Wednesday, October 8, 2008

Paraphilia and paraphilia related disorders: A brief explanation

The literal meaning of paraphilia is love (philia); and beyond the usual (para). The condition of paraphilia describes when a person's sexual arousal and gratification depend on fantasising about and engaging in sexual behaviour that is atypical, antisocial and extreme. A paraphilia can revolve around a particular object or around an act (such as inflicting pain, or exposing oneself). In legal terminology, paraphilia is a perversion or deviancy and in common vernacular, it refers to kinky or bizarre sex.

The American Psychiatric Association, (1994) consider those who suffer from paraphilia have several behavioural characteristics in common. They are recurrent, fixed, compulsive, sexually motivated, and personally or socially maladaptive, and interfere with capacity for reciprocal affection. To comply with this definition these behaviours should have been an established pattern for no less than six months duration. Sexual acts are only considered paraphiliac if the person's internal experience matches these criteria (Love, 1995).

A second aspect of paraphilia pertains to the object to which the person is attracted. For example, a podophile would be attracted to feet and a retifist, shoes.

A third aspect of paraphilia involves compulsion and its aspects that make self-control of undesirable behaviour difficult.

The neuro-transmitter, which stimulates compulsive behaviour, is glucocorticoid and is normally triggered when the individual becomes excited. The function of the neuro-transmitter appears to help focus on the stimulus and will remain until the person can conquer it, resolve it, or are out of danger. Provided some type of arousal surrounds the object the release of glucocoticoid increases compulsive behaviour and makes a return to normal routine very difficult.

A fourth aspect of paraphilia relates to loss of compensation. Experts believe the brain creates pain and anxiety to ensure the body is provided with certain items needed for survival. In return the body produces opiates that trigger a pleasure response. Under certain circumstance the brain may compensate when the simple primal needs are lost or restricted. Instead the brain will use another need and use it as a source of pleasure.

Eating disorders are thought, by many, to be a compensating measure when the brain releases opiates to gratify the action. Symptoms of depression may develop in individuals with paraphilia and are often accompanied by an increase in the frequency and intensity of the paraphiliac behaviour. Anything that has the potential to cause fear or anger can be utilised by some people to induce passion or sexual arousal.

Passion, like other forms of emotion, produces adrenalin (epinephrine) which leads to the production of other neuro-transmitters. Factors, which appear to determine how this stimulus is perceived and acted upon, relate to an individual's judgment of these circumstances or sex appeal of the other person. Change in body chemistry may cause things such as avoidance behaviour, an increase in heart rate, oxygen intake, and blood pressure; all of the responses needed to flight or fight (and sex). Anxiety and distress are thought by many to be the initial driving force behind the need to seek pleasure or gratification. It appears during infancy or early childhood, at a primitive learning level, certain individuals discover pleasure and gratification as a coping mechanism to deal with stress, and that, Obsessive Compulsive Disorder (OCD) helps to establish the paraphilia or paraphilic related disorder.

It is generally thought paraphilias and paraphilia related disorders are more clinically prevalent than most clinicians suspect. These disorders are cloaked in shame and guilt and it is unlikely clients will encourage conversation about their particular fetish. Paraphiliac behaviour is more common in men than women. The focus on a paraphiliac is usually very specific and unchanging. This may explain the difference between a foot fetishist or podophile and a shoe fetishist or retifist. Paraphilia may be classified into two pathological categories. In severe cases the essential features of a paraphilic are recurrent intense sexually arousing fantasies, sexual urges or behaviours generally involving 1) non-human objects, 2) the suffering or humiliation of oneself or one's partner, or 3) children or other non-consenting person. In less severe states the behaviour, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational or other relevant areas of functioning. Paraphila types are distinguished by the preoccupation with the object or behaviour to the point of being dependent on that object or behaviour for sexual gratification. Unless the person fantasises about the paraphilia at the same time they lose their arousal or satisfaction potential.

According to Money (1984) the DSM III incorrectly designated the majority of paraphilias as atypical and has classified them into eight types based on forensic history rather than by pathology and therapeutic need. He argues heterosexual child play in childhood lays the foundations for uncomplicated heterosexuality in adulthood. Interference with an individual's love map development may result in some developing paraphilia. Money attests every one develops a love map which carries the program of individual’s erotic fantasies and their corresponding practices. Once formed these remain uniquely personalised and these develop throughout childhood.

If the love map is interrupted this alters the functioning of the sex organs in genital intercourse. The hyoperphilic solution which results is one in which the love map, defied defacement so sex organs of the adult are used with exaggerated defiance frequency, and compulsiveness and or with great multiplicity of partners, in pairs or in-groups. Another variation on the love map is not completely defaced but redesigned with detours that include either new elements or relocations of original ones. Relocation may derive from a history of atypical sexual rehearsal play and /or eroto-sexual experience in childhood. Or they may derive from some other childhood encounter or series of encounters in which the sexual organs become stimulated e.g. seeing a shoe. The erotic fantasies and their practices or animations are programmed in distorted love maps and recognised by others as kinky or bizarre behaviour. Each paraphilia has its own paths on the mental love map which is a strategy for circumventing the individually encountered incompatibility of the sacred and the profane in eroto-sexualism. Money classified paraphiliac love maps into six strategies.

Sacrificial Paraphilia was where one or both of the partners must atone for the wicked and degenerate acts of defiling the saint with ecstatic lust by undergoing an act of penance or sacrifice.

Sadomasochistic sacrifice is not always directed at the sex organs. Erotic arousal may arise from afflictions of other parts of the body including the feet. These may be beaten, squeezed, stretched, pierced or cut. In some cases of erotic masochism the first pain produced fades and becomes transformed into sensuous ecstasy.

Predatory Paraphiliac describe those wicked and degenerate ecstasies of the sinful act of lust which is so defiling it can be indulged only if stolen, or taken from the saint by force. In some cases stealing alone takes place as a substitute for genital intercourse. The Sleeping princess syndrome (somnophilia) may involve kissing or intimacy with the feet. When reported to the police these assaults are usually mistaken for attempted rape.

Merchantile Paraphilia describes the wicked and degenerate ecstasy of the sinful act of lust and is the social vice practised only by professional sex workers. This may also appear as a role playing fantasy within domestic sex.

The Fetish paraphilias describe a compromise made with the saintliness of chastity and abstinence by including in the sexual act a token that symbolises the wickedness and degeneracy of the sinful act of ecstatic lust. The token symbolically permits the partner to remain as if saintly pure and undefiled. The fetish is the sinful agent of exotic and sexual excitement and arousal. Often the fetish item is stolen. The item may be more important that the owner and with transvestites they have to wear the item to perform genitally. If the partner objects he must fantasize he is wearing them in order to perform. Attractions vary but may include rubber fetish combines feel and smell.

Eligibility Paraphilias describe self abandonment to the wicked and degenerate ecstasy of the sinful act can be achieved only if the partner qualifies as something different i.e. from a different religion, race or creed. Necrophilia would represent a special niche attraction. Body tattoos may attract and in some cases stigmatoghilia (erotic piercing) is the attraction. In sever case the attraction is to mutilation or surgical amputation. Erotic turn on is to the stump. In very rare cases people may be turned on by getting amputation (apotemnophlia). Cases have been reported where people have staged managed an injury to ensure a professional amputation is undertaken in a hospital. Once a paraphilia is lodged in the brain it becomes like an addiction and difficult to dislodge.

Many paraphiliac men are able to have several ejaculations (hyperorgasmia) as many as ten on a daily basis. The rationale for defining paraphilias as crimes instead of illness derives from the philosophy of the Inquisition and demon possession, for which offenders were burned at the stake. In the eighteenth century this was replaced by degeneracy theory. This theory was first published by Simon Andre Tissot in 1758 and was issued to explain both social and individual ills on the basis of personal responsibility, for the cause of degeneracy was attributed to the loss of vital fluid in masturbation, and also to indulge in concupiscent thoughts and fantasies. After the event of germ theory in 1870s, degeneracy theory rapidly became outmoded in most branches of medicine, except in sexual medicine. Degeneracy theory allows the paraphiliac to be held responsible for his condition and hence punishment as a treatment is held justified. In mid 60s in Germany cyproterone acetate (steroid hormone) was first used on offenders. Medroxyprogesterone was used in the US; it is an androgen-depleting antiandrogen. It is probably an erotic tranquilliser that has a direct effect on eroto-sexual pathways in the limbic brain. Chemical treatment is often given in conjunction with counseling therapy. Paraphilias appear more frequently in males which may relate to the gender specific reliance on visual stimuli favoured by males. Females are more dependent of skin feelings for erotic excitation. Love maps enter the brain through vision. rather than through sound. Early childhood appears a vital time for the love map development.

Love B 1995 The encyclopaedia of unusual sex practices London: Greenwich Editions
Money J 1984 Paraphilias: Phenomenology & classification American Journal of Psychotherapy 38 164-179.

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