492 CHAPTER 11
Classical conditioning may be amplifi ed by the Zeigarnik effect (Deutsch, 1968),
which makes people more likely both to recall interrupted activities than ones that
they fi nished and to try to complete interrupted activities when later allowed to do
so. Applied to paraphilias, sexual arousal that has been associated with an object or
situation may be such an interrupted activity: Sexual arousal at a young age that isn’t
allowed expression at that time becomes “interrupted”; the person is later driven to
“complete” the interrupted activity. A sexual Zeigarnik effect is more likely to occur
in males because of the nature of male anatomy, thus accounting for the predomi-
nance of men among those with paraphilias (Munroe & Gauvain, 2001).Social Factors: More Erotica?
The Zeigarnik effect can also help explain why traditional, nonindustrialized societ-
ies have lower prevalence of paraphilias than do Western societies: Western societ-
ies provide many erotic stimuli—in magazines, in movies, and on billboards and
television—to which males can become aroused. In turn, males, particularly boys,
are thus more likely to be “interrupted,” leading to a desire to complete the task
(Munroe & Gauvain, 2001).To summarize, three main factors appear to contribute to paraphilias: a neuro-
logical similarity to OCD, classical conditioning of sexual arousal, and the Zeigar-
nik effect. One hypothesis for the almost exclusive prevalence of these disorders
among males pertains to how the male anatomy promotes more frequent and easier
accidental sexual arousal, along with the consequences of being interrupted while
aroused (the Zeigarnik effect).Treating Paraphilias
Only some people who have paraphilias receive treatment—typically those who en-
gaged in predatory paraphilic behavior with nonconsenting individuals and so were
brought into the criminal justice system (where they are classifi ed as sex offenders).
The goal of treatment, which may be ordered by a judge, is to decrease paraphilic
impulses and behaviors by targeting neurological, psychological, and social factors;
research on treatments for paraphilic disorders is not yet advanced enough to indi-
cate how feedback loops arise as a result of treatment.Targeting Neurological and Other Biological Factors: Medication
One goal of treatment for men who have engaged in predatory paraphilic behaviors
with nonconsenting individuals is to decrease or eliminate their sex drive.Chemical
castrationrefers to the use of medications to achieve this goal. Medications
include antiandrogen drugs such as medroxyprogesterone acetate(Depo-Provera)
andcyprotereone acetate (Androcur), which decrease testosterone levels. In turn,
decreased testosterone levels lead to decreased sexual urges, fantasies, and behaviors
in sexual offenders (Bradford, 2000; Gijs & Gooren, 1996; Robinson & Valcour,
1995). However, these medications don’t necessarily diminish men’s paraphilic
interests along with sex drive. Moreover, within a few weeks of stopping the
medication, the men again experience the urges and may engage in the predatory
behaviors (Bradford, 2000; Gijs & Gooren, 1996).
In addition, as noted earlier, SSRIs may help decrease the sexual fantasies,
urges, and behaviors in men whose paraphilic disorder has obsessive-compulsive
elements (Abouesh & Clayton, 1999; Bradford, 2001; Kafka & Hennen, 2000;
Roesler & Witztum, 2000). Thus, a treatment that targets neurological factors can
affect thoughts (fantasies), which are psychological factors.Targeting Psychological Factors: Cognitive-Behavior Therapy
CBT may be used to decrease cognitive distortions that promote paraphilic fantasies,
urges, and behaviors. For example, such distortions might include the belief that sex-
ual actions directed toward nonconsenting individuals are not harmful. BehavioralMost men who receive treatment for a paraphilia
do so after coming to the attention of the criminal
justice system, as did this man.AFP Photos/Newscom
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