Paraphilia without symptoms of primary psychiatric disorder: a case report.

BACKGROUND: Paraphilias are recurrent and arousing fantasies, thoughts, and behaviors that cause distress to sufferers and surrounding people. This case report details the challenge of managing multiple paraphilias with compulsive sexual behavior. CASE PRESENTATION: A 48-year-old Malay man presented with compulsive sexual behavior, encompassing voyeuristic, frotteurism, and exhibitionistic behavior, increasing progressively over the years, with accompanying overvalued ideas of erotomania. Despite the high level of dysfunction occupationally and socially, there were no apparent psychotic, manic, or depressive symptoms. An organic workup was unremarkable, and he was diagnosed with multiple paraphilias. Treatment with selective serotonin reuptake inhibitors was commenced, and psychologically he was managed with techniques specific to compulsive sexual behavior. CONCLUSION: Though rare in the literature, both paraphilic disorders and compulsive sexual behaviors are very distressing to sufferers and their families alike, and thorough biopsychological investigations are essential to ensure reversible causes are not overlooked.

Um capítulo esquecido na história da psicologia? sexualidades desviantes, psicopatologia e normalidade / A forgotten chapter in the history of psychology? deviant sexualities, psychopathology, and normality / ¿Un capítulo olvidado en la historia de la psicología? sexualidades desviadas, psicopatología y normalidad

Este artigo tem como objetivo produzir uma análise histórica sobre as intersecções entre Psicologia e sexualidade desviantes da norma no Brasil, de fins do século XIX a meados da década de 1980. Esta temporalidade foi escolhida por abarcar o surgimento das pesquisas científicas sobre sexualidade e desvios sexuais, a consolidação dos estudos psicológicos sobre a temática e o processo mais recente de despatologização da homossexualidade. Em termos teóricos e metodológicos, foram adotados os pressupostos da História Social da Psicologia e da historiografia das homossexualidades no Brasil. Desse modo, buscou-se compreender como as ideias, concepções e práticas psicológicas foram mudando ao longo do tempo, em conexão com as transformações socioculturais e políticas que ocorreram durante o século XX. Para isto, foram utilizadas fontes primárias e secundárias de pesquisa com vistas à produção de interpretações sobre as conexões entre as ideias, os atores e os eventos narrados. Argumenta-se, ao longo do artigo, que as ideias e práticas psicológicas estão intrinsecamente conectadas aos contextos socioculturais e políticos de seu tempo, sendo os movimentos dinâmicos e os conflitos presentes nesses contextos fatores determinantes para a sua constituição.(AU)

This article aims to produce a historical analysis of the intersections between Psychology and sexualities that deviate from the norm in Brazil, from the late 19th century to the mid-1980s. This period was chosen because it encompasses the emergence of scientific research on sexuality and sexual deviations, the consolidation of psychological studies on the subject and the most recent process of de-pathologization of homosexuality. Theoretically and methodologically, the assumptions of the Social History of Psychology and the historiography of homosexualities in Brazil were adopted. Therefore, we sought to understand how psychological ideas, conceptions and practices have changed over time, in connection with the sociocultural and political transformations that occurred throughout the 20th century. For this, primary and secondary sources of research were used to produce interpretations about the connections between the ideas, the actors and the narrated events. It is argued, throughout the article, that the psychological ideas and practices are intrinsically connected to the sociocultural and political contexts of their time, being the dynamic movements and conflicts present in these contexts determining factors for their constitution.(AU)

Este artículo tiene como objetivo realizar un análisis histórico de las intersecciones entre la Psicología y las sexualidades desviadas de la norma en Brasil desde finales del siglo XIX hasta mediados de la década de 1980. Esta temporalidad fue elegida por abarcar el surgimiento de las investigaciones científicas sobre sexualidad y desvíos sexuales, la consolidación de los estudios psicológicos sobre el tema y el más reciente proceso de despatologización de la homosexualidad. En el marco teórico y metodológico, se adoptaron los presupuestos de la Historia Social de la Psicología y de la historiografía de las homosexualidades en Brasil. De esta manera, se pretende comprender cómo las ideas, concepciones y prácticas psicológicas han cambiado a lo largo del tiempo, en conexión con las transformaciones socioculturales y políticas ocurridas durante el siglo XX. Para ello, se utilizaron las fuentes de investigación primarias y secundarias con miras a generar interpretaciones sobre las conexiones entre las ideas, los actores y los eventos narrados. Se argumenta, a lo largo de este artículo, que las ideas y las prácticas psicológicas están intrínsecamente conectadas a los contextos socioculturales y políticos de su tiempo, y los movimientos dinámicos y los conflictos presentes en estos contextos fueron los factores determinantes para su constitución.(AU)

Sex Differences in Voyeuristic and Exhibitionistic Interests: Exploring the Mediating Roles of Sociosexuality and Sexual Compulsivity from an Evolutionary Perspective.

Sociosexuality and sexual compulsivity predict sex differences in voyeuristic interest in the population. In this study, we used a sample of 1113 participants from the UK (46% men) to consider whether sociosexuality and sexual compulsivity interacted to explain these sex differences and whether this relationship extended to the related domain of exhibitionism. In doing so, we tested novel predictions derived from an evolutionary perspective which views voyeuristic and exhibitionistic interest as manifestations of a short-term mating strategy. Participants reported their levels of repulsion toward voyeurism and exhibitionism and their interest in performing such acts under different levels of risk. There were clear sex differences in voyeuristic and exhibitionistic repulsion that were partially mediated by the serial combination of sociosexuality and sexual compulsivity. Examining the sexes separately revealed qualitatively different relationships between sociosexuality and sexual compulsivity when predicting exhibitionistic, but not voyeuristic, repulsion. Combined, sociosexuality and sexual compulsivity also mediated the sex difference in willingness to commit acts of voyeurism, but not exhibitionism, which was equally low for both sexes. The results highlight the role sociosexuality plays in voyeuristic and exhibitionistic interest, which coupled with an evolutionary perspective, may have implications for how we view courtship disorders.

Portrait of an Exhibitionist.

Exhibitionism has been viewed through many lenses, from the perspectives of sexual deviance, forensic psychiatry, psychopathology, psychological dynamics, feminism, behaviorism, and psychopharmacology. Starting from the description of one psychotherapy patient, the aim of this paper is to synthesize this disparate literature. The findings of the synthesis include an estimate of the lifetime male prevalence of exhibitionism, 2-4%, peaking in late adolescence. Insecure attachment, sexual abuse in childhood, substance abuse, and sexual dysfunction are acknowledged risk factors. Motives behind the act of genital exposure remain obscure, constructed of both sexual and non-sexual impulses. The usual response of women victims is alarm and disgust. Successful treatment relies on a strong therapeutic alliance with specific psychological and psychopharmacological interventions - comparative effectiveness not yet determined. In conclusion, precedents for exhibitionism vary. The frequency of the behavior usually wanes with age and, while exhibitionists may pose a risk to others, they usually do not. There is, as yet, no gold standard treatment; the recommendation for therapists is to respond to individual facets of the patient's circumstances and history.

Estimated prevalence and impact of the experience of becoming a victim of exhibitionism and frotteurism in Korea: A general population based study.

Exhibitionism and frotteurism are often considered just nuisance crimes but may cause serious distress to the victims. Previous studies of victim experience have focused on specific groups, such as healthcare professionals or university students. To estimate the prevalence of victimisation by exhibitionism and frotteurism among young general population adults in Korea and to describe the impact of such experiences, trained researchers randomly recruited young adults for face to face interviews at transport hubs and on university campuses. In addition, we posted the questionnaire as a Google survey to a limited number of local websites. Data were analysed descriptively. Of 900 people directly approached, 747 (83%) agreed participation, as did 423 online. These two samples were similar demographically, so combined for analyses. Two hundred and thirty-five (20%) reported experiencing exhibitionism and 130 (11%) frotteurism. Exposure victims were older (means 23.2:21.1 years) and more likely to be women than frotteur victims. All but two exposure and nine frotteur perpetrators were said to be men. Reporting to police was rare (17 exposure, 2 frotteur); most exposure victims (73%) but under half of frotteur victims told family or friends. All but 15% of each group had bad feelings about the experience, varying by experience type. Ten percent of exposure and 20% of frotteur victims described distress lasting months; more reported enduring behaviour changes, like avoiding subways. Although our sample is unlikely to be wholly representative of the general population, our research examines a broader range of people than previous studies. Most victims of these "nuisance crimes" were distressed by them, and, hitherto less well recognised, at least a fifth of such victims may have long-term distress. Further research could establish the extent to which support outside the family or friends' group or treatment would be indicated.

Risk factors for being a victim of online grooming in adolescents / Factores de riesgo de ser víctima de online grooming en adolescentes

BACKGROUND: The risk of child grooming has spread exponentially with the massive access of adolescents to social networks and the internet. The aim of the study was to examine the personal factors (body self-esteem and disinhibition) and erotic-sexual factors (sexual initiation strategies and erotic-pornographic sexting) that predict grooming. METHOD: The sample was comprised of 1,200 adolescents aged between 12 and 16 years (M = 14.54, SD = 1.17; 50.83% girls). A cross-sectional design with self-report data was used and structural equation modeling (SEM) with mediation analysis was performed. RESULTS: The results indicated two paths explaining child grooming: 1) physical attractiveness and disinhibition are indirectly associated with grooming through erotic sexting and direct sexual initiation strategies; both of which partially mediate this relationship; 2) disinhibited behavior has an indirect impact on grooming; pornographic sexting and coercive strategies acting as mediators. The semi-partial mediation model explains 54% of the variance of grooming. CONCLUSIONS: These findings highlight the urgent need to implement prevention programs considering these attitudes and behaviors that function as precursors of victimization and the risk of falling into pedophile networks

ANTECEDENTES: el riesgo de grooming se ha propagado exponencialmente con el acceso masivo de los adolescentes a las redes sociales y al internet. El objetivo del estudio fue conocer los factores personales (autoestima corporal y desinhibición) y los factores erótico-sexuales (estrategias de avance sexual y sexting erótico-pornográfico) que predicen el grooming. MÉTODO: los participantes fueron 1.200 adolescentes entre 12 y 16 años (M = 14.54, DT = 1.17, 50.83 % chicas). Se utilizó un diseño transversal con datos de auto-informes y se aplicó un modelo de ecuaciones estructurales (SEM) con análisis de mediación. RESULTADOS: los resultados indican dos vías para explicar el grooming: 1) el atractivo físico y la desinhibición influyen en el grooming de forma indirecta a través del sexting erótico y las estrategias de avance sexual directas que median parcialmente esta relación; 2) la conducta desinhibida tiene un impacto indirecto sobre el grooming, actuando como mediadores el sexting pornográfico y las estrategias de coerción. El modelo de mediación explica un 54 % de la varianza del grooming. CONCLUSIONES: estos resultados nos alertan de la necesidad de implementar programas preventivos considerando estas actitudes y conductas, que funcionan como factores de riesgo de la victimización y de caer en redes pedófilas

Risk factors for being a victim of online grooming in adolescents.

BACKGROUND: The risk of child grooming has spread exponentially with the massive access of adolescents to social networks and the internet. The aim of the study was to examine the personal factors (body self-esteem and disinhibition) and erotic-sexual factors (sexual initiation strategies and erotic-pornographic sexting) that predict grooming. METHOD: The sample was comprised of 1,200 adolescents aged between 12 and 16 years (M = 14.54, SD = 1.17; 50.83% girls). A cross-sectional design with self-report data was used and structural equation modeling (SEM) with mediation analysis was performed. RESULTS: The results indicated two paths explaining child grooming: 1) physical attractiveness and disinhibition are indirectly associated with grooming through erotic sexting and direct sexual initiation strategies; both of which partially mediate this relationship; 2) disinhibited behavior has an indirect impact on grooming; pornographic sexting and coercive strategies acting as mediators. The semi-partial mediation model explains 54% of the variance of grooming. CONCLUSIONS: These findings highlight the urgent need to implement prevention programs considering these attitudes and behaviors that function as precursors of victimization and the risk of falling into pedophile networks.

I'll Show You Mine so You'll Show Me Yours: Motivations and Personality Variables in Photographic Exhibitionism.

Given that the sharing of genital images - colloquially known as "dick pics" - has become a widespread phenomenon, the purpose of the present study was to explore men's motivations for sending unsolicited images of their genitalia. A secondary purpose was to investigate the personality and sexuality characteristics of men who send dick pics relative to those who do not. 1,087 men completed an online survey, which included a demographic questionnaire and measures of narcissism, exhibitionism, erotophilia-erotophobia, and sexism. Also included was a measure developed specifically for the current study exploring the motivations behind sending unsolicited genital pictures as well as reactions senders hoped to elicit from their recipients. We determined that the most frequently reported motivational category for sending genital images was a transactional mindset (i.e., motivated by hopes of receiving images in return), while the most commonly desired reaction from recipients was that of sexual excitement. Further, we determined that men who reported having sent unsolicited dick pics demonstrated higher levels of narcissism and endorsed greater ambivalent and hostile sexism than their non-sending counterparts. This study is among the first to provide empirical evidence into the motivations and personality characteristics of men who send unsolicited dick pics.

Encountering an Exhibitionist: The Female Victim's Perspective.

Although exhibitionism is thought to be one of the most common sexual offenses, relatively little is known about its victims. The present study aimed to explore the correlates of encountering an exhibitionist, the course of exhibitionist acts, and their impact on the victim. An online survey was completed by 1,075 women, 58.7% of whom had encountered an exhibitionist. Previous victimization had the strongest impact on the probability of encountering an exhibitionist; victims' habits had no impact. The most frequent type of place where the incidents occurred was green spaces. Most exhibitionists touched their genitals and a third of them talked to the victim. The perpetrators usually did not chase their victims, but those who did were more aggressive. The emotions most frequently reported by the victims as accompanying the incident were surprise, disgust and fear. Taking action to avoid further incidents was reported by 29.0% of the respondents. Few incidents were reported to the authorities (7.0%). The results suggest that the impact of encountering an exhibitionist is in some ways similar to other types of sexual victimization.

A Comparison of Unidimensionality and Measurement Precision of the Narcissistic Personality Inventory and the Narcissistic Admiration and Rivalry Questionnaire.

The current study compares the closeness to unidimensionality (CU) and measurement precision (MP) of the Narcissistic Personality Inventory (NPI)-with either a pairwise forced-choice or 5-point Likert-type scale response format-to the Narcissistic Admiration and Rivalry Questionnaire (NARQ). Minimum rank factor analysis and item information curves from item response models were utilized. The results mainly confirmed our expectations that NPI subscales are lower in CU and MP compared with NARQ subscales when the NPI was administered with its traditional forced-choice response format. When the NPI was administered with a 5-point Likert-type scale response format, the NPI subscale Leadership/Authority and NPI Grandiose Exhibitionism showed similarly high levels of CU and MP as the two NARQ subscales. While the NPI subscale Entitlement/Exploitativeness had a higher CU than the NARQ subscales it showed considerably lower levels of MP.

CIO inventory: A new tool for measuring personality traits common to psychopathy and narcissism and their interaction with gender.

A lack of empathy, interpersonal dominance, aggression and the exploitation of others are the key features of both narcissism and psychopathic disorders. With the aim to better capture the shared facets of these traits, this study developed a new tool named the Capability to Influence Others (CIO) Inventory, which is based on the pleasantness evaluation of ten items-verbs presented in the infinitive form. The inventory, characterized by very quick submission, was administered to 67 males and 100 females and was correlated with the concurrent Narcissistic Personality Inventory (NPI) and Levenson Self-Report Psychopathy Scale (LSRP). An exploratory factor analysis supported the presence of only one factor in both the male and female groups. Internal consistency of the CIO was very good for both men (Cronbach's alpha = 0.85; 95% CIs: 0.80-0.90) and women (Cronbach's alpha = 0.83; 95% CIs: 0.77-0.87). Further statistics showed a high correlation between the CIO and the LSRP-F1 (primary psychopathy) in both genders (r > 0.47). Clear gender differences were found in the correlation between the CIO and the NPI: the correlation was high (r = 0.58) in males and absent in females. The CIO may represent a quick and low demanding tool for a preliminary screening of individuals with high psychopathic/narcissistic traits from community samples, forensic institutions, high schools and company personnel.

The pleasures of drunken one-night stands: Assemblage theory and narrative environments.

BACKGROUND: In this study, we use assemblage theory to investigate the link between alcohol use and one-night stands. METHODS: The data come from qualitative interviews conducted with 104 young participants in the night-time economy. RESULTS: We show that: (i) alcohol-fuelled sexual explorations (e.g. erotic fantasizing, flirting and sex) are of paramount importance for young partygoers; (ii) sexualized territories (e.g. private parties, rural feasts and the backseat of cars) significantly shape the experience and performance of one-night stands; and (iii) contrary to previous research, one-night stands are to a large degree associated with pleasure-the immediate pleasure of having sex and the long-term pleasure of telling about it to others. CONCLUSION: We argue that drunken one-night stands are part and parcel of a drinking culture that places high value on sexual encounters and personal sex stories.

Considerações sobre o transtorno parafílico: a interface entre a psiquiatria, a psicologia e a justiça criminal / Considerations on paraphilic disorder: the interface between psychiatry, psychology and criminal justice

O presente artigo versa sobre o transtorno parafílico (TP) cuja diferença nas práticas sexuais gera conotação pejorativa na sociedade, o que pode estar associado a dificuldade em compreender manifestações de desejo diferente e a relação entre crime sexual hediondo e parafilia. Indivíduos com TP apresentam interesse sexual intenso e persistente não voltado para a estimulação genital ou para carícias preliminares com parceiros humanos (fenótipo normal e maturidade física) e prévio consentimento para a atividade sexual. A parafilia está presente no repertório sexual individual da população geral com conteúdo de: humilhação, dominação, fetiche e bondage. A prática parafílica não visa à aproximação entre os parceiros e compromete, com o tempo, o relacionamento íntimo e/ou interpessoal e o trabalho. O Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) divide o transtorno em: voyeurista, exibicionista, frotteurista, masoquismo sexual, sadismo sexual, pedofílico, fetichista, transvéstico. O comportamento sexual parafílico pode ser dividido do ponto de vista criminal quanto à legalidade e à ilegalidade, com o consentimento e o não consentimento, em casos de adultos e comportamento parafílico com crianças e crianças pré-puberes. Ampliar a compreensão da interface entre a psiquiatria, a psicologia e a justiça criminal para a parafilia e o transtorno parafilico contribui para o diagnóstico (presença ou ausência de sofrimento), a avaliação e a punição do comportamento, com a presença ou não de vítima, e perspectivas psicológicas para o tratamento do transtorno parafílico, com a possibilidade de mudança no processo de excitação sexual, compreensão sintomatológica e desenvolvimento, ampliação do repertório do indivíduo.

Exibindo-se: a função de espelho do psicólogo na cirurgia digestiva aguda / Exhibiting: the psychologist's mirror function in acute digestive surgery

Resumo: Trabalhar com pacientes diagnosticados com a doença de Crohn e internados em cirurgia digestiva aguda nos leva a questionar os fundamentos psíquicos de uma falha das funções do Eu-pele, associados aos movimentos exibicionistas e uma complacência para com sua própria "monstruosidade". O fato de "mostrar" e "falar tudo" ao outro impõe-no um encontro com a inquietante estranheza. Após uma leitura psicanalítica de nossos encontros clínicos, nos deparamos com a constatação de que esta falta de distância está inscrita em um registro narcisista, no qual o sujeito despe-se para reconstituir-se no olhar reparador do outro.

Abstract: The mirror function of the psychologist in digestive surgery. Working with patients suffering from Crohn's disease and hospitalized for severe symptoms and digestive surgery raises questions about the psychic background which explains failures in their skin-ego functions combined with the exhibition of movements and connivance toward their own "monstrosity". "Showing" and "telling everything" to the other pushes the individual to confront his/her disturbing oddness. A psychanalytical approach allows us to see that this lack of distance belongs to a narcissistic dimension where one undresses to bring oneself together in a restorative view of the other.

An Integrative Analysis of the Narcissistic Personality Inventory and the Hypomanic Personality Scale: Implications for Construct Validity.

The primary goal of this study was to explicate the construct validity of the Narcissistic Personality Inventory (NPI) and the Hypomanic Personality Scale (HPS) by examining their relations both to each other and to measures of personality and psychopathology in a community sample ( N = 255). Structural evidence indicates that the NPI is defined by Leadership/Authority, Grandiose Exhibitionism, and Entitlement/Exploitativeness factors, whereas the HPS is characterized by specific dimensions reflecting Social Vitality, Mood Volatility, and Excitement. Our results establish that (a) factor-based subscales from these instruments display divergent patterns of relations that are obscured when relying exclusively on total scores and (b) some NPI and HPS subscales more clearly tap content specifically relevant to narcissism and mania, respectively, than others. In particular, our findings challenge the construct validity of the NPI Leadership/Authority and HPS Social Vitality subscales, which appear to assess overlapping assertiveness content that is largely adaptive in nature.

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.

Unusual brain images of a boy with adolescent cerebral X-linked adrenoleukodystrophy presenting with exhibitionism: A CARE-compliant case report.

RATIONALE: The respective involvements of both the thalamus and exhibitionism in cerebral X-linked adrenoleukodystrophy (X-ALD) have not been reported. PATIENT CONCERNS: An 11-year-old boy initially presented with exhibitionism and progressive neurobehavioral symptoms. He subsequently developed transient urinary and fecal incontinence, and an unwillingness to eat or communicate. DIAGNOSES: We conducted contrast-enhanced brain magnetic resonance imaging (MRI), which revealed symmetrical altered signal intensities in bilateral frontal white matter, the basal ganglia, and dorsal thalami, as well as a peripheral rim of contrast enhancement. Diagnosis of adolescent cerebral X-ALD was confirmed on the basis of next generation genetic sequencing analysis. INTERVENTIONS: We initiated the patient on hormonal replacement therapy. OUTCOMES: We observed rapidly progressive neurologic deterioration in this patient, and the boy fell into a vegetative state 10 months after discharge. LESSONS: We recommend that physicians should not disregard X-ALD in patients with isolated psychiatric symptoms, including hypersexual behavior. The combination of detailed clinical evaluation, MRI, and next generation genetic sequencing can expedite the diagnostic process of atypical variant of X-ALD.

Narcissism is associated with weakened frontostriatal connectivity: a DTI study.

Narcissism is characterized by the search for affirmation and admiration from others. Might this motivation to find external sources of acclaim exist to compensate for neurostructural deficits that link the self with reward? Greater structural connectivity between brain areas that process self-relevant stimuli (i.e. the medial prefrontal cortex) and reward (i.e. the ventral striatum) is associated with fundamentally positive self-views. We predicted that narcissism would be associated with less integrity of this frontostriatal pathway. We used diffusion tensor imaging to assess the frontostriatal structural connectivity among 50 healthy undergraduates (32 females, 18 males) who also completed a measure of grandiose narcissism. White matter integrity in the frontostriatal pathway was negatively associated with narcissism. Our findings, while purely correlational, suggest that narcissism arises, in part, from a neural disconnect between the self and reward. The exhibitionism and immodesty of narcissists may then be a regulatory strategy to compensate for this neural deficit.