Chapter 11 – Variations in Sexual Behavior

Learning Outcomes

• Distinguish between sexual disorders in the DSM-V (coercive, paraphilic) and functional sexual behaviors (consensual, less common).
• Give examples of atypical sexual behavior, including noncoercive paraphilias (e.g., fetishism, transvestism, sexual sadism and sexual masochism, etc.) and coercive paraphilias (e.g., exhibitionism, obscene phone calls, voyeurism, frotteurism, etc.).
• Describe some of the dynamics involved in these behaviors as well as treatment strategies for coercive paraphilias.

Introduction

This week’s reading is both fascinating and, potentially, triggering. We are covering variations in sexual behaviors, which includes everything from consensual activities, such as agreed upon sex play involving bondage (blindfolding, binding, tying up a partner, etc) to nonconsensual sexual activities, such as exhibitionism (exposing your genitals to someone without their consent). Inevitably, we must take cultural norms and shifts into account as we examine how the field (and society) responds and treats folks engaged in paraphilic behavior. With that in mind, issues of consent, levels of distress, and legal matters are all factors to consider. Additionally, we are tasked with being curious in our academic thinking around sexual norms, taboos, and behaviors in order to best navigate psychological positions/interventions of disordered vs. typical sexual behaviors.

Paraphilic Disorders of the DSM-5

Paraphilias are persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature (Fisher & Marwaha, 2020). Although paraphilias are not innately pathological, a paraphilic disorder can evolve if paraphilia invokes harm, distress, or functional impairment on the lives of the affected individual or others. A total of eight paraphilias are listed in the DSM-V (American Psychiatric Association [APA], 2013) and include pedophilia, exhibitionism, voyeurism, sexual sadism, sexual masochism, frotteurism, fetishism, and transvestic fetishism. Indeed, if these interests cause a “clinically significant” level of distress or dysfunction for the person or if they were conducted with/against a non-consenting other (child, adult, animal, or corpse) then they become a paraphilic disorder (Joyal, 2018).

People with paraphilias have historically been rejected by society. In some cases, such as voyeurism and pedophilia, the behavior is unacceptable (and illegal) because it involves a lack of consent on the part of the recipient of the sexual advance. But other paraphilias are rejected simply because they are unusual, even though they are consensual and do not cause distress or dysfunction to the partners. Sexual sadism and sexual masochism, for instance, are usually practiced consensually, and thus may not be harmful to the partners or to society.

When considering the evolution of acceptance of sexual behaviors in different cultures, we can actively see shifts in attitudes about acceptability (e.g. sex for pleasure, masturbation, etc). Current research in areas of sexual behavior once thought to be entirely deviant (e.g. BDSM), find that practitioners who aren’t experiencing levels of shame or distress have high levels of psychological well-being (Joyal, 2018; Labrecque, Potz, Larouche & Joyal, 2020 ). Again, as sociocultural norms about the appropriateness of behaviors change, the revision of the DSM (APA, 2013), changed its classification system of these behaviors. Similarly, the World Health Organization’s International Classification of Disease (ICD) has also shifted many of their definitions and eliminated three paraphilias from their diagnostic list (Krueger, Reed, First, Marais, Kismodi & Briken, 2017; Moser & Kleinplatz, 2020).

As Jusin Lehmiller summarized (2019), “We can think of a paraphilia as simply representing an unusual sexual interest that does not require any type of treatment. In contrast, a paraphilic disorder represents an unusual sexual interest that is personally distressing to the individual and/or involves victimization of others (p. 365).

Types of Paraphilia – Nonconsensual Pedophilic disorder

1 in 5 girls and 1 in 20 boys is a victim of child sexual abuse, making pedophilia a common paraphilia (Watford, 2020) . Offenders are usually family friends or relatives. Types of activities vary and may include just looking at a child or undressing and touching a child. However, acts often involve oral sex or touching of genitals of the child or the offender. Studies suggest that children who feel uncared for or lonely may be at higher risk for sexual abuse.

Associated features

The key feature of this disorder is that the individual experiences sexual arousal when with children that may be equal to, if not greater than, that which they experience with individuals who are physically mature.

This may also include recurring sexual dreams, behaviors, or urges concerning children that are 13 years old or younger. Some pedophiles are attracted to both boys and girls. Some are attracted to only children, while others are attracted to children as well as adults. These issues must be persistent for at least 6 months and must cause impairment to everyday functioning to be considered symptoms. If an individual is 16 years old and exhibits these behaviors with someone that is at least 5 years younger, he would be considered for this disorder.

To be diagnosed as having pedophilia, the individual must be at least 16 years of age. The disorder typically begins in adolescence, although some individuals with Pedophilia report that they did not become sexually aroused by children until middle adulthood.

Pedophiles may limit their activity to exposing themselves to the child (sometimes known as flashing), touching and fondling the child gently, undressing the child and looking at him or her, or masturbating in front of the child.

Gender and cultural differences in presentation

The word “Pedophilia” is derived from the Greek words “paidos” (child) and “philia” (love). Awareness of Pedophilia has been raised in the past two decades, and it has become more difficult for these individuals to find children with whom to act out their fantasies. In response to the scarcity of vulnerable children, many pedophiles have turned to chatrooms and child pornography.

Males are more often diagnosed with this disorder than women. Pedophilia is more prevalent among Caucasians than among other ethnicities. It is also known that if a male prefers males, it is more likely that he will repeat his pedophilic actions. This has led certain religious or otherwise radical activists to suggest that pedophilia and homosexuality are “one and the same,” resulting in further media attention to an already well-covered topic.

One of the biggest issues in assessing behavior as pedophilic or normal is the criteria for pedophilia by Western standards. Some cultures allow “child weddings,” or unions between mature males and prepubescent females. In some tribal societies across the globe, pedophilic behavior is considered perfectly normal; men often take “boy-wives” in addition to wives. The men engage in sexual activity with these boy-wives until it is deemed time for the young boy to choose a wife of his own. At this point, the boy’s “husband” will then aid him in choosing a wife, and the boy will be allowed to leave to start a family of his own. Clearly, it is important to note any religious or cultural backgrounds in individuals being examined as having pedophilia. This is a very difficult situation, as some groups have voiced the concern that any pedophile can simply convert to a belief system that accommodates and excuses their behaviors.

Epidemiology

There is very little known about the prevalence of pedophilia at this time because, due to the severely negative stigma associated with having pedophilia, many people with pedophilia rarely seek help from a mental health professional. The ratio of sex offenders against female children and sex offenders against male children is about 2:1. It’s important to consider that not all sex offenders who victimize children are pedophiles; only about 40 percent of convicted sex offenders meet the diagnostic criteria for the disorder. Note: The large commercial market in pedophiliac pornography suggests a much higher prevalence than the limited medical data indicates.

Exhibitionist Disorder

The term exhibitionist was first used in 1877 by French physician and psychiatrist Charles Lasègue. Various earlier medical-forensic texts discuss genital self-exhibition, however. Exhibitionism is the act of exposing in a public or semi-public context those parts of one’s body that are not normally exposed – for example, the breasts, genitals or buttocks. The practice may arise from a desire or compulsion to expose themselves in such a manner to groups of friends or acquaintances, or to strangers for their amusement or sexual satisfaction or to shock the bystander. Exposing oneself only to an intimate partner is normally not regarded as exhibitionism. In law, the act of exhibitionism may be called indecent exposure, “exposing one’s person”, or other expressions.

When exhibitionistic sexual interest is acted on with a non-consenting person or interferes with a person’s quality of life or normal functioning, it can be diagnosed as exhibitionist disorder in the DSM-5. The DSM states that the highest possible prevalence for exhibitionistic disorder in men is 2% to 4%. It is thought to be much less common in women. In one survey, men were twice as likely as women to have exposed their genitals to a stranger (Lehmiller, 2019).

DSM-V DIAGNOSTIC CRITERIA FOR EXHIBITIONISTIC DISORDER

Associated features

In some cases exhibitionists masturbate while exposing themselves (or while fantasizing that he/she is exposing himself/herself) to another person. There is a pattern in which males exhibit themselves and there are three characteristic features of the exhibition: 1) It is performed for unknown women. 2) It takes place where sexual intercourse is impossible (e.g. a crowded shopping center). 3) It seems designed to surprise and shock the woman. The male exhibitionist usually exposes his erect penis, but it is not necessarily essential for the activity. Ejaculation may occur at the moment of exposure or develop later with masturbatory stimulation. Some exhibitionists are aware of a conscious desire to shock or upset their target; while others fantasize that the target will become sexually aroused by their display.

Child vs. adult presentation

Generally, society accepts exhibitionism in children as a natural curiosity, not a disorder, however if the behaviors continue a paraphilia is probable. Disorder appears to develop before the age of 18, and rarely is found in people over the age of 50.

Gender and cultural differences in presentation

Most reported cases of exhibitionism involve males. Some scientists argue that women who undress in front of windows (as to invite a person to watch), or who wear low cut gowns are exhibitionists in a sense. Exhibitionism generally appears in Western society and is believed to be almost absent in such countries as Japan, Burma, and India. Additionally, in American society it can be a crime when committed by a male, particularly when there is an erection present.

Epidemiology

Prevalence and incidence are not easily defined because people with this disorder usually do not seek treatment voluntarily. Exhibitionism is one of the three most common sexual offenses, the other two being voyeurism and pedophilia. It is rarely diagnosed in general mental health clinics, but most professionals believe that it is probably under diagnosed and under-reported.

Risk Factors appear to be Antisocial history, Antisocial personality disorder, Alcohol misuse and Pedophilic sexual preference.

Voyeuristic Disorder

Voyeurism is the sexual interest in or practice of spying on people engaged in intimate behaviors, such as undressing, sexual activity, or other actions usually considered to be of a private nature. The term comes from the French voir which means “to see”. A male voyeur is commonly labelled as “Peeping Tom” or a “Jags”, a term which originates from the Lady Godiva legend. However, that term is usually applied to a male who observes somebody secretly and, generally, not in a public space.

DSM-V DIAGNOSTIC CRITERIA FOR VOYEURISTIC DISORDER

• A. Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors.

AND

• B. The individual has acted on these sexual urges with a non-consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AND

• C. The individual experiencing the arousal and/or acting on the urges is at least 18 years of age.

Specify if:

• In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in voyeuristic behavior are restricted.

OR

• In full remission: The individual has not acted on the urges with a non-consenting per­son, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Associated features

Voyeurism, a form of paraphilia, refers to the achievement of sexual gratification by observing or spying on unsuspecting people, especially while they dress, undress, or engage in sexual activity. The observers, often known as “Peeping Tom’s”, may not feel guilt or remorse when intruding upon other individuals’ privacy. Voyeuristic individuals may rationalize their behavior, claiming “no harm, no foul.” Voyeurism is considered a crime in several states, but the definition of voyeurism varies from state to state.

The voyeur may wait outside their victims window and masturbate to the subject undressing, taking a shower, or even a couple having sex. They also may wait until afterwards to masturbate while replaying the incident in their mind. The voyeur may risk injury by assuming precarious positions to catch a preferred view of their target.

Child vs. adult presentation

Lack of maturity and understanding prevents children from being diagnosed with voyeurism.

Gender and cultural differences in presentation

Men are much more likely to be diagnosed with voyeurism than women. There does not seem to be any differences with the cultural presentation of voyeurism. However, with the social nature of the prohibited activity it appears to be an important factor in the sexual arousal pertaining to voyeurism. Some suggest that voyeurs tend to harbor feelings of inadequacy and to lack social and sexual skills (APA, 2013).

Epidemiology

The onset for the disorder is normally before the age of 15 years. Some studies have shown that men express voyeuristic tendencies more often than women, but the disorder is not unique to males (American Psychiatric Association, 2013). The prevalence of voyeuristic disorder is 12,000 per 100,000 (12%) among the male population and 4,000 per 100,000 (4%) among the female population. The prevalence rate of this abnormality is not known. Some research suggests that people in the U.S. are showing more voyeuristic characteristics due to the increase in reality television shows being aired. Risk factors appear to be Childhood sexual abuse, Substance misuse, Sexual preoccupation and Hypersexuality.

Revenge Porn

Frotteuristic Disorder

Frotteurism is a paraphilic interest in rubbing, usually one’s pelvic area or erect penis, against a non-consenting person for sexual pleasure. It may involve touching any part of the body, including the genital area. A person who practices frotteuristic acts is known as a frotteur. “Frottage” derives from the French verb frotter, meaning “to rub”. The term frotteur, originally meaning “floor polisher”, entered police jargon around 1882. Frotteuristic acts were interpreted as signs of a psychological disorder in 1887 and in ensuing work by French psychiatrist Valentin Magnan, who described three acts of “frottage” in an 1890 study. It was popularized by German sexologist Richard von Krafft-Ebing in his book Psychopathia Sexualis, borrowing from Magnan’s French terminology.

Frotteuristic disorder is a sexual dysfunction disorder characterized by sexual arousal from rubbing against or touching a non-consenting person.

DSM-V DIAGNOSTIC CRITERIA FOR FROTTEURISTIC DISORDER

• A. Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a non consenting person, as manifested by fantasies, urges, or behaviors.

AND

• B. The individual has acted on these sexual urges with a non consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to touch or rub against a non consenting person are restricted.

In full remission: The individual has not acted on the urges with a nonconsenting person, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Associated features

A person who is suffering from frotteurism usually experiences symptoms such as intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a non-consenting person for over a period of at least six months. These fantasies, urges, and behaviors can cause distress and problems associated with work, social atmospheres, and other important daily activities.

Toucherism is sexual arousal based on grabbing or rubbing one’s hands against an unexpecting (and non-consenting) person. It usually involves touching breasts, buttocks or genital areas, often while quickly walking across the victim’s path. Some psychologists consider toucherism a manifestation of frotteurism, while others distinguish the two.

Frotteurism is also known as “mashing”. Mashing has been reported exclusively among males (DSM, 2000). Mashing usually takes place in crowded places, such as buses, elevators, or subway cars. The man usually incorporates images of his mashing within his masturbation fantasies. Mashing is related to “toucherism”, which is the fondling of non-consenting strangers. Mashing can be so furtive and fleeting that the victim may not realize what has happened.

Child vs. adult presentation

Typically, children under the age of 12 do not have Frotteurism due to lack of understanding and maturity. Most individuals who participate in frotteurism are between the ages of 15 and 25.Tendencies typically increase the age of 15 and decrease after the age of 25.

Epidemiology

Frotteurism is associated with paraphilic fantasies, but it occurs most commonly in adolescents. This disorder is not associated with traumatic experiences in either adolescent or adult life. Risk Factors appear to be Nonsexual antisocial behavior and Sexual preoccupation/hypersexuality. The DSM estimates that 10%–14% of men seen in clinical settings for paraphilias or hypersexuality have frotteuristic disorder, indicating that the population prevalence is lower. However, frotteuristic acts, as opposed to frotteuristic disorder, may occur in up to 30% of men in the general population. The majority of frotteurs are male and the majority of victims are female, although female on male, female on female, and male on male frotteurs exist. This activity is often done in circumstances where the victim cannot easily respond, in a public place such as a crowded train or concert. Usually, such nonconsensual sexual contact is viewed as a criminal offense: a form of sexual assault albeit often classified as a misdemeanor with minor legal penalties. Conviction may result in a sentence or psychiatric treatment.

Paraphilias – Mixed Fetishistic Disorder

A fetish (from French fétiche; from Portuguese feitiço; from Latin facticius, “artificial” and facere, “to make”) is an object believed to have supernatural powers, or in particular a man-made object that has power over others. Later Sigmund Freud appropriated the concept to describe a form of paraphilia where the object of affection is an inanimate object or a specific part of a person.

Sexual fetishism or erotic fetishism is a sexual fixation on a nonliving object or nongenital body part. The object of interest is called the fetish; the person who has a fetish for that object is a fetishist. A sexual fetish may be regarded as a non-pathological aid to sexual excitement, or as a Fetishistic disorder if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life. Sexual arousal from a particular body part can be further classified as partialism. Partialism is sexual interest with an exclusive focus on a specific part of the body other than the genitals. Partialism is categorized as a fetishistic disorder in the DSM-5 only if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life.

Individuals who exhibit partialism sometimes describe the anatomy of interest to them as having equal or greater erotic attraction for them as do the genitals. Partialism occurs in heterosexual, bisexual, and homosexual individuals. The foot is considered one of the most common partialisms.

The following are some of the partialisms commonly found among people:

In a review of 48 cases of clinical fetishism in 1983, fetishes included clothing (58.3%), rubber and rubber items (22.9%), footwear (14.6%), body parts (14.6%), leather (10.4%), and soft materials or fabrics (6.3%). A 2007 study counted members of Internet discussion groups with the word fetish in their name.

Of the groups about body parts or features, 47% belonged to groups about feet (podophilia), 9% about body fluids (including urophilia, scatophilia, lactaphilia, menophilia, mucophilia), 9% about body size, 7% about hair (hair fetish), and 5% about muscles (muscle worship). Less popular groups focused on navels (navel fetishism), legs, body hair, mouth, and nails, among other things. Of the groups about clothing, 33% belonged to groups about clothes worn on the legs or buttocks (such as stockings or skirts), 32% about footwear (shoe fetishism), 12% about underwear (underwear fetishism), and 9% about whole-body wear such as jackets. Less popular object groups focused on headwear, stethoscopes, wrist wear, pacifiers, and diapers (diaper fetishism).

While medical definitions restrict the term sexual fetishism to objects or body parts, fetish can, in common discourse, also refer to sexual interest in specific activities. This broader usage of fetish covers parts or features of the body (including obesity and body modifications), objects, situations and activities (such as BDSM – a variety of often erotic practices or roleplaying involving bondage, discipline, dominance and submission, sadomasochism, and other related interpersonal dynamics). Paraphilias such as urophilia (urination) and coprophilia (poop) have been described as fetishes. Many people who reveal that they have fetishes don’t experience any significant distress or dysfunction from their behavior, hence they do not meet the criteria for fetishistic disorder (Lehmiller, 2019). In some instances, such as in cases of necrophilia (corpses) or zoophilia (animals), consent is an issue thereby rendering a more likely determination of fetishistic disorder.

Devotism involves being attracted to body modifications on another person that are the result of amputation. Devotism is only a sexual fetish when the person who has the fetish considers the amputated body part on another person the object of sexual interest.

Under the DSM-5, fetishism is sexual arousal from nonliving objects or specific nongenital body parts, excluding clothes used for cross-dressing (as that falls under transvestic disorder). Fetishism usually becomes evident during puberty, and may develop prior to that. No single cause for fetishism has been conclusively established, though issues of classical and operant conditioning have been studied.

DSM-V DIAGNOSTIC CRITERIA FOR FETISHISTIC DISORDER

Sexual Masochism And Sexual Sadism Disorders

“The Entryway” by mrbill is licensed under CC BY 2.0

Sexual masochism disorder (SMD) is the condition of experiencing recurring and intense sexual arousal in response to enduring moderate or extreme pain, suffering, or humiliation. Conversely, Sexual sadism disorder is the condition of experiencing sexual arousal in response to the extreme pain, suffering or humiliation of others. The words sadism and sadist are derived from Marquis de Sade. Many of Marquis de Sade’s books, including Justine (1791), Juliette (1797) and The 120 Days of Sodom (published posthumously in 1905), are written from a cruelly sadistic viewpoint.

BDSM ( bondage, domination, sadomasochism) is a colloquial term relating to individuals who willingly engage in consenting forms of pain or humiliation, typically for sexual purposes. The term BDSM describes the activities between consenting partners that contain sadistic and masochistic elements. Many behaviors such as erotic spanking, tickling and love-bites that many people think of only as “rough” sex also contain elements of sadomasochism. It is not currently a diagnosable condition in either the DSM or ICD system.

There are a lot of misnomers about BDSM practitioners (those that engage in BDSM behaviors). Importantly, BDSM practices are relatively common, with some surveys indicating that 14% of men and 11% of women have had at least one experience with sadomasochistic experiences (Lehmiller, 2019). For many people, BDSM behaviors are not pathological, in fact, people who practice BDSM are no more psychologically disturbed than anyone else and there’s no correlation to having been a victim of childhood sexual assault (Lehmiller, 2019). Additionally, the personality of BDSM practitioners indicate they experience less neuroticism, more extraversion, more openness to new experiences, more conscientiousness (safe, sane and consenting), have less fear of rejection, and higher subjective well-being than average (Joyal, 2018). Similar to issues in fetishism, one must look at high levels of distress/dysfunction and/or nonconsensual behaviors in order for a diagnosis to occur.

DSM-V DIAGNOSTIC CRITERIA FOR SEXUAL SADISM DISORDER

DSM-V DIAGNOSTIC CRITERIA FOR SEXUAL MASOCHISM DISORDER

The prevalence of sexual masochism disorder in the population is unknown, but the DSM-5 suggests that 2.2% of males and 1.3% of females may be involved in BDSM, whether they have sexual masochism disorder or not. Extensive use of pornography depicting humiliation is sometimes associated with sexual masochism disorder.

Behaviors associated with sexual masochism disorder can be acted out alone (e.g., binding, self-sticking pins, self-administration of electric shock, or self-mutilation) or with a partner (e.g., physical restraint, blindfolding, paddling, spanking, whipping, beating, electric shock, cutting, pinning and piercing, and humiliation such as by being urinated or defecated upon, being forced to crawl and bark like a dog, or being subjected to verbal abuse). Behaviors sometimes include being forced to cross-dress or being treated like an infant.

Erotic asphyxiation is the use of choking to increase the pleasure in sex. The fetish also includes an individualized part that involves choking oneself during the act of masturbation, which is known as auto-erotic asphyxiation. This usually involves a person being connected and strangled by a homemade device that is tight enough to give them pleasure but not tight enough to suffocate them to death. This is dangerous due to the issue of hyperactive pleasure seeking which can result in strangulation when there is no one to help if the device gets too tight and strangles the user.

Paraphilic coercive disorder refers to the preference for non-consenting over consenting sexual partners. It differs from sexual sadism disorder in that although the individual with this disorder may inflict pain or threats of pain in order to gain the compliance of the victim, the infliction of pain is not the actual goal of the individual. The condition is typically described as a paraphilia and continues to undergo research, but does not appear in the current DSM or ICD. Alternate terms for the condition have included Biastophilia, Coercive Paraphilic Disorder, and Preferential Rape.

With paraphilic coercive disorder, the individual employs enough force to subdue a victim, but with sexual sadism disorder, the individual often continues to inflict harm regardless of the compliance of the victim, which sometimes escalates not only to the death of the victim, but also to the mutilation of the body. What is experienced by the sadist as sexual does not always appear obviously sexual to non-sadists: Sadistic rapes do not necessarily include penile penetration of the victim. In a survey of offenses, 77% of cases included sexual bondage, 73% included anal rape, 60% included blunt force trauma, 57% included vaginal rape, and 40% included penetration of the victim by a foreign object. In 40% of cases, the offender kept a personal item of the victim as a souvenir.

On personality testing, sadistic rapists apprehended by law enforcement have shown elevated traits of impulsivity, hypersexuality, callousness, and psychopathy. Although there appears to be a continuum of severity from mild (hyperdominance or BDSM) to moderate (paraphilic coercive disorder) to severe (sexual sadism disorder), it is not clear if they are genuinely related or only appear related superficially.

Very little is known about how sexual sadism disorder develops. Most of the people diagnosed with sexual sadism disorder come to the attention of authorities by committing sexually motivated crimes. Surveys have also been conducted to include people who are interested in only mild and consensual forms of sexual pain/humiliation (BDSM).

Most of the people with full-blown sexual sadism disorder are male, whereas the sex ratio of people interested in BDSM is closer to 2:1 male-to-female. People with sexual sadism disorder are at an elevated likelihood of having other paraphilic sexual interests.

Paraphilia Disorders – Consensual

Transvestic Disorder

Large group of cross-dressing party-goers” by simpleinsomnia is licensed under CC BY 2.0

Transvestism is the practice of cross-dressing, which is the act of wearing items of clothing and other accoutrements commonly associated with the opposite sex within a particular society. The term cross-dressing refers to an action or a behavior, without attributing or implying any specific causes or motives for that behavior. Cross-dressing is not synonymous with being transgender. A transvestic fetishist is a person who cross-dresses as part of a sexual fetish (though cross-dressing, alone, doesn’t equal disordered behavior, Lehmiller, 2019). According to the fourth edition of Diagnostic and Statistical Manual of Mental Disorders, this fetishism was limited to heterosexual men; however, DSM-5 does not have this restriction, and opens it to women and men, regardless of their sexual orientation.

There are two key criteria before a psychiatric diagnosis of transvestic disorder is made:

1. Recurrent, intense sexually arousing fantasies, urges, or behavior, involving cross-dressing.
2. This causes clinically significant distress or impairment, whether socially, at work, or elsewhere.

Thus, transvestism is not considered a mental illness unless it causes significant problems for the person concerned. Transvestic disorder, transvestic fetishism and sometimes transvestism are also often used to describe any sexual behavior or arousal that is in any way triggered by the clothes of the other gender. Especially the latter is problematic, because transvestism and cross-dressing are neither a sexual fetish, nor do they necessarily have anything to do with sexual behavior or arousal.

Also, not every sexual behavior where clothes of the opposite gender are involved is transvestic disorder, they are also often used in sexual role play without being a fetish. Also, many transgendered people cross-dress before coming out in sexual or social contexts. This behavior is likewise not considered transvestic disorder, as it is not cross-dressing for sexual pleasure, rather it is simply their gender expression.

There is a popular stereotype that most transvestites are gay men, however that’s not the case; 87% identified as straight and 83% are currently married (or married before; Lehmiller, 2019). Most transvestic fetishists are said to be heterosexual men, although there are no studies that accurately represent either their sexual orientation or gender, and most information on this is based on anecdotal evidence or informal surveys.

Some male transvestic disordered people collect women’s clothing, e.g. nightgowns, baby dolls, slips, and other types of nightwear, lingerie stockings and pantyhose, items of a distinct feminine look and feel. They may dress in these feminine garments and take photographs of themselves while living out their secret fantasies. Many men love the feeling of wearing silk or nylon and adore the silky fabric of women’s nightwear, lingerie and nylons. This is where the issue of culture and gender, combined with disordered vs. normative behavior becomes all the more pressing to consider. Why is it culturally acceptable for female identifying folks to wear men’s clothing but not vice-versa (and indeed…if there’s any form of arousal then it’s considered disordered?). Perhaps the even the issue of distress should be evaluated in terms of actual distress due to the behavior or distress due to cultural norms/ideas about gendered clothing.

DSM-V DIAGNOSTIC CRITERIA FOR TRANSVESTIC DISORDER

Future Considerations/Conclusion

As indicated earlier, cultural and social norms are consistently shifting, which can impact society’s acceptance of a wide-range of sexual behaviors. Currently, the DSM-V (APA, 2013) identifies eight (8) types of paraphilic diagnoses. Interestingly, the International Classification of Disease recommendations in the definition of paraphilias has opted to remove fetishism, masochism, sadism (not to be confused with coercive sexual sadism), and transvestism since these behaviors are not inherently harmful (Joyal, 2018). Instead, paraphilias in the ICD-11 are focused on non-consent and criminogenic behaviors. This has been applauded as a step in the right direction in terms of reducing stigma of normative, albeit occasionally atypical, sexual activities. Still- the ICD-11 refers to the international version via the World Health Organization (the IDC-10 is still synced with the U.S. DSM-V).

Paraphilic interests have been increasingly important to study as the growth of the internet is allowing individuals access to communities made up of others with atypical inter­ests. Potter (2013) suggested that such communities may allow people to experiment with atypical behavior in a safe manner, rather than acting upon such interests. However, the question remains whether individuals can entertain atypical sexual fantasies (e.g., rape fantasies or sexual interest in children) and not be moved to act on them (Potter, 2013; as cited in Mundy & Cioe, 2019, pp. 304-5). Indeed, more research is required in these domains.

Licenses & Attributions

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Introduction to Psychology – 1st Canadian Edition by Jennifer Walinga and Charles Stangor is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted. https://opentextbc.ca/introductiontopsychology/chapter/12-6-somatoform-factitious-and-sexual-disorders/.

Adaptations: Reformatted. Added learning objectives. Modified content for language, application to subject and cohesion. Updated sources.

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AsapSCIENCE. (2017, August 31). Is your sexual fantasy normal (SFW) [Video]? https://www.youtube.com/watch?v=-h2xWLbXkT8&t=113s. License: All Rights Reserved. License Terms: Standard YouTube license.

Chisolm, D. (2018, June). How revenge porn turns lives upside down [Video]. TEDx. https://www.ted.com/talks/darieth_chisolm_how_revenge_porn_turns_lives_upside_down#t-6361. Creative Commons BY–NC–ND 4.0 International.

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Sexplanations (2018, March 21). Erotic choking [Video]. https://www.youtube.com/watch?v=DPlrum6p4xg&t=177s License: All Rights Reserved. License Terms: Standard YouTube license.

Washington Post (2017, July 6). The legality of revenge porn [Video]. https://www.youtube.com/watch?v=T7cC7hgeE0c. License: All Rights Reserved. License Terms: Standard YouTube license.

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