Abnormal Psychology

Gender and Sexual Disorders 493

methods, such as extinction, are designed to decrease sexual arousal to paraphilic

stimuli while increasing arousal to normal stimuli (Akins, 2004). Treatment for sex

offenders may involve both medication and CBT (Heilbrun et al., 1998). Both types

of interventions, when effective, ultimately change arousal patterns, sexual fantasies

and urges, and sexual behaviors toward nonconsenting individuals.

In addition, treatment may sometimes include relapse prevention training,

which teaches men to identify and recognize high-risk situations and learn strategies

to avoid them. Such training also involves learning new coping skills, such as anger

management or assertiveness (Pithers, 1990). However, such treatments tend not to

reduce subsequent offenses among those sex offenders who are also psychopaths—

people who lack empathy, show little remorse or guilt about hurting others, and

shirk responsibility for their actions (Barbaree, 2005; Langton et al., 2006).

Targeting Social Factors

Some treatments for sex offenders target social factors, for example, by training

these men to empathize with victims in the hopes that they will be less likely to

reoffend in the future (Marshall, O’Sullivan, & Fernandez, 1996). However, many

offenders do not complete psychosocial treatments (Hanson, Bloom, & Stevenson,

2004; Langevin, 2006). Furthermore, such treatments have not been found to be

very successful (Hanson, Bloom, & Stephenson, 2004).

In sum, most men who receive treatment—of any type—for a paraphilic disorder

do so because their paraphilic behavior involves nonconsenting people; treatment typ-

ically is instigated by the criminal justice system. In this context, the goal of treatment

is to reduce the likelihood of reoffending—of acting on the paraphilic urges. Treat-

ments that target neurological factors primarily infl uence the behaviors, but not the

underlying fantasies or urges; CBT addresses both the behaviors and the fantasies.

Key Concepts and Facts About Paraphilias

• Paraphilias are characterized by a predictable sexual arousal
  pattern regarding “deviant” fantasies, objects, or behaviors.
  Paraphilias can involve (1) nonconsenting partners or children
  (exhibitionism, voyeurism, frotteurism, and pedophilia), (2) suf-
  fering or humiliating oneself or one’s partner (sexual masoch-
  ism and sexual sadism), or (3) arousal by nonhuman objects
  (fetishism and transvestic fetishism). To be diagnosed with a
  paraphilia, either the person must have acted on these sexual
  urges and fantasies, or these arousal patterns must cause the
  patient signifi cant distress.


• Assessments of paraphilias may involve the use of a penile pl-
  ethysmograph to determine the sorts of stimuli that arouse a
  man, as well as self-reports of arousing stimuli and reports from
  partners and from the criminal justice system for those appre-
  hended for sexual crimes.


• Criticisms of the DSM-IV-TR paraphilia classifi cation include the
  following: What is determined to be sexually “deviant” varies
  across cultures and over time; the diagnostic criteria are overly
  broad (e.g., fantasies or behavior, distress or no distress) and
  thereby lead clinicians to group together very different disor-
  ders (that is, to create a heterogeneous group); and the criteria
  do not address the ability to control the paraphilic urges.
  
  
  • Research shows that paraphilias share similarities with OCD.
    Additional possible contributing factors include classically con-
    ditioned arousal and the Zeigarnik effect.
  
  
  • Most frequently, men who receive treatment for paraphilias were
    ordered to do so by the criminal justice system. Treatments that
    target neurological factors decrease paraphilic behaviors through
    medication; however, although the behaviors may decrease,
    the interests often do not. Treatments that target psychological
    factors are designed to change cognitive distortions about the
    predatory sexual behaviors, especially the false belief that the be-
    havior is not harmful to the nonconsenting victims. A goal of such
    treatments is to change sexual arousal patterns using behavioral
    methods, as well as to prevent relapse. Although social factors
    may be the target of treatment for sex offenders, they have not
    generally been successful.
  
  
  
  

Making a Diagnosis

• Reread Case 11.2 about Tom, and determine whether or not his
  symptoms meet the diagnostic criteria for exhibitionism. Spe-
  cifi cally, list which criteria apply and which do not. If you would
  like more information to determine his diagnosis, what informa-
  tion—specifically—would you want, and in what ways would
  the information infl uence your decision?
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