraphilic Disorder, and Other Specific Paraphilic Disorder. A paraphilia “denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners” (DSM-5 685). Sometimes the sexual interest focuses on the individual’s erotic activities (spanking, whipping, cutting, binding, or strangulating another person) or on the target of the individual’s sexual interest (children, corpses, or amputees [as a class], as well as intense or preferential interest in nonhuman animals) (685).
The Sexually Addicted Couple
Published in Len Sperry, Katherine Helm, Jon Carlson, The Disordered Couple, 2019
While not true for every person with a sex addiction, the counselor should assess for paraphilic interests and behaviors. Multiple studies have confirmed the presence of paraphilic behavior in sexual addicts (Black et al., 1997; Langstrom & Hanson, 2006; Kafka, 2010). A paraphilia can be defined as non-genital sexual desires and behaviors equal to or exceeding interest in genital-focused sexuality (American Psychological Association, 2013). While Black et al. (1997), found the presence of paraphilic behaviors within their sample, this was true for only 3% of their sample. The behaviors reported within this study included exhibitionism, sadism, transvestic fetishism, fetishism, and telephone sex. Contrary to these findings, Langstrom and Hanson (2006) found a strong correlation between sexually addicted men and exhibitionism, voyeurism, masochism, and sadism.
Sexual and Violent Recidivism of Empirically-Typed Individuals Convicted of Rape
Published in International Journal of Forensic Mental Health, 2023
Laura Freudenthaler, Ulrich S. Tran, Reinhard Eher
The low prevalence of paraphilia diagnosis and PRDs in our study seems to indicate that the quality of paraphilic interest may be more relevant than the quantity (number of diagnoses). Yet, we tested the presence of such diagnoses and did not consider differences with regards to content. Apart from paraphilia diagnosis and PRD, we did not have any other indicators of sexualization factors (e.g., self-reported sexual interests), which likely influenced the outcome on sexual deviance. Sexual sadism was treated as a dimensional construct and found relevant only for a small number of subjects, both of which may have led to the underestimation of its importance for classification and the prediction of sexual offense recidivism. However, previous studies have also found no significant predictive value of injury to victims or force used for sexual offense recidivism (Hanson & Bussière, 1998). Low internal consistency of SESAS scores (Cronbach α = .49) in the present study indicate problems of reliability for this measure, but could also stem from the only small number of sexual sadistic offenders in the sample. The sample was rather homogeneous in this respect, which likely deflated Cronbach alpha of this scale. Sexual sadism is generally a rare offender characteristic (Eher et al., 2019).
Concordance and Discordance between Paraphilic Interests and Behaviors: A Follow-Up Study
Published in The Journal of Sex Research, 2022
Christian C. Joyal, Julie Carpentier
In accordance with the first hypothesis, the mean correlation between interests and behaviors was significantly higher (z = 2.0362, p < .05) for legal (.46) than for illegal paraphilia (.35). As expected, having the desire to engage in a paraphilic behavior represents a significant factor to realize it for all paraphilias (Table 1, see also Seto et al., 2021). Also in line with the report of Seto et al. (2021), the two highest associations between behaviors and interests were sexual masochism and sexual sadism (Table 1). In partial accordance with the second hypothesis, some (but not all) paraphilic behaviors were significantly associated with gender: fetishism (men), voyeurism (men), exhibitionism (men) and masochism (a trend toward women; Table 1). As for concordance between interest and behavior, it was significantly moderated by gender (being a man) for three paraphilias: fetishism, transvestism, exhibitionism (the number of pedophilic acts reported was too low to allow further statistical analyses).
A Brief Report on Fetishism in Romania: An Approach Based on Gender and Sexual Orientation
Published in International Journal of Sexual Health, 2022
Florin Gabriel Berariu, Mihaela Jitaru, Octav Sorin Candel
Recent research is also interested in the correlates of paraphilic interests. Previous studies found that fetishistic interests were mostly unrelated to sexual and life satisfaction (Ahlers et al., 2011; Bouchard et al., 2017; Mundy & Cioe, 2019). However, the stigmatization of those with unusual sexual interests remains an important social issue (Moser & Kleinplatz, 2020), especially since paraphilia was strongly associated with psychopathology in the older versions of the DSM (Moser & Kleinplatz, 2006). While some paraphilias are more associated with stigma that others (such as pedophilia, Lehmann et al., 2021), “Individuals with paraphilias experience bias in health care, psychotherapy, employment, and political and social spheres” (Moser & Kleinplatz, 2020, p. 395). Having paraphilic interests could impact life satisfaction and well-being not due to their simple presence, but because they are associated with considerable stigma from society. Culture could also be an important factor that could be taken into account. Thus, in a more sex-negative country such as Romania, having a fetishistic interest might lead to more stigmatization, which might link paraphilias with lower well-being (Bullough, 1976).