Intersex Pretenders.

False claims of having an intersex condition have been observed in print, video, Internet media, and in live presentations. Claims of being intersexed in publicly accessible media were examined and evidence that they were false was considered sufficiently conclusive in 37 cases. Falsity was most often detected due to medical implausibility and/or inconsistency, but sometimes also using information from third-party or published sources. The majority, 26/37, of cases were natal males; 11/37 were natal females. Almost all (34/37) were transgendered, living, or aspiring to live, in their non-natal sex or as socially intergender. The most commonly claimed diagnosis was ovotesticular disorder ("true hermaphroditism") due to chimerism, an actually uncommon cause of authentic intersexuality. Motivations for pretending to be intersexed were inferred from statements and behaviors and were varied. Some such pretenders appear to be avoiding the external or internalized stigma of an actual transgendered condition. Some appear, similarly to persons with factitious disorder, to be seeking attention and/or the role of a sick, disadvantaged, or victimized person. Some showed evidence of paraphilia, most frequently autogynephilia, and, in several cases, paraphilic diaperism. For some cases, such claims had been accepted as authentic by journalists or social scientists and repeated as true in published material.

Trophy, souvenir, or simple theft? Taking items from the victim in sexual homicide.

Although most people have heard the terms 'souvenirs', 'trophies', and 'mementos', discussed in books and movies on the true crimes of sexual murderers, limited research has delved into the phenomenon of theft in sexual homicide (SH). Using a sample of 762 SH cases coming from the Sexual Homicide International Database, the current study examines the crime-commission process of the pre-crime, crime, and post-crime phases of sexual homicide offenders (SHOs) who engaged in theft during a SH. Additionally, this study seeks to determine if a specific type of SHO engages in this behaviour over others. Results from the sequential logistic regression indicate that victims who are 16 years or older, were strangers to the SHO, and were sex workers were more likely to be victims of theft. Additionally, results indicate that the presence of sadism made it more likely the SHO would engage in theft from the victim and/or crime scene. Findings suggest there is a group of SHOs who engage in theft not for monetary purposes but due to the paraphilia of the offender. These findings can inform the police investigation of these crimes.

A Descriptive Model of Voyeuristic Behavior.

Over the last 50 years, there has been a plethora of research exploring sexual offending with a recent focus on online offending. However, little research has focused on voyeurism despite convictions and media awareness growing rapidly. Currently, there is sparse theoretical or empirical literature to guide research and practice for individuals engaging in voyeuristic behaviors. As such, 17 incarcerated men with a conviction of voyeurism in the UK were interviewed on the cognitive, affective, behavioral, and contextual factors leading up to and surrounding their offense(s). Grounded theory analyses were used to develop a temporal model from background factors to post-offense factors; the Descriptive Model of Voyeuristic Behavior (DMV). The model highlights vulnerability factors for men engaging in voyeuristic behaviors in this sample. Following this, the same 17 men were plotted through the model and three key pathways were identified: Sexual Gratification, Maladaptive Connection Seeking, and Access to Inappropriate Person(s). The characteristics of each pathway are discussed, and treatment implications considered.

Sexual Orientation, Sexual Motivation, and Erotic Target Identity Inversions in Male Adult Baby/Diaper Lovers.

Adult baby/diaper lovers (AB/DLs) enjoy role-playing as babies and/or wearing diapers. They also engage in other related activities, such as urinating or defecating themselves and having an adult care for them. Previous surveys have revealed that AB/DLs commonly report sexual motivation, a finding that is corroborated by case reports in the psychiatric literature and some media interviews. The fact that AB/DLs change their appearance and behavior to become more like babies raises the possibility that they have an erotic target identity inversion (ETII). In ETIIs, a person's external erotic target is inverted into the self, resulting in sexual arousal by the fantasy of being a member of the target class or by imitating one. If AB/DLs are sexually motivated by an ETII, they should experience both sexual attraction to babies and sexual arousal by the fantasy of being a baby. We surveyed 207 male AB/DLs recruited from the Internet about their sexual orientation, sexual motivation, and sexual interests for a primarily quantitative analysis. Consistent with past research, a substantial minority of participants reported non-heterosexual identities (42%), and a large majority reported some degree of sexual motivation for being AB/DLs (93%). Wearing diapers and urinating or defecating oneself were rated as especially sexual. Even though 40% of participants reported sexual arousal by the fantasy of being a baby, only 4% reported sexual attraction to babies. This pattern of results is contrary to predictions from the concept of ETIIs. Instead, participants indicated that physical or mental pain, humiliation, and an adult woman were important to their sexual fantasies of being a baby. Masochism appears to be a promising alternative to an ETII for explaining the sexual motivation of AB/DLs.

Elaborating and Testing Erotic Target Identity Inversion Theory in Three Paraphilic Samples.

Some men sexually attracted to types of persons (e.g., women) or things (e.g., animals) also have internalized sexual attractions: sexual arousal by the idea of being the type of person or thing to whom they are attracted. Consequently, some of these men develop erotic target identity inversions, in which they imitate, yearn to be, or identify as an instance of their erotic target. Erotic Target Identity Inversion Theory predicts that for every external erotic target to which men are attracted, a subset of men will develop an internalized sexual attraction, which may cause an erotic target identity inversion. We examined these predictions in Internet surveys of three samples of men with paraphilic sexual interests: 322 men attracted to amputees, 1501 men attracted to animals, and 402 men attracted to severely obese persons. All samples included substantial minorities of men reporting internalized sexual attractions and erotic target identity inversions specific to their external sexual attractions (e.g., men attracted to amputees who are also aroused by the fantasy of being amputees and wish to become amputees). The correlation between degree of each internalized sexual attraction and degree of its corresponding erotic target identity inversion was approximately 1.0 after correction for attenuation. In each sample, participants' specific internalized sexual attraction was positively correlated with autogynephilia, likely the most common internalized sexual attraction in men. Erotic Target Identity Inversion Theory can potentially explain a variety of otherwise puzzling phenomena, including transgender identity among female-attracted natal males and men seeking amputations of healthy limbs.

Psychological and Developmental Correlates of Paraphilic and Normophilic Sexual Interests.

The classification of sexual fantasies and behaviors (here referred to as 'sexual interests') has historically been divided into 'paraphilic' and 'normophilic'. However, studies on paraphilic interests are often limited to clinical or forensic samples and normophilic interests are rarely assessed in tandem. Previous research has found mixed results for psychological and other correlates of sexual interests, potentially due to inconsistency in operationalism and measurement of fantasies and behaviors. The aim of the current study was to quantify correlates of sexual interests via the Sexual Fantasies and Behaviors Inventory, containing factors related to general fantasies/behaviors, normophilia, power dynamics, sadomasochism, and courtship paraphilias, using a large (N = 4280) non-clinical sample. Psychological, developmental, sexual, and demographic correlates were investigated via bivariate correlations, mean difference testing, and multiple regression. Sexual interest domains were largely unrelated to psychopathology and developmental factors. Sociosexuality and more accepting attitudes towards sadomasochism was generally related to more arousal to/engagement in normophilic and paraphilic domains. More autism spectrum disorder traits were related to decreased normophilic interests. Psychopathic traits, sexual sensation seeking, and sexual compulsivity were related to paraphilia dimensions, especially courtship paraphilias and domination/sadism; the former was also associated with negative attitudes about establishing consent. Men, non-monogamous, and non-heterosexual participants indicated greater sexual fantasies and behaviors compared to women (except in the case of submission and masochism), monogamous, and heterosexual participants, respectively.

How Autogynephilic Are Natal Females?

Blanchard proposed that autogynephilia is a natal male's paraphilic sexual arousal in response to the thought or fantasy of being a woman. Furthermore, based on evidence collected from natal males with gender dysphoria, Blanchard argued that autogynephilia is the fundamental motivation among nonhomosexual males (i.e., those not exclusively attracted to men) who pursue sex reassignment surgery or live as transgender women. These ideas have been challenged by several writers who have asserted, or offered evidence, that autogynephilia is common among women. However, their evidence was weakened by problematic measures and limited comparison groups. We compared four samples of autogynephilic natal males (N = 1549), four samples of non-autogynephilic natal males (N = 1339), and two samples of natal females (N = 500), using Blanchard's original measure: the Core Autogynephilia Scale. The autogynephilic samples had much higher mean scores compared with non-autogynephilic natal males and natal females, who were similar. Our findings refute the contention that autogynephilia is common among natal females.

Behavioral, Neural, and Molecular Mechanisms of Conditioned Mate Preference: The Role of Opioids and First Experiences of Sexual Reward.

Although mechanisms of mate preference are thought to be relatively hard-wired, experience with appetitive and consummatory sexual reward has been shown to condition preferences for partner related cues and even objects that predict sexual reward. Here, we reviewed evidence from laboratory species and humans on sexually conditioned place, partner, and ejaculatory preferences in males and females, as well as the neurochemical, molecular, and epigenetic mechanisms putatively responsible. From a comprehensive review of the available data, we concluded that opioid transmission at µ opioid receptors forms the basis of sexual pleasure and reward, which then sensitizes dopamine, oxytocin, and vasopressin systems responsible for attention, arousal, and bonding, leading to cortical activation that creates awareness of attraction and desire. First experiences with sexual reward states follow a pattern of sexual imprinting, during which partner- and/or object-related cues become crystallized by conditioning into idiosyncratic "types" that are found sexually attractive and arousing. These mechanisms tie reward and reproduction together, blending proximate and ultimate causality in the maintenance of variability within a species.

Compulsive Conditioned Sexual Responding of Male Japanese Quail in Extinction.

Previous experiments showed that following acquisition of an association between a terry-cloth object conditioned stimulus (CS) and a live female unconditioned stimulus (US), male quail increased the frequency of their copulations with the inanimate CS during subsequent CS-alone (extinction) trials. The present experiment was conducted to identify the potential factors responsible for this unexpected increase in conditioned sexual behavior during extinction. A total of 57 naïve male quail were given pairings of a terry-cloth CS with a live female during acquisition. A total of 36 of these quail (the approach responders) showed only conditioned approach response to the CS object, whereas the remaining 21 quail (the consummatory responders) also displayed copulatory or consummatory responses to the CS. In the extinction phase, these two sets of quail were divided into two subgroups: one subgroup received a female in their home cages while the other did not. Consummatory responders that were not exposed to a female quail in the home cage showed a significant increase in conditioned consummatory responding as the extinction trials progressed (i.e., compulsive conditioned sexual responding), whereas the other subgroup showed no change. However, both subgroups showed resistance to extinction in both conditioned approach and consummatory behavior. These findings indicate that the increase in copulation with the terry-cloth CS during extinction is possibly caused by US deprivation. The findings also suggest that conditioned copulation with the terry-cloth CS may lead to partial drive satisfaction, which may contribute to persistence of the behavior. Implications of these findings for paraphilias and compulsive sexual behavior are discussed.

A Comparison of Sexual Arousal in Men Exposed to Visual Stimuli With and Without Facial Blurring.

The role of the facial images in arousal and attraction has been examined before but never via penile plethysmography (PPG). This retrospective chart review aimed to determine the significance and magnitude of differences in arousal measured by PPG in 1,000 men exposed to slide stimuli with or without facial blurring in subjects of various ages. Arousal in response to blurred stimuli was significantly higher than nonanonymized stimuli with modest effect sizes for slides across age and gender categories. Facial blurring increased differences in arousal between adults and adolescents with a modest effect size. Our findings support the use of facial blurring to further protect the anonymity of models and limit the ethical and legal challenges of using slide stimuli with child models.

The "Furry" Phenomenon: Characterizing Sexual Orientation, Sexual Motivation, and Erotic Target Identity Inversions in Male Furries.

Furries are individuals who are especially interested in anthropomorphic or cartoon animals (e.g., Bugs Bunny). They often strongly identify with anthropomorphic animals and create fursonas, identities of themselves as those anthropomorphic animals. Some practice fursuiting, or wearing costumes that resemble anthropomorphic animals. Furries have been portrayed as sexually motivated in the media and popular culture, although little empirical research has addressed this issue. If some furries are sexually motivated, they may be motivated by an erotic target identity inversion (ETII): sexual arousal by the fantasy of being the same kinds of individuals to whom they are sexually attracted. Furries with ETIIs would experience both sexual attraction to anthropomorphic animals and sexual arousal by fantasizing about being anthropomorphic animals, because they often change their appearance and behavior to become more like anthropomorphic animals. We surveyed 334 male furries recruited from the Internet about their sexual orientation, sexual motivation, and sexual interests. A large majority of our sample reported non-heterosexual identities (84%) and some degree of sexual motivation for being furries (99%). Male furries also tended to report a pattern of sexual interests consistent with an ETII involving anthropomorphic animals. Both sexual attraction to anthropomorphic animals and sexual arousal by fantasizing about being anthropomorphic animals were nearly universal. Furthermore, male furries tended to be sexually aroused by fantasizing about being the same kinds of anthropomorphic animals to whom they were sexually attracted, with respect to gender and species. This sexual motivation and these unusual sexual interests do not justify discrimination or stigmatization.

Sexuality in the 21st century: Leather or rubber? Fetishism explained.

The sexual physical act is related to sexual attraction, sexual fantasy and sexual behaviour. Fetish has been recognised as an attraction to objects with the aim of achieving sexual gratification. There have been historical accounts of fetishism, and the subject has been of significant interest to clinicians especially those who work in the field of managing mental illnesses. There are various types of fetishism. Reported for the first time in the 19th century, the condition is of various subtypes. Of these, fetishistic disorder can be recognised as sexual fantasies, sexual urges and sexual behaviours which cause significant distress or impairment in an individual in social, occupational or other important areas of function. Fetishism may be related to specific body parts, non-living objects or others. In clinical settings, patients with fetishistic disorders are often referred because of having got into trouble with the law. Fetishism needs to be differentiated from paraphilias. Various explanations including psychoanalysis and behavioural theories have been offered to explain the genesis and management of fetishistic disorders. A fetish is attraction to an object. Treatments can include behavioural, cognitive or psychoanalytic strategies. In this review article, a brief overview on the fetish is offered with suggestions for management.

Diagnostic Issues in the Paraphilias.

PURPOSE OF REVIEW: To examine the empirical bases underlying the diagnoses of the paraphilias. We address issues concerning the reliability of these diagnoses and their implications for etiology, treatment, and prognosis. RECENT FINDINGS: Research on these issues with the paraphilias is quite limited except for those paraphilics whose interests lead them to sexually offend. Even among these clients, research has, for the most part, failed to distinguish those who meet criteria for a paraphilia from those who do not, thereby limiting the possibility of drawing firm conclusions regarding the value of a paraphilic diagnosis. Speculations regarding the etiology of the paraphilias are for the most part limited to those who sexually offend and these theories do not distinguish those who do, or do not, meet paraphilic criteria. Treatment of sex offenders, when effective, appears to have the same impact regardless of whether or not clients meet criteria for a paraphilia. In terms of prognosis, it was only among untreated child molesters that a paraphilic diagnosis (in this case "pedophilia") predicted long-term outcome. In the face of these problems, we suggest a dimensional approach to diagnoses may represent an improvement over the current categorical model.

Understanding Men's Self-Reported Sexual Interest in Children.

A few studies have found that even in the general population, a minority of adults-men as well as women-report some sexual interest in a young age group. The purpose of the present study was to identify factors associated with self-reported sexual interest in children among a community-based sample of men. Using an online survey methodology, we examined the extent to which different types of childhood adversities (witnessing parental violence, sexual, physical, and emotional abuse), atypical childhood sexual experiences, and participants' self-reported likelihood of engaging in a variety of sexual behaviors (heightened sexual interest) were related to sexual interest in children (SIC) reported by a non-forensic/non-clinical sample of 173 men. Data were analyzed using hierarchical multiple regression. After controlling for physical and emotional abuse and witnessing parental violence, self-reported experiences of childhood sexual abuse (CSA) significantly increased the amount of variance explained in SIC scores. However, only early masturbation and current heightened sexual interests contributed significantly to the final model. Total variance explained by the model as a whole was 24% (adjusted R2 = 20%). Early masturbation and heightened sexual interests significantly mediated the relationship between CSA and SIC scores. Findings add to the small but growing body of literature examining the etiology of pedophilic sexual interests in non-clinical samples.

The Puzzle of Male Chronophilias.

In this article, I return to the idea that pedophilia, a sexual interest in prepubescent children, can be considered a sexual orientation for age, in conjunction with the much more widely acknowledged and discussed sexual orientation for gender. Here, I broaden the scope to consider other chronophilias, referring to paraphilias for age/maturity categories other than young sexually mature adults. The puzzle of chronophilias includes questions about etiology and course, how chronophilias are related to each other, and what they can tell us about how human (male) sexuality is organized. In this article, I briefly review research on nepiophilia (infant/toddlers), pedophilia (prepubescent children), hebephilia (pubescent children), ephebophilia (postpubescent, sexually maturing adolescents), teleiophilia (young sexually mature adults, typically 20s and 30s), mesophilia (middle-aged adults, typically 40s and 50s), and gerontophilia (elderly adults, typically 60s and older) in the context of a multidimensional sexual orientations framework. Relevant research, limitations, and testable hypotheses for future work are identified.

Evidence of Construct Validity in the Assessment of Hebephilia.

Hebephilia refers to a persistent intense sexual interest in pubescent children. Although not as widely studied as pedophilia, studies of hebephilia have indicated convergence in self-report and sexual arousal. The present study expanded on previous work by examining convergent and divergent validity across indicators of hebephilia that included self-report, sexual behavior, and sexual arousal in a sample of 2238 men who had sexually offended. We included men who denied such interest and specifically examined the overlap between hebephilia and pedophilia and examined pedohebephilia (i.e., sexual interests in both prepubescent and pubescent children). Results indicated that there was considerable convergence across indicators of hebephilia. The results suggested poor divergent validity between hebephilia and pedophilia, as there was substantial overlap between the two constructs across analyses. Finally, a distinct pattern of sexual arousal was found in offenders with pedohebephilia. The results of the present study were discussed with a focus on implications for the assessment of sexual interest in children and the conceptualization of pedohebephilia.

The Development of In Vivo Measures to Assess the Impact of Sex-Drive Reducing Medications in an Offender with an Intellectual Disability.

The ability to adequately evaluate medications in the treatment of paraphilias has been limited by reliance upon self-report as a measure of effectiveness over periods of time that may be too short to detect reoffending. One solution to this shortcoming is the development of valid, long-term, stable assessment measures. The purpose of this case study was to analyze the effects of Prozac and Provera on an array of behaviors germane to the successful treatment of paraphilias, including: (a) sexual arousal in the laboratory and natural environment, (b) sexual thoughts (deviant and nondeviant) accompanied by arousal in the natural environment, and (c) overt actions in the community associated with increased risk of reoffending over a 31-month period for an exhibitionist with an intellectual disability. Despite the ineffectiveness of the medications, the measures demonstrated long-term, differentiated significant clinical responding; further underscored the importance of assessing deviant sexual arousal and adherence to relapse-prevention procedures in the natural environment; and provided a new methodology to assess sexual preoccupations and sexual arousal. Use of these in vivo measures raises questions regarding their potential to improve the predictability of risk assessments, and serve as an aide in the analysis of whether a treatment procedure is effective for an individual.

Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11).

The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH's proposals for Paraphilic Disorders in ICD-11 are based on the WHO's role as a global public health agency and the ICD's function as a public health reporting tool.

More Than a Nuisance: The Prevalence and Consequences of Frotteurism and Exhibitionism.

Despite indications that acts of frotteurism and exhibitionism are frequent occurrences, these sexual paraphilias have received little empirical attention. To address this gap in our knowledge about these paraphilias, 459 undergraduate students in a major metropolitan city completed a self-report measure designed to investigate the frequency and correlates of frotteurism and exhibitionism. Results indicate a high rate of victimization among female college students for both paraphilias. Furthermore, acts of frotteurism and exhibitionism most often occurred in places related to public transportation (e.g., subway trains or platforms) in this urban setting. In addition, victims reported a number of negative outcomes as a consequence of victimization, including feelings of violation, changes in behavior, and even long-term psychological distress. Older females were the most likely to be victimized. These findings are discussed as they pertain to the prevention and deterrence of paraphilic sexual acts.