1

SEXUAL AND GENDER IDENTITY

DISORDERS
A. GENDER IDENTITY
DISORDERS
paraphilias 1
B. PARAPHILIAS
C. SEXUAL DYSFUNCTIONS
PARAPHILIAS
RECURRENT INTENSE SEXUALLY
AROUSING FANTASIES AND URGES OR
BEHAVIOURS WITH:
1) nonhuman objects
2) suffering or humiliation of oneself or partner
3) children or other nonconsenting persons
paraphilias 2
) gp
THESE CAUSE CLINICALLY SIGNIFICANT
DISTRESS OR IMPAIRMENT IN SOCIAL,
OCCUPATIONAL OR OTHER IMPORTANT
AREAS OF FUNCTIONING
OFTEN 2 OR 3 PARAPHILIAS TOGETHER
ALMOST TOTALLY MALE POPULATIONS
Severity
Mild: marked distress by paraphilic urges but
has never acted on them (e.g. child porn)
Moderate: person has occasionally acted on
paraphilias 3
p y
paraphilic urges
Severe : person has repeatedly acted on
paraphilic urges (e.g. armed forces)
PROBLEM WITH CRITERIA
1) many are not problematic and are considered
ill ( e.g. fetishism, transvestism)
2) manydonot consider themselvesill but are
paraphilias 4
2) many do not consider themselves ill but are
problematic (pedophiles)
3) many behaviours are problematic and do not
meet criteria( e.g. rapists)
2
DIAGNOSTIC CRITERIA FOR FETISHISM
A) OVER A PERIOD OF AT LEAST 6 MONTHS,
RECURRENT, INTENSE SEXUALLY AROUSING
FANTASIES, SEXUAL URGES, OR BEHAVIOURS
INVOLVING THE USE OF NONLIVING OBJECTS
B) THE FANTASIES, SEXUAL URGES, OR
BEHAVIOURS CAUSE CLINICALLY SIGNIFICANT
DISTRESS OR IMPAIRMENT IN SOCIAL,
OCCUPATIONAL OR OTHER IMPORTANT AREAS
paraphilias 5
OCCUPATIONAL, OR OTHER IMPORTANT AREAS
OF FUNCTIONING
C) THE FETISH OBJECTS ARE NOT LIMITED TO
ARTICLES OF FEMALE CLOTHING USED IN
CROSS DRESSING (as in Transvestic Fetishism) OR
DEVICES DESIGNED FOR THE PURPOSE OF
TACTILE GENITAL STIMULATION (e.g. a vibrator)
(e.g. leather car seat guy)
DIAGNOSTIC CRITERIA FOR VOYEURISM
A) OVER A PERIOD OF AT LEAST 6 MONTHS,
RECURRENT, INTENSE SEXUALLY
AROUSING FANTASIES, SEXUAL URGES,
OR BEHAVIOURS INVOLVING THE ACT OF
OBSERVING AN UNSUSPECTING PERSON
WHO IS NAKED, IN THE PROCESS OF
DISROBING OR ENGAGING IN SEXUAL
paraphilias 6
DISROBING, OR ENGAGING IN SEXUAL
ACTIVITY
B) DISTRESS & IMPAIRMENT
(not teenager walking by, Mark)
DIAGNOSTIC CRITERIA FOR EXHIBITIONISM
A) OVER A PERIOD OF AT LEAST 6
MONTHS, INTENSE SEXUALLY
AROUSING FANTASIES, SEXUAL
URGES, OR BEHAVIOURS INVOLVING
THE EXPOSURE OF ONES GENITALS
TO AN UNSUSPECTING STRANGER
paraphilias 7
TO AN UNSUSPECTING STRANGER
(courtship disorder)
B) DISTRESS & IMPAIRMENT
Note that 12% of pedophiles and rapists had this as
first deviant behaviour
(Hockey Player, picture window)
DIAGNOSTIC CRITERIA FOR
FROTTEURISM
A) OVER A PERIOD OF AT LEAST 6 MONTHS,
RECURRENT, INTENSE SEXUALLY
AROUSING FANTASIES, SEXUAL URGES, OR
BEHAVIOURS INVOLVING TOUCHING AND
RUBBING AGAINST A NONCONSENTING
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PERSON.
B) DISTRESS & IMPAIRMENT
(Phantom Feeler)
3
DIAGNOSTIC CRITERIA FOR SEXUAL
MASOCHISM
A) OVER A PERIOD OF AT LEAST 6 MONTHS,
RECURRENT, INTENSE SEXUALLY AROUSING
FANTASIES, SEXUAL URGES, OR
BEHAVIOURS INVOLVING THE ACT (REAL
paraphilias 9
BEHAVIOURS INVOLVING THE ACT (REAL,
NOT SIMULATED) OF BEING HUMILIATED,
BEATEN, BOUND, OR OTHERWISE MADE TO
SUFFER
B) DISTRESS & IMPAIRMENT
DIAGNOSTIC CRITERIA FOR SEXUAL
SADISM
A) OVER A PERIOD OF AT LEAST 6 MONTHS,
RECURRENT, INTENSE SEXUALLY
AROUSING FANTASIES, SEXUAL URGES, OR
BEHAVIOURS INVOLVING ACTS ( REAL,
NOT SIMULATED) IN WHICH THE
PSYCHOLOGICAL OR PHYSICAL
SUFFERING (INCLUDING HUMILIATION) OF
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SUFFERING (INCLUDING HUMILIATION) OF
THE VICTIM IS SEXUALLY EXCITING TO
THE PERSON necrophilia
(criteria in our research .. excessive violence, phallo)
B) DISTRESS & IMPAIRMENT
(BIG ADOLESCENT)
DIAGNOSTIC CRITERIA FOR 302.2 PEDOPHILIA
A. Over a period of at least 6 months, recurrent, intense sexually
arousing fantasies, sexual urges, or behaviours involving sexual
activity with a prepubescent child or children (generally 13 years
or younger)
B. The fantasies, sexual urges, or behaviours cause clinically
significant distress or impairment in social, occupational, or other
important areas of functioning
C. The person is at least age 16 years and at least 5 years older than
the child or children in Criterion A.
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the child or children in Criterion A.
Note: do not include an individual in late adolescence involved in
an ongoing sexual relationship with a 12 or 13 year old
SPECIFY IF: sexually attracted to males, sexually attracted to
females, sexually attracted to both
SPECIFY IF: limited to incest
SPECIAL TYPE: exclusive type (attracted only to children),
nonexclusive type
(Montreal Teacher, ethics; prettymodel drugaddict)
Severity
Mild: marked distress by paraphilic urges but
has never acted on them
Moderate: person has occasionally acted on
paraphilias 12
p y
paraphilic urges
Severe : person has repeatedly acted on
paraphilic urges
child porn
4
PARAPHILIA SEXUAL OFFENSE
SEXUAL OFFENSE PARAPHILIA
CHILD MOLESTATION PEDOPHILIA
PEDOPHILIA CHILD MOLESTATION
paraphilias 13
RAPE (SEXUAL ASSAULT) SADISM
SADISM RAPE
INCEST OFFENDER: offends against family member(s)
CHILD MOLESTER: offends against non family child
SITUATIONAL: opportunistic non predatory, preference is adult
PREFERENTIAL: predatory, preference is child,
nondiscriminating
PREFERENTIAL SITUATIONAL
paraphilias 14
CHILD
MOLESTER
PEDOPHILE PEDOPHILE
INCEST
OFFENDER
PEDOPHILE PEDOPHILE


RISK ASSESSMENT OF OFFENSIVE
SEXUAL BEHAVIOUR
(PROGNOSIS)
1. Arousal patterns
2 B h i
paraphilias 15
2. Behaviour
PHALLOMETRIC ASSESSMENTS - AUDIO TAPES
a) SEXUAL ACTIVITY WITH FEMALE OR MALE PARTNER
b) WITH FEMALE OR MALE PARTNER/VICTIM
RAPE INDEX
adult rapestimulus/mutual consent
paraphilias 16
adult rape stimulus/mutual consent
PEDOPHILE INDEX
child initiates or child mutual/adult consent
5
PHALLOMETRIC ASSESSMENTS- AUDIO TAPES
a) sexual activity with female or male partner
b) with female or male partner/victim (8 categories)
Rape Index (RI)
adult coercive sex 32 mm
=
1.18
adult consent sex 27 mm
paraphilias 17
adult consent sex 27 mm
PHALLOMETRIC ASSESSMENTS- AUDIO TAPES
a) sexual activity with female or male partner
b) with female or male partner/victim (8 categories)
Pedophile Index (PI)
child mutual sex 32 mm
=
1.18
adult consent sex 27 mm
paraphilias 18
adult consent sex 27 mm
Offense Number % Total % Sex Recid. % Viol
Recid.
% Any
Recid.
Incest 295 44 10 20 27
Child
Molester
206 31 23 34 46
Court Referred Sexual Offenders In Ottawa
1982-1992
paraphilias 19
Rapist 87 13 24 37 57
Mixed 86 12 35 42 60
Total 674
Exhibit. 208 9 23 31 39
Prediction of Sexual/Violent
Recidivism
CPIC (rapists, child molesters, incest
offenders, exhibitionists)
Psychopathy(child molesters, incest offenders,
hibi i i )
paraphilias 20
exhibitionists)
Alcohol abuse(rapists, child molesters, incest)
Phallometrics(child molesters, exhibitionists)