Assessment of problematic sexual interests with the penile plethysmograph: an overview of assessment laboratories.

Phallometric testing, or penile plethysmography (PPG), is an objective measure of sexual arousal for males. While extensive research on the reliability and validity of PPG has promoted its reputation as the "gold standard" of objective measurement of sexual arousal, there is a lack of standardization of stimulus sets and interpretation of results between sites. This article describes the laboratory protocol employed for PPG at the Royal Ottawa Mental Health Centre's Sexual Behaviours Clinic (SBC) in Ottawa, Ontario, as well as those used by the Sexual Behaviors Clinic and Lab (SBCL) in the Community and Public Safety Psychiatry Division (CPSPD) of the Department of Psychiatry and Behavioral Sciences at Medical University of South Carolina (MUSC) in Charleston, South Carolina. The need for standardization in both testing protocol and stimuli use across sites are highlighted.

Paralyzed by desire: a new type of body integrity identity disorder.

BACKGROUND: Body incongruity in body integrity identity disorder (BIID) manifests in the desire to have a healthy limb amputated. We describe a variant of the disorder: the desire to become paralyzed (paralysis-BIID). METHOD: Sixteen otherwise healthy participants, recruited through Internet-based forums, websites, or word of mouth, completed questionnaires about details of their desire and accompanying symptoms. RESULTS: Onset of the desire for paralysis typically preceded puberty. All participants indicated a specific level for desired spinal cord injury. All participants simulated paralysis through mental imagery or physical pretending, and 9 (56%) reported erotic interest in paraplegia and/or disability. Our key new finding was that 37.5% of paralysis-BIID participants were women, compared with 4.4% women in a sample of 68 individuals with amputation-BIID. CONCLUSIONS: BIID reflects a disunity between self and body, usually with a prominent sexual component. Sex-related differences are emerging: unlike men, a higher proportion of women desire paralysis than desire amputation, and, while men typically seek unilateral amputation, women typically seek bilateral amputation. We propose that these sex-related differences in BIID manifestation may relate to sex differences in cerebral lateralization, or to disruption of representation and/or processing of body-related information in right-hemisphere frontoparietal networks.

[Review of symptoms and therapy of paraphylias]. / A parafíliák tünettanák és terápiajának áttekintése.

The authors review the historical main milestones in the legislative aspects of sexual deviances, from ancient times through age of enlightenment to present times, including the factors affecting the Hungarian public attitudes towards it. The evolution of nomenclature of sexual orientation disorders is also evaluated thoroughly, detailing the DSM-IV-TR classification and the attempts and difficulties to further develop the present classification system. The authors also review the difficulties of epidemiological studies and sum up the pioneer work of Alfred Kinsey. The etiology of paraphylias is summed up based on biological, psychodynamic and learning theory approaches. Finally, the pharmacological and psychotherapeutic interventions are evaluated considering also comorbidity, outer control and forensic psychiatric aspects.

Inappropriate sexual behaviors in dementia.

Dementias are the most common type of neurodegenerative disorder. Behavioral disturbances are seen in more than 80% of patients suffering from these disorders. Although sexually inappropriate behaviors are not as common as some of the other behaviors seen in dementia, they can cause immense distress to all those who are affected. There are no randomized trials for the treatment of these behaviors, but the available data suggest efficacy for some commonly used treatment modalities. In this review, we systematically discuss various aspects of these behaviors and available treatments.

The monoamine hypothesis for the pathophysiology of paraphilic disorders: an update.

A monoamine hypothesis for the pathophysiology of paraphilic disorders was first articulated in 1997 by Kafka. This hypothesis was based on four converging lines of empirical evidence. First, the monoamine neurotransmitters, dopamine, norepinephrine, and serotonin serve a modulatory role in human and mammalian sexual motivation, appetitive, and consummatory behavior. Second, the sexual effects of pharmacological agents that affect monoamine neurotransmitters can have both significant facilitative and inhibitory effects on sexual behavior. Third, paraphilic disorders appear to have Axis I comorbid associations with nonsexual psychopathologies that are associated with monoaminergic dysregulation. Last, pharmacological agents that enhance central serotonergic function in particular, have been reported to ameliorate paraphilic sexual arousal and behavior. Contemporary data supporting or refuting a monoaminergic hypothesis as a biological component associated with paraphilic sex offending behaviors will be reviewed. Particular attention will be given to pharmacological-metabolic probe studies, reports of Axis I comorbidity, the proposed role of disinhibited sexual motivation or sexual appetitive behavior, and cumulative pharmacological treatment data sets.

Acquired sexual paraphilia in patients with multiple sclerosis.

BACKGROUND: Sexual dysfunction in patients with multiple sclerosis is typically characterized by diminished libido, erectile and ejaculatory dysfunction in men, and poor lubrication and anorgasmy in women. In contrast, hypersexual behavior and paraphilias are distinctly uncommon in this population of patients, but have been associated with various focal brain lesions. PATIENT AND METHODS: We describe a man with clinically definite multiple sclerosis who developed profound and abrupt disinhibition and paraphilic behavior during an exacerbation. RESULTS: Neuroimaging revealed a marked increase in the number of enhancing lesions in the right sides of the hypothalamus and mesencephalon and extending into the right sides of the red nucleus, substantia nigra, and internal capsule. The altered sexual behavior was characterized by an obsessive and insatiable desire to touch women's breasts. CONCLUSIONS: Acquired sexual paraphilic behavior is uncommon in patients with multiple sclerosis but may occur when inflammatory demyelination involves the hypothalamic and septal regions of the basal prosencephalon. Our experience with this man illustrates the great difficulty involved in treating such patients when the paraphilic behavior becomes persistent.

[Music therapy single case process research--development and organization of a research field]. / Musiktherapeutische Einzelfall-Prozessforschung--Entwicklung und Aufbau eines Forschungsfeldes.

Music therapy yet to be discovered as a target of psychotherapy research. A first step consists in creating adequate samples of significant musical dialogues. Video-recording is an essential requirement for establishing such data. To test the clinical view that the emotional content of the musical dialogue in music therapy reflects the basic relationship issues of a patient was the objective of this study. By using ratings of significant musical dialogue sequences with the instrument of semantic differential comparing groups with varying clinical expertise (music therapists, psychoanalyts, lay persons) the results demonstrate that there is considerable stability of the judgments; however, systematic differences exists among the three groups of raters.

Paleodigms and paleodigmatics: a new theoretical construct applicable to Munchausen's syndrome by proxy, child-abuse dwarfism, paraphilias, anorexia nervosa, and other syndromes.

A paleodigm is a formulation of ancient folk wisdom that encodes a causal explanation in a saying or story that penetrates the idiom of everyday language and influences behavior. Although paleodigms are not, per se, causative, they have diagnostic, prognostic, and therapeutic significance in syndromes like Munchausen's syndrome by proxy.

Expectancy, covert sensitization and imaginal desensitization in compulsive sexuality.

Twenty subjects were randomly allocated to receive either imaginal desensitization (ID) or covert sensitization (CS) to reduce compulsive anomalous sexual behaviours. It was predicted from a behavioural completion model of compulsive urges, that patients' response to ID would be at least as good as their response to CS and would correlate with reduction in their general levels of tension following treatment. These predictions were supported. Correlations between patients' expectancies of treatment success and their response were of moderate strength for expectancy measures taken following the first session of both treatments, but much stronger for expectancy measures following the last session of ID. It was suggested that patients experienced a specific response during the further sessions of ID, which enabled them to improve their prediction of response. As aversive therapies remain the standard behavioural therapy for sexual paraphilias, the finding of the present study that imaginal desensitization without traumatic imagery or aversive physical stimuli is at least as effective would seem to require urgent replication, if only on ethical grounds.

Notes on flying and dying.

Focused on selected details in the lives and creative works of Samuel Johnson, Edgar Allan Poe, and Houdini, this paper explores a seeming antinomy between claustrophobic annihilation and aviation. At first glance the latter appears as an antidote to the threat of entrapment and death. On a deeper level the distinction fades as the impression arises that in the examples cited, flying may represent an unconscious expression of a wish for death and ultimate reunion.

Conceptual factors in the treatment of paraphilias: a preliminary report.

The purpose of this paper is to discuss conceptual components of treating paraphilia. Detailed description of the treatment interventions will be published subsequently. The format of the psychotherapy has components similar to the programs for sexual dysfunction and homosexual dissatisfaction therapy. Intensive short-term directive conjoint therapy remains essential. The therapeutic model focuses on the paraphilia as an interpersonal relationship disorder which is manifested as an unproductive and sometimes addictive means of coping with stress, particularly engendered by discomfort with intimacy in adult erotic relationships. The basic model of psychotherapy includes specific intervention directed at potential social skill deficits, changing erotic imagery, attitude and cognitive restructuring, self-esteem difficulties, dating anxiety, sexual dysfunction, intimacy issues and addictive behavior, all of which encourage mastery, self-assertion, self-responsibility and communication skills within the context of a relationship.

Pornographic imagery and prevalence of paraphilia.

The authors classified 1,760 heterosexual pornographic magazines according to the imagery of the cover photographs. Covers depicting only a woman posed alone predominated in 1970 but constituted only 10.7% of the covers in 1981. Bondage and domination imagery was the most prevalent nonormative imagery and was featured in 17.2% of the magazines. Smaller proportions of material were devoted to group sexual activity (9.8%), tranvestism and transsexualism (4.4%), and other nonnormative imagery. The authors suggest that pornographic imagery is an unobtrusive measure of the relative prevalence of those paraphilias associated with preferences for specific types of visual imagery and for which better data are lacking.

Psychosurgery of sexually deviant patients: review and analysis of new empirical findings.

From 1962 to 1979, 74 men and one woman considered sexually abnormal have received surgical hypothalamotomies in the Federal Republic of Germany. This paper reviews the neurophysiological assumptions behind the surgery, the criteria for surgery, and the effects and side effects of surgery as far as has been documented by medical, psychiatric, psychological, sexual, and social data. The neurophysiological bases for hypothalamotomies on humans with deviant sexual behavior appear dubious, the indications make use of questionable scientific and clinical categories and assumptions, few reliable data have been submitted for side effects, and follow-up studies are based on poor methodology. Restrictive regulations against this type of "experimental therapy" are suggested.