{"id":831,"date":"2020-08-10T22:11:30","date_gmt":"2020-08-10T22:11:30","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=831"},"modified":"2022-07-26T20:06:25","modified_gmt":"2022-07-26T20:06:25","slug":"case-studies-examining-sexual-deviations-and-dysfunctions","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/case-studies-examining-sexual-deviations-and-dysfunctions\/","title":{"raw":"Case Studies: Examining Sexual Deviations and Dysfunctions","rendered":"Case Studies: Examining Sexual Deviations and Dysfunctions"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Identify sexual deviation and dysfunction in case studies<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>Case Study: Derek<\/h2>\r\nDerek and Camilla met online and hit it off immediately. Derek knew Camilla had a nine-year-old daughter named Maggie, and when Camilla introduced the two of them, they also hit it off. No one was surprised when they decided to marry, even if they had only known each other shortly. Derek and Camilla were visibly in love, and they all seemed to be a happy family. Not too long after his marriage, Derek began developing an inappropriately close relationship with Maggie, now his stepdaughter. Seemingly innocent back rubs turned into extra time to give her bubble baths. He found it harder and harder to control urges he was having when left alone with the child. After only two months of life together under the same roof, Derek's behavior stepped outside the limits of normal parental physical affection. When Camilla, a nurse, left for work early each morning, Derek invited Maggie to the parental bedroom on the pretext that she could watch cartoons with him on the bed. He\u00a0 would stroke Maggie's hair and gradually proceed to massage her body while encouraging her to touch his genitals, saying that it was \"OK for her to learn about what daddies are like.\" Maggie was confused by his behavior and even a little scared, but she did as she was told. Derek reinforced compliance to this behavior by offering Maggie gifts. He also encouraged her to keep their secret, and stated that even if she told anyone, he would deny it. One day Camilla returned home unexpectedly because she had forgotten something and caught him engaging in this behavior. She later learned that it had been going on for over a year.\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/79999e8e-2938-4a5d-8857-ff90ab05eaee\r\n\r\n<\/div>\r\n<h3>Treatment<\/h3>\r\n<p id=\"id_0077421000_001_009789\">As evident in Derek's case, individuals with pedophilic disorder often do not feel distressed as a result of their urges and may never seek treatment. Thus, the first issue to address in psychotherapy would be to help Derek realize the harm he had done to both Maggie and Camilla; in other words, making his disorder ego-dystonic. The hope would be that it would become increasingly difficult for Derek to deny the problems his urges caused and recognize that he would have to work to control his urges throughout the rest of his life. He might eventually accept\u00a0<span style=\"font-size: 1em;\">that his disorder was harmful to others and to his relationship with his wife, and that there could have been\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">legal ramifications. Therapy would focus on <\/span><span style=\"font-size: 1rem; text-align: initial;\">controlling his urges and fantasies about children, in combination with the antiandrogen medication to reduce his fantasies and urges to have sex with children.\u00a0<\/span><\/p>\r\nCase Study: Anne\r\n\r\nFor a number of years, Anne and Jodie have mutually enjoyed BDSM (bondage, domination\/discipline, sadism\/submission, and masochism) sex parties as a part of a community. Lately, Anne has developed a strong interest in maintaining control, both in regard to sex (e.g., tying up her girlfriend, Jodie) and in her life. She has insisted on submitting Jodie to demeaning and abusive sexual behavior. In the early years of their relationship, Jodie's requests involved relatively innocent pleas that Anne pinch her and bite her while they were sexually intimate. Over time, however, behaviors that involved pain increased and the nature of the pain changed. At present, they engage in what they call \u201cprivate parties,\u201d during which Anne handcuffs Jodie to the bed and inflicts various forms of torture. Jodie goes along with and likes Anne's ideas of new ways to inflict pain. Now Anne has a repertoire of behaviors, ranging from burning Jodie's skin with matches to cutting her with razor blades. Anne and Jodie\u00a0no longer have an interest in sexual intimacy other than that involving pain.\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/c3ab2728-25b7-4d05-8d51-bb3d188bcba6\r\n\r\n<\/div>\r\n<h2>Controversies in Diagnosing Paraphilias<\/h2>\r\nAs mentioned in this module, deciding what is \u201cnormal\u201d in the area of sexuality is an issue fraught with difficulty and controversy. Critics of the\u00a0DSM\u00a0argue that several of the paraphilic disorders in\u00a0DSM-5 pathologize nonnormative sexual behavior. These critics maintain that even breaking the law is not a sufficient basis for determining that an individual engaging in a paraphilic behavior has a psychological disorder. This criticism also applies to exhibitionistic, voyeuristic, and frotteuristic disorders, which don't involve victims in the same sense as do the other paraphilic disorders.[footnote]Hinderliter, A. C. (2010). Disregarding science, clinical utility, and the DSM's definition of mental disorder: The case of exhibitionism, voyeurism, and frotteurism. <em>Archives of Sexual Behavior<\/em>, 39, 1235\u20131237.[\/footnote]","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Identify sexual deviation and dysfunction in case studies<\/li>\n<\/ul>\n<\/div>\n<h2>Case Study: Derek<\/h2>\n<p>Derek and Camilla met online and hit it off immediately. Derek knew Camilla had a nine-year-old daughter named Maggie, and when Camilla introduced the two of them, they also hit it off. No one was surprised when they decided to marry, even if they had only known each other shortly. Derek and Camilla were visibly in love, and they all seemed to be a happy family. Not too long after his marriage, Derek began developing an inappropriately close relationship with Maggie, now his stepdaughter. Seemingly innocent back rubs turned into extra time to give her bubble baths. He found it harder and harder to control urges he was having when left alone with the child. After only two months of life together under the same roof, Derek&#8217;s behavior stepped outside the limits of normal parental physical affection. When Camilla, a nurse, left for work early each morning, Derek invited Maggie to the parental bedroom on the pretext that she could watch cartoons with him on the bed. He\u00a0 would stroke Maggie&#8217;s hair and gradually proceed to massage her body while encouraging her to touch his genitals, saying that it was &#8220;OK for her to learn about what daddies are like.&#8221; Maggie was confused by his behavior and even a little scared, but she did as she was told. Derek reinforced compliance to this behavior by offering Maggie gifts. He also encouraged her to keep their secret, and stated that even if she told anyone, he would deny it. One day Camilla returned home unexpectedly because she had forgotten something and caught him engaging in this behavior. She later learned that it had been going on for over a year.<\/p>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_79999e8e-2938-4a5d-8857-ff90ab05eaee\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/79999e8e-2938-4a5d-8857-ff90ab05eaee?iframe_resize_id=assessment_practice_id_79999e8e-2938-4a5d-8857-ff90ab05eaee\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<h3>Treatment<\/h3>\n<p id=\"id_0077421000_001_009789\">As evident in Derek&#8217;s case, individuals with pedophilic disorder often do not feel distressed as a result of their urges and may never seek treatment. Thus, the first issue to address in psychotherapy would be to help Derek realize the harm he had done to both Maggie and Camilla; in other words, making his disorder ego-dystonic. The hope would be that it would become increasingly difficult for Derek to deny the problems his urges caused and recognize that he would have to work to control his urges throughout the rest of his life. He might eventually accept\u00a0<span style=\"font-size: 1em;\">that his disorder was harmful to others and to his relationship with his wife, and that there could have been\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">legal ramifications. Therapy would focus on <\/span><span style=\"font-size: 1rem; text-align: initial;\">controlling his urges and fantasies about children, in combination with the antiandrogen medication to reduce his fantasies and urges to have sex with children.\u00a0<\/span><\/p>\n<p>Case Study: Anne<\/p>\n<p>For a number of years, Anne and Jodie have mutually enjoyed BDSM (bondage, domination\/discipline, sadism\/submission, and masochism) sex parties as a part of a community. Lately, Anne has developed a strong interest in maintaining control, both in regard to sex (e.g., tying up her girlfriend, Jodie) and in her life. She has insisted on submitting Jodie to demeaning and abusive sexual behavior. In the early years of their relationship, Jodie&#8217;s requests involved relatively innocent pleas that Anne pinch her and bite her while they were sexually intimate. Over time, however, behaviors that involved pain increased and the nature of the pain changed. At present, they engage in what they call \u201cprivate parties,\u201d during which Anne handcuffs Jodie to the bed and inflicts various forms of torture. Jodie goes along with and likes Anne&#8217;s ideas of new ways to inflict pain. Now Anne has a repertoire of behaviors, ranging from burning Jodie&#8217;s skin with matches to cutting her with razor blades. Anne and Jodie\u00a0no longer have an interest in sexual intimacy other than that involving pain.<\/p>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_c3ab2728-25b7-4d05-8d51-bb3d188bcba6\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/c3ab2728-25b7-4d05-8d51-bb3d188bcba6?iframe_resize_id=assessment_practice_id_c3ab2728-25b7-4d05-8d51-bb3d188bcba6\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<h2>Controversies in Diagnosing Paraphilias<\/h2>\n<p>As mentioned in this module, deciding what is \u201cnormal\u201d in the area of sexuality is an issue fraught with difficulty and controversy. Critics of the\u00a0DSM\u00a0argue that several of the paraphilic disorders in\u00a0DSM-5 pathologize nonnormative sexual behavior. These critics maintain that even breaking the law is not a sufficient basis for determining that an individual engaging in a paraphilic behavior has a psychological disorder. This criticism also applies to exhibitionistic, voyeuristic, and frotteuristic disorders, which don&#8217;t involve victims in the same sense as do the other paraphilic disorders.<a class=\"footnote\" title=\"Hinderliter, A. C. (2010). Disregarding science, clinical utility, and the DSM's definition of mental disorder: The case of exhibitionism, voyeurism, and frotteurism. Archives of Sexual Behavior, 39, 1235\u20131237.\" id=\"return-footnote-831-1\" href=\"#footnote-831-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-831-1\">Hinderliter, A. C. (2010). Disregarding science, clinical utility, and the DSM's definition of mental disorder: The case of exhibitionism, voyeurism, and frotteurism. <em>Archives of Sexual Behavior<\/em>, 39, 1235\u20131237. <a href=\"#return-footnote-831-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":16,"template":"","meta":{"_candela_citation":"[]","CANDELA_OUTCOMES_GUID":"37ae1e81-929d-4478-83fa-de697be90abc, f5bdd369-45fd-4cc7-ae08-a0533feeb9e8","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-831","chapter","type-chapter","status-publish","hentry"],"part":150,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/831","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":27,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/831\/revisions"}],"predecessor-version":[{"id":7531,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/831\/revisions\/7531"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/parts\/150"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/831\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/media?parent=831"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapter-type?post=831"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/contributor?post=831"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/license?post=831"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}