Sex Offenders and the Paraphilias

• Author: Hy Bloom, Richard D Schneider
• Pages: 219-252

219

chapter seven

Sex Offenders and the Paraphilias

A. INTRODUCTION TO THE PARAPHILIAS

It goes without saying, but worth mentioning nevertheless at the outset of

this chapter, that even a treatise, let alone a chapter t hat focuses on the legal

aspects of sexua l behaviour in a primer of this kind, w ill not do justice to the

complexities of human sexuality, the various normal and “abnormal” ways

of expressing it, and the bountiful theories regarding the causes of psycho-

sexual pathology. This c hapter introduces the reader to the phenomenology

of sexual offending and the psychopathological processes associated with

sexual deviation (paraphilias). “Paraphilias” is the proper psychiatric ter-

minology for the various kinds of sex ually anomalous behaviours identif‌ied

in the Diagn ostic and Statistical Manual of the America n Psychiatric Associ-

ation (DSM-5).1 T he pref‌ix “para” denotes a deviation, and the suff‌ix “philia”

means that the deviation is in relation to sex ual attraction.

The intensity of the drive to pursue sexual gratif‌ication, and the degree

to which the individual’s life may be taken up with that pursuit, is one of

the more notable clinical features of paraphilic (and hypersexual, albeit to

normal stimuli) patients. “Pathological sexuality,” which in today’s age can

be more easily indulged (and arguably fostered) by Internet access to por-

nography, was described more than one hundred years ago by Kraff t-Ebing

It permeates all his t houghts and feelings, allowing of no ot her aims in life,

tumultuously, and in a rut-like fashion demanding gratif‌ication without

granting the possibility of moral and righteous counter-presentations, and

resolving itself into an i mpulsive, insatiable succession of sexual e njoyments

1 American Psyc hiatric Associat ion, Diagnosti c and Statistical Manu al of Mental Disorders,

5th ed, (Washin gton, DC: American Psyc hiatric Association, 2 013) [DSM-5].

220MENTAL DISORDER AND THE LAW

. . . . This pathological se xuality is a dreadful scou rge for its victim, for he is

in constant danger of v iolating the laws of the state and of moralit y, of losing

his honor, his freedom and even his life.2

Paraphiliacs are def‌ined by either (or both) sexually anomalous fanta-

sies and urges or deviant sexual behaviours. Fantasies, urges, and behav-

iours are paraphilic when their subject matter or object involves children,

unconsenting partners, non-human subjects, or the inf‌liction of pain and

suffering on oneself or another, or when they cause the individual subject-

ive distress and/or interfere with day-to-day functioning. DSM-5 stipulates

that a diagnosis can only be m ade if symptoms have been present for at least

six consec utive months.

Paraphiliacs exper ience deviant fantasies, urges, and behaviours to vary-

ing degrees of exclusivity (over non-paraphilic interests) and levels of inten-

sity. There are individuals for whom the paraphilic subject matter or object

is obligatory, in that the behaviour or person of interest must invariably be

included in sexual activity in order for the paraphiliac to become erotically

aroused. There are other cases, however, where the problematic interests

and preferences (for example, voyeurism, or exhibitionism) occur only epi-

sodically; these beh aviours are commonly brought out by stress. Individuals

in this category are generally able to function sexually without reliance on

the paraphilic component. Pedophilia is another example. There are exclu-

sive pedophiles, who cannot be aroused by anyone other than a prepubescent

child, and non-exclusive pedophi les who may be equally or more attracted to

age-appropriate partners.

Predecessor editions of the Diagnostic and Statistical Manual (for ex-

ample, DSM II)3 considered homosexuality to be a disorder. Ref‌lecting ad-

vancements in the understanding of human sexuality (and no doubt the

times), a subsequent edition (DSM III-R)4 delisted homosexuality as a dis-

order, and instead included the diagnostic designation “ego dystonic5 homo-

sexuality” as a psychopathological characterization of a condition that may

result when an individual fails to accept his homosexual orientation. DSM

2 As quoted by Dan J Stein et al, “Hyperse xual Disorder and Preocc upation with Internet

Pornograp hy” (2001) 158 Amer ican Journal of Psyc hiatry 1590–9 4, online: http://ajp.

psychiatryonline.org/doi/pdf/10.1176/appi.ajp.158.10.1590.

3 American Psych iatric Association, Di agnostic and Sta tistical Manual of Ment al Disorders,

2d ed (Washington , DC: American Psychiat ric Association, 1968) [DSM II].

4 American Psychi atric Association, Di agnostic and Stat istical Manual of Ment al Disorders,

3d ed, revised ( Washington, DC: America n Psychiatric Associat ion, 1987) [DSM III-R].

5 The term ego dyst onic refers to thoughts, fanta sies, and/or circumstances th at the indi-

vidual exp eriences as alien or repugna nt to his self-image and sense of sel f.

Chapter Seven: Sex Offenders and the Paraphilias221

IV-TR preserved the construct of ego-dystonic homosexuality under the ru-

bric sexual disorders, and called it “sexual disorder not otherwise specif‌ied”

(NOS); it was characterized by “persistent and marked dis tress about sexual

orientation .” DSM-5 makes no mention of a ny condition consistent w ith this

(former) condition. Note that cross-examiners, hoping to denigrate psych-

iatry’s status as a medical science, have occasionally drawn on homosexu-

ality’s history in the DSM to highlight the arbitrariness of the inclusion or

exclusion of diagnoses as a little more tha n a function of changing tides.

From a psychiatric and sexologic perspective, there is a grey zone be-

tween sexua l practices (however bizarre) engaged in by consenting adults in

privacy, and true paraphilic sexual practices. Ostensibly deviant or counter-

cultural sexual practices may be “normalized” provided no laws are broken

and both (or all) participants consent (and are capable of consenting). Sad-

istic and masochistic activities — whether pain is inf‌licted or blood is

drawn — are within the realm of acceptable behaviour, provided t wo capable

adults have consented to the activity.

B. BASIC DEFINITIONS

Paraphilic Disorders: The essential feature of this group of psychosexual dis-

orders involving anomalous activity preferences and/or anomalous target

preferences is the necessity of unusual, deviant, or bizarre images, urges,

or behaviours for sexual arousa l. The arousing fantasies or activities involve

either non-human objects, the use of chi ldren or adult non-consenting indi-

viduals, or causing one’s partner (or oneself) to experience either suffering

or humiliation. The term paraphilia, according to DSM-5, refers to “any sex-

ual interest greater than or equal to normaphilic sexual interests”6 and sub -

sumes sexual preferences or interests that equals or exceeds the person’s

interest in copulation or similar activities with others but does not cause

distress, impairment or harm to self or others that would make it a “para-

philic disorder.”

To meet DSM-5’s criteria, the paraphilic disorder either needs to cause

distress in the individua l in question, or cause harm or distress to an uncon-

senting person or a person incapable of consenting. Having a paraphilia is

not synonymous with being a sex of fender. In the case of certain paraphilias,

there is a high co-occurrence rate between the clinical and legal designa-

tions. A list of some of the more common paraphilic disorders follows below.

6 DSM-5, above note 1 at 685.