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What Constitutes Atypical Sexual Behavior?
What are the primary distinguishing characteristics of atypical
sexual behaviors?
What impact do atypical sexual behaviors have on both a person
who exhibits them and others to whom they may be directed?
Noncoercive Paraphilias
How do noncoercive paraphilias differ from coercive paraphilias?
How does fetishism develop?
How does transvestic fetishism differ from female impersonation,
transsexualism, and homosexuality?
What factors might motivate people to engage in sadomasochistic
behavior?
Coercive Paraphilias
What characteristics are common to individuals who engage in
exhibitionism?
What are some helpful strategies for dealing with obscene phone
calls?
Are there characteristics and causative factors common to people
who engage in voyeurism?
Sexual Addiction: Fact, Fiction, or Misnomer?
Can people become addicted to sex?
Is there widespread support among professionals for the sexual
addiction model?
487
Mike Diver/Stone/Getty Images
16
Atypical
Sexual Behavior
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488 CHAPTER 16
My last sexual partner was very much into golden showers. Having spent a little
of my time watching G. G. Allen movies, I was well acquainted with the existence
of water sports, but somehow it never occurred to me that I would like to partake
in them. When my partner revealed his desire to drink my urine, I was taken off
guard. I have been known to try some things I would deem a little atypical, so I
gave it a shot. I was very nervous about the actual art of the procedure, though.
Thoughts such as “What if he was joking—he would think I’m nuts” and What if
I completely miss” entered my head. It was nerve-racking and made it especially
hard to pee. Eventually, my anxiety subsided and I was able to participate. His
reaction was amazing to me. He began to masturbate feverishly and lapped up
my urine ecstatically. I had never seen him so turned on. More surprising, though,
was how much I enjoyed it. Although I cannot imagine being on the other end, it
was really an empowering and enjoyable experience. (Authors’ files)
This description of a rather unusual sexual experience, provided by a student in a
sexuality class, may strike our readers as reflecting an abnormal or perhaps even devi-
ant form of sexual behavior. However, we believe it is more realistic to consider this
anecdote an account of uncommon or atypical sexual behavior. One note of caution:
Because HIV has been found in the urine of infected persons, it is prudent to avoid
contact with a partners urine unless he or she is known to be HIV-negative and not
infected with any other STIs. Now let us consider for a moment what constitutes
atypical sexual behavior.
What Constitutes Atypical Sexual Behavior?
In this chapter, we focus on a number of sexual behaviors that have been variously
labeled as deviant, perverted, aberrant, or abnormal. More recently, the less judgmen-
tal term paraphilia (pair-uh-FILL-ee-uh) has been used to describe these somewhat
uncommon types of sexual expression. Literally meaning beyond usual or typical love,
this term stresses that such behaviors are usually not based on an affectionate or loving
relationship but rather are expressions of behavior in which sexual arousal or response,
or both, depends on some unusual, extraordinary, or even bizarre activity (American
Psychiatric Association, 2000; Shindel & Moser, 2011). The term paraphilia is used in
much of the psychological and psychiatric literature. However, in our own experience
in dealing with and discussing variant sexual behaviors, the one common character-
istic that stands out is that each behavior in its fully developed form is not typically
expressed by most people in our society. Therefore we also categorize the behaviors
discussed in this chapter as atypical sexual behaviors.
Several points should be noted about atypical sexual expression in general before
we discuss specic behaviors. First, as with many other sexual expressions discussed in
this book, the behaviors singled out in this chapter represent extreme points on a con-
tinuum. Atypical sexual behaviors exist in many gradations, ranging from mild, infre-
quently expressed tendencies to full-blown, regularly manifested behaviors. Although
these behaviors are atypical, many of us may recognize some degree of such behaviors
or feelings in ourselves—perhaps manifested at some point in our lives, or mostly
repressed, or emerging only in private fantasies.
A second point has to do with the state of our knowledge about these behaviors.
In most of the discussions that follow, the person who manifests the atypical behavior
is assumed to be male, and evidence strongly indicates that in most reported cases
paraphilia
A term used to describe uncommon
types of sexual expression.
atypical sexual behaviors
Behaviors not typically expressed by
most people in our society.
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Atypical Sexual Behavior489 489
of atypical or paraphilic behaviors, the agents of such acts are male (J. Miller, 2009).
However, the tendency to assume that males are predominantly involved may be inu-
enced by the somewhat biased nature of dierential reporting and prosecution. Female
exhibitionism, for example, is far less likely to be reported than is similar behavior in
a male. Of the paraphilias discussed in this chapter, sexual masochism is the one most
likely to be expressed by women ( J. Miller, 2009). John Money (1981) suggested that
atypical sexual behavior is decidedly more prevalent among males than females because
male erotosexual dierentiation (the development of sexual arousal in response to vari-
ous kinds of images or stimuli) is more complex and subject to more errors than that
of the female.
A third noteworthy point is that atypical behaviors often occur in clusters. at
is, the occurrence of one paraphilia appears to increase the probability that others will
also be manifested, simultaneously or sequentially (Bradford et al., 1992; Kafka, 2009).
Research on men whose paraphilias resulted in medical or legal attention revealed that
over half of the men reported engaging in more than one paraphilia and almost one in
ve reported experience with four or more paraphilias (Abel & Osborn, 2000). One
hypothesis oered to account for this cluster eect is that engaging in one atypical
behavior, such as exhibitionism, reduces the participant’s inhibitions to the point that
engaging in another paraphilia, such as voyeurism, becomes more likely (Stanley, 1993).
A nal consideration is the eect of atypical behaviors both on the person who
exhibits them and on the people to whom they may be directed. People who manifest
atypical sexual behaviors often depend on these acts for sexual satisfaction. e behav-
ior is frequently an end in itself. It is also possible that the unconventional behavior will
alienate others. Consequently, these people often nd it dicult to establish satisfying
sexual and intimate relationships with partners. Instead, their sexual expression can
assume a solitary, driven, even compulsive quality. Some of these behaviors do involve
other people whose personal space is violated in a coercive, invasive fashion. In the fol-
lowing section, we consider the distinction between coercive and noncoercive paraphil-
ias.
Table 16.1 summarizes the paraphilias discussed in this chapter.
Critical Thinking Question
Do you think that the disproportionate rate
of atypical sexual behavior reported among
men is due to biology or social/cultural
conditioning? Explain.
At a Glance
TABLE 16.1 Summary of Several Paraphilias
Name Description Classication
Fetishism Sexual arousal associated with focus on inanimate object or body part Noncoercive
Transvestic fetishism Sexual arousal derived from wearing clothing of other sex Noncoercive
Sexual sadism Association of sexual arousal with pain Noncoercive
Sexual masochism Sexual arousal through receiving physical or psychological pain Noncoercive
Autoerotic asphyxia Enhancement of sexual arousal by oxygen deprivation Noncoercive
Klismophilia Sexual pleasure associated with receiving enemas Noncoercive
Coprophilia and Urophilia Sexual arousal associated with contact with feces or urine, respectively Noncoercive
Exhibitionism Sexual arousal associated with exposing ones genitals to unwilling observer Coercive
Obscene phone calls Sexual arousal associated with obscene telephone conversation with unwilling
recipient
Coercive
Voyeurism Sexual arousal associated with observing naked bodies or sexual activities of
people without their consent
Coercive
Frotteurism Obtaining sexual pleasure by pressing or rubbing against another person in a
crowded public place
Coercive
Zoophilia Sexual contact between humans and animals Coercive
Necrophilia Sexual gratication obtained by viewing or having intercourse with a corpse Coercive
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490 CHAPTER 16
Noncoercive Versus Coercive Paraphilias
A key distinguishing characteristic of paraphilias is whether they involve an element
of coercion. Several of the paraphilias are strictly solo activities or involve the partici-
pation of consensual adults who agree to engage in, observe, or just put up with the
particular variant behavior. Because coercion is not involved and a persons basic rights
are not violated, such so-called noncoercive atypical behaviors are considered relatively
benign or harmless by many. Clearly, the chapter opening account
falls into this category. However, as we will see, these noncoercive
behaviors occasionally engender potentially adverse consequences
for people drawn into their sphere of influence.
Some paraphilias, such as voyeurism or exhibitionism, are def-
initely coercive or invasive, in that they involve unwilling recipients
of the behavior. Furthermore, research suggests that such coercive
acts can harm their targets, who may be psychologically trauma-
tized by the experience. Such recipients may feel that they have
been violated or that they are vulnerable to physical abuse, and
they may develop fears that such unpleasant episodes will recur.
is is one reason that many of these coercive paraphilias are ille-
gal. On the other hand, many people who encounter such acts are
not adversely aected. Because of this fact, and because many of
these coercive behaviors do not involve physical or sexual contact
with another person, many authorities view them as minor sex
oenses (sometimes called nuisance oenses). However, evidence
that some people progress from nuisance oenses to more serious
forms of sexual abuse may lead to a reconsideration of whether
these oenses are minor” (Bradford et al., 1992; Fedora et al.,
1992). We examine this issue in more detail later in this chapter.
In our discussion of both coercive and noncoercive paraphilias,
we examine how each of these behaviors is expressed, common
characteristics of people who exhibit the paraphilia, and various
factors thought to contribute to the development of the behavior. More severe forms of
sexual coercion, such as rape, incest, and child abuse, are discussed in Chapter 17.
Noncoercive Paraphilias
In this section, we first discuss four fairly common types of noncoercive paraphilias:
fetishism, transvestic fetishism, sexual sadism, and sexual masochism. We will also
describe four less common varieties of noncoercive paraphilias.
Fetishism
Fetishism (FET-ish-iz-um) refers to sexual behavior in which an individual becomes
sexually aroused by focusing on an inanimate object or a part of the human body. As
with many other atypical behaviors, it is often difficult to draw the line between normal
activities that might have fetishistic overtones and activities that are genuinely paraphilic.
Many people are erotically aroused by the sight of womens lingerie and certain specific
body parts, such as feet, legs, buttocks, thighs, and breasts. Many men and some women
use articles of clothing and other paraphernalia as an accompaniment to masturbation
or sexual activity with a partner. Only when a person becomes focused on these objects
or body parts to the exclusion of everything else is the term fetishism truly applicable
Fuse/Jupiterimages
fetishism
A sexual behavior in which a person
obtains sexual excitement primarily or
exclusively from an inanimate object
or a particular part of the body.
Inanimate objects or a part of the human body, such as feet,
can be sources of sexual arousal for some people.
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Atypical Sexual Behavior491 491
(Lowenstein, 2002). In some instances, a person cannot experience sexual arousal and
orgasm in the absence of the fetish object. In other situations where the attachment
is not so strong, sexual response can occur in the absence of the object but often with
diminished intensity. For some people fetish objects serve as substitutes for human
contact and are dispensed with if a partner becomes available. Some common fetish
objects include womens lingerie, shoes (particularly those with high heels), boots (often
affiliated with themes of domination), hair, stockings (especially black mesh hose), and
a variety of leather, silk, and rubber goods (American Psychiatric Association, 2000;
Seligman & Hardenburg, 2000). Leather is an especially popular fetish object: leather
coats, pants, corsets, and boots (Davis, 2011).
How does fetishism develop? One way is through incorporating the object or body
part, often through fantasy, in a masturbation sequence in which the reinforcement of
orgasm strengthens the fetishistic association ( Juninger, 1997). Another possible expla-
nation for the origins of some cases of fetishism looks to childhood. Some children
learn to associate sexual arousal with objects (such as panties or shoes) that belong
to an emotionally signicant person, such as their mothers or older sisters (Freund &
Blanchard, 1993). e process by which this occurs is sometimes called symbolic trans-
formation. In this process, the object of the fetish becomes endowed with the power
or essence of its owner, so that the child (usually a male) responds to this object as
he might react to the actual person (Gebhard et al., 1965). If such a behavior pattern
becomes suciently ingrained, the person will engage in little or no sexual interaction
with other people during the developmental years and even as an adult may continue to
substitute fetish objects for sexual contact with other humans.
Only rarely does fetishism develop into an oense that might harm someone. Occa-
sionally, an individual may commit burglary to supply a fetish object, and burglary is the
most frequent serious oense associated with fetishism (Lowenstein, 2002). Uncom-
monly, a person may do something bizarre, such as cut hair from an unwilling person.
In extremely rare cases a man may murder and mutilate his victim, preserving certain
body parts for fantasy masturbation activities.
Common fetish items include women’s lingerie and shoes. People involved in fetishism can become aroused by these
common inanimate objects.
© David Muscroft/SuperStock
© Image Source/Corbis
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492 CHAPTER 16
Transvestic Fetishism
Until recently, nontranssexual cross-dressers were generally labeled transvestites. This term
is now considered appropriately applied only to people who put on the clothes of the other
sex to achieve sexual arousal (Langstrom & Zucker, 2005). The sexual component of cross-
dressing for these individuals distinguishes them from female impersonators who cross-
dress to entertain, gay men who occasionally “go in drag” to attract men or as a kind of
camp acting out, and transsexuals who, as we discussed in Chapter 5, cross-dress to obtain
a partial sense of physical and emotional completeness rather than to achieve sexual arousal.
Transvestism comprises a range of behaviors. Some people prefer to don the entire garb
of the other sex. is is often a solitary activity, occurring privately in their homes. Occa-
sionally, a person may go out on the town while so attired, but this is unusual. In general,
the cross-dressing is a momentary activity, producing sexual excitement that often cul-
minates in gratication through masturbation or sex with a partner. In many cases of
transvestism, a person becomes aroused by wearing only one garment, perhaps a pair
of panties or a brassiere. Because this behavior has a strong element of fetishism (Freund
et al., 1996), the American Psychiatric Association (2000) formalized the link between
transvestism and fetishism by placing both conditions in the diagnostic category trans-
vestic fetishism. A distinguishing feature of transvestic fetishism is that the clothing
article is actually worn instead of just being viewed or fondled, as is the case with fetishism.
According to the American Psychiatric Association (2000), a diagnosis of transves-
tic fetishism is appropriately applied to heterosexual males who experience signicant
psychological distress or impaired functioning as a result of recurrent sexual fantasies,
urges, or behavior involving cross-dressing that persist for at least 6 months.
Today, many members of the transgendered community, who are increasingly gaining
a voice in both the professional literature and the popular media, contend that cross-
dressing is often an appropriate and legitimate source of sexual arousal and expression
rather than an indicator of disordered behavior or psychological impairment. Conse-
quently, they reject the label of transvestic fetishism and its implication of abnormality.
e diagnostic criteria previously outlined specify that transvestic fetishism is the
sole province of heterosexual males. Apparently, it is usually men who are attracted to
transvestic fetishism. is seems true of all contemporary societies for which we have
data. However, a few isolated cases of women cross-dressing for sexual pleasure also
appear in the clinical literature (V. Bullough & Bullough, 1993; Stoller, 1982).
Several studies of both clinical and nonclinical populations suggest that transvestic
fetishism occurs primarily among married men with predominantly heterosexual orien-
tations (Bullough & Bullough, 1997; Doctor & Prince, 1997).
As with fetishism and some other atypical behaviors, the development of transvestic
fetishism often reveals a pattern of conditioning. Reinforcement, in the form of arousal
and orgasm, may accompany cross-dressing activities at an early point in the develop-
ment of sexual interest, as illustrated in the following anecdote:
When I was a kid, about 11 or 12, I was fascinated and excited by magazine pic-
tures of women modeling undergarments. Masturbating while looking at these
pictures was great. Later, I began to incorporate my mothers underthings in
my little masturbation rituals, at first just touching them with my free hand, and
later putting them on and parading before the mirror while I did my handjob.
Now, as an adult, I have numerous sexual encounters with women that are
quite satisfying without the dress-up part. But I still occasionally do the dress-
up when I’m alone, and I still find it quite exciting. (Authors’ files)
Many people who engage in transvestic
fetishism feel that cross-dressing is an
appropriate and legitimate source of
arousal and expression, rather than a
disorder or impairment.
© Zen Icknow/Corbis
transvestic fetishism
A sexual behavior in which a person
derives sexual arousal from wearing
clothing of the other sex.
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Atypical Sexual Behavior493 493
Sexual Sadism and Sexual Masochism
Sadism and masochism are often discussed under the common category sadomasoch-
istic (SAY-doh-ma-suh-kis-tik) (SM) behavior because they are two variations of the
same phenomenon: the association of sexual expression with pain. Furthermore, the
dynamics of the two behaviors are similar and overlapping. Thus in the discussion that
follows we will often refer to SM behavior or activities. However, a person who engages
in one of these behaviors does not necessarily engage in the other, and thus sadism
and masochism are actually distinct behaviors. The American Psychiatric Association
(2000) underlines this distinction by listing these paraphilias as separate categories:
sexual sadism and sexual masochism. Sexual masochism is the only paraphilia that is
expressed by women with some frequency (American Psychiatric Association, 2000).
(People who engage in SM often label these activities as bondage-domination-sadism-
masochism, or BDSM; Gross, 2006.)
Labeling behavior as sexual sadism or sexual masochism is complicated because
many people enjoy some form of aggressive interaction during sex play (such as “love
bites”) for which the label sadomasochistic seems inappropriate. Alfred Kinsey and his
colleagues (1948, 1953) found that 22% of the males and 12% of the females in their
sample responded erotically to stories with SM themes. In another study, approximately
25% of both sexes reported erotic response to receiving love bites during sexual interac-
tion (Gross, 2006). Another survey of 975 men and women found that 25% reported
occasionally engaging in a form of SM activity with a partner (Rubin, 1990). ere are
indications that ease of access to people with SM inclinations, facilitated by the Inter-
net, has resulted in an increased number of people who are exploring their SM interests
(Gross, 2006; Kleinplatz & Moser, 2004).
Although SM practices have the potential for being physically dangerous, most par-
ticipants generally stay within mutually agreed-on limits, often conning their activities
to mild or even symbolic SM acts with a trusted partner. In mild forms of sexual sadism
the pain inicted is often more symbolic than real. For example, a willing partner may
be beaten with a feather or a soft object designed to resemble a club. Under these con-
ditions the receiving partner’s mere feigning of suering is sucient to induce sexual
arousal in the individual inicting the symbolic pain.
People with masochistic inclinations are aroused by such things as being whipped, cut,
pierced with needles, bound, or spanked. e degree of pain that the person must experi-
ence to achieve sexual arousal varies from symbolic or very mild to, rarely, severe beatings or
mutilations. Sexual masochism is also reected in individuals who achieve sexual arousal as
a result of being held in contempt, humiliated, and forced to do menial, lthy, or degrading
service (Money, 1981, p. 83). e common notion that any kind of pain, physical or men-
tal, will sexually arouse a person with masochistic inclinations is a misconception. e pain
must be associated with a staged encounter whose express purpose is sexual gratication.
In yet another version of masochism, some individuals derive sexual pleasure from
being bound, tied up, or otherwise restricted. is behavior, called bondage, usually
takes place with a cooperative partner who binds or restrains the individual and some-
times administers discipline, such as spankings or whippings (Santilla et al., 2002). One
survey of 975 heterosexual women and men revealed that bondage is a fairly common
practice: One fourth of respondents reported engaging in some form of bondage during
some of their sexual encounters (Rubin, 1990).
Many individuals who engage in SM activities do not conne their participation to
exclusively sadistic or masochistic behaviors. Some alternate between the two roles, often
out of necessity, because it may be dicult to nd a partner who prefers only to inict
or to receive pain. Most of these people seem to prefer one or the other role, but some
are equally comfortable in either role (Mosher & Levitt, 1987; Taylor & Ussher, 2001).
sadomasochistic (SM) behavior
The association of sexual expression
with pain.
sexual sadism
The act of obtaining sexual arousal
through giving physical or psychologi-
cal pain.
sexual masochism
The act of obtaining sexual arousal
through receiving physical or psycho-
logical pain.
bondage
A sexual behavior in which a per-
son derives sexual pleasure from
being bound, tied up, or otherwise
restricted.
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494 CHAPTER 16
Research has indicated that individuals with sexual sadistic tendencies are less
common than their masochistic counterparts (Sandnabba et al., 1999). is imbal-
ance might reect a general social script—certainly it is more virtuous to be pun-
ished than to carry out physical or mental aggression toward another. A person who
needs severe pain as a prerequisite for sexual response may have diculty nding
a cooperative partner. Consequently, such individuals may resort to causing their
own pain by burning or mutilation. Likewise, a person who needs to inict intense
pain to achieve sexual arousal may nd it dicult to nd a willing partner, even for
a price. We occasionally read of sadistic assaults against unwilling victims: e clas-
sic lust murder is often of this nature (Money, 1990). In such instances orgasmic
release may be achieved by the homicidal violence itself.
Many people in contemporary Western societies view sadomasochism in a
highly negative light. is attitude is certainly understandable, particularly in peo-
ple who regard sexual sharing as a loving, tender interaction between partners who
wish to exchange pleasure. However, much of this negativity stems from a general-
ized perception of SM activities as perverse forms of sexual expression that involve
severe pain, suering, and degradation. It is commonly assumed that individuals
caught up in such activities are often victims rather than willing participants.
One group of researchers disputed these assumptions, suggesting that the tra-
ditional medical model of sadomasochism as a pathological condition is based on a
limited sample of individuals who come to clinicians’ attention because of person-
ality disorders or severe personality problems. As with some other atypical behaviors
discussed in this chapter, these researchers argued that it is misleading to draw conclu-
sions from such a sample. ey conducted their own extensive eldwork in nonclini-
cal environments, interviewing a variety of sadomasochism participants and observing
their behaviors in many dierent settings. Although some subjects’ behaviors t tradi-
tional perceptions, the researchers found that, for most participants, sadomasochism
was simply a form of sexual enhancement involving elements of dominance and sub-
mission, role-playing, and consensuality, which they voluntarily and mutually chose to
explore (Weinberg et al., 1984, p. 388). Another study of 164 men who were members
of sadomasochism-oriented clubs revealed that these individuals were socially well
adjusted and that sadomasochistic behavior occupied only a portion of their broader
sexual lives (Sandnabba et al., 1999).
Many people who engage in SM activities are motivated by a desire to experience
dominance or submission, or both, rather than pain (Weinberg, 1987, 1995). is
desire is reected in the following account, provided by a student in a sexuality class:
I fantasize about sadomasochism sometimes. I want to have wild animalistic
sex under the control of my husband. I want him to “force” me to do things.
Domination and mild pain would seem to fulfill the moment. I have read books
and talked to people about the subject, and I am terrified at some of the things,
but in the bounds of my trusting relationship I would not be afraid. It seems like
a silly game, but it is so damned exciting to think about. Maybe someday it will
happen. (Authors’ files)
Studies of sexual behavior in other species reveal that many nonhuman animals engage
in what might be labeled combative or pain-inicting behavior before coitus (Gross, 2006).
Some theorists have suggested that such activity has denite neurophysiological value,
heightening accompaniments of sexual arousal such as blood pressure, muscle tension, and
hyperventilation (Gebhard et al., 1965). For a variety of reasons (such as guilt, anxiety, or
Some individuals derive sexual pleasure
from the restrictions created by bondage
attire and role-playing.
Howard Kingsnorth/Stone/Getty Images
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Atypical Sexual Behavior495 495
apathy), some people may need additional nonsexual stimuli to achieve sucient arousal. It
has also been suggested that resistance or tension between partners enhances sex and that
sadomasochism is just a more extreme version of this common principle (Tripp, 1975).
Sadomasochism might also provide participants with an escape from the rigidly
controlled, restrictive role they must play in their everyday public lives. is possibility
helps explain why men who engage in SM activity are much more likely to play masoch-
istic roles than are women (Baumeister, 1997). A related theory sees sexual masochism
as an attempt to escape from high levels of self-awareness. Similar to some other behav-
iors (such as getting drunk) in which a person may attempt to lose himself or herself,
masochistic activity blocks out unwanted thoughts and feelings, particularly those that
induce anxiety, guilt, or feelings of inadequacy or insecurity (Baumeister, 1988).
Clinical case studies of people who engage in sadomasochism sometimes reveal early
experiences that may have established a connection between sex and pain. For example,
being punished for engaging in sexual activities (such as masturbation) might lead a child
or an adolescent to associate sex with pain. A child might even experience sexual arousal
while being punished—for example, getting an erection or lubricating when his or her
pants are pulled down and a spanking is administered (spanking is a common SM activity).
Many people, perhaps the majority, who participate in SM behaviors do not depend
on these activities to achieve sexual arousal and orgasm. SM interests often exist con-
currently with more conventional sexual desires (Kleinplatz & Moser, 2004). ose who
practice sadomasochism only occasionally nd that at least some of its excitement and
erotic allure stem from its being a marked departure from more conventional sexual prac-
tices. Other people who indulge in SM acts may have acquired strong negative feelings
about sex, often believing it is sinful and immoral. For such people masochistic behavior
provides a guilt-relieving mechanism: Either they get their pleasure simultaneously with
punishment, or they rst endure the punishment to entitle them to the pleasure. Similarly,
people who indulge in sadism may be punishing partners for engaging in anything so evil.
Furthermore, people who have strong feelings of personal or sexual inadequacy may resort
to sadistic acts of domination over their partners to temporarily alleviate these feelings.
Other Noncoercive Paraphilias
In this section, we consider four additional varieties of noncoercive paraphilias that
are generally uncommon or even rare. We begin our discussion by describing auto-
erotic asphyxia, a dangerous form of variant sexual behavior. We then offer a few brief
comments about three other uncommon noncoercive paraphilias: klismaphilia, copro-
philia, and urophilia.
Autoerotic Asphyxia
Autoerotic asphyxia (also called hypoxyphilia or asphyxiophilia) is a rare and life-
threatening paraphilia in which an individual, almost always a male, seeks to reduce
the supply of oxygen to the brain during a heightened state of sexual arousal (Hucker,
2009; Hucker et al., 2011). The oxygen deprivation is usually accomplished by apply-
ing pressure to the neck with a chain, leather belt, ligature, or rope noose (by means of
hanging). Occasionally, a plastic bag or chest compression is used as the asphyxiating
device. A person might engage in these oxygen-depriving activities while alone or with
a partner. Available data indicate that the majority of people who express this para-
philia are White males (Sauvageau & Racette, 2006).
We can only theorize from limited data about what motivates such behavior. Peo-
ple who practice autoerotic asphyxia rarely disclose this activity to relatives, friends, or
therapists, let alone discuss why they engage in such behavior (Garza-Leal & Landron,
autoerotic asphyxia
The enhancement of sexual excite-
ment and orgasm by pressure-
induced oxygen deprivation.
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496 CHAPTER 16
1991; Saunders, 1989). For some the goal seems to be to increase sexual arousal and to
enhance the intensity of orgasm. In this situation the item used to induce oxygen depri-
vation (such as a rope) is typically tightened around the neck to produce heightened
arousal during masturbation and is then released at the time of orgasm. Individuals
often devise elaborate techniques that enable them to free themselves from the stran-
gling device before losing consciousness.
e enhancement of sexual excitement by pressure-induced oxygen deprivation may
bear some relationship to reports that orgasm is intensied by inhaling amyl nitrate
(“poppers”), a drug used to treat heart pain. is substance is known to temporarily
reduce brain oxygenation through peripheral dilation of the arteries that supply blood
to the brain.
It has also been suggested that autoerotic asphyxia is a highly unusual variant of
sexual masochism in which participants act out ritualized bondage themes (American
Psychiatric Association, 2000; Cosgray et al., 1991). People who engage in this practice
sometimes keep diaries of elaborate bondage fantasies and, in some cases, describe fan-
tasies of being asphyxiated or harmed by others as they engage in this rare paraphilia.
One important fact about this seldom-seen paraphilia is quite clear: is is an extremely
dangerous activity that often results in death (Cooper, 1996; Garos, 1994; Hucker, 2009).
Accidental deaths sometimes occur because of equipment malfunction or mistakes, such
as errors in the placement of the noose or ligature. Data from the United States, England,
Australia, and Canada indicate that one to two deaths per 1 million people are caused
by autoerotic asphyxiation each year (American Psychiatric Association, 2000; Hucker,
2009; Hucker et al., 2011). e Federal Bureau of Investigation estimates that deaths in
the United States resulting from this activity may run as high as 1,000 per year.
Klismaphilia
Klismaphilia (kliz-muh-FILL-ee-uh) is an unusual variant of sexual expression in
which an individual obtains sexual pleasure from receiving enemas (Agnew, 2000).
Less commonly, the erotic arousal is associated with giving enemas. The case histories
of many individuals who express klismaphilia reveal that as infants or young children
they were frequently given enemas by concerned and affectionate mothers. This asso-
ciation of loving attention with anal stimulation may eroticize the experience for some
people so that as adults they may manifest a need to receive an enema as a substitute or
prerequisite for genital intercourse.
Coprophilia and Urophilia
Coprophilia (kah-pruh-FILL-ee-uh) and urophilia (yoo-roh-FILL-ee-uh) refer to
activities in which people obtain sexual arousal from contact with feces and urine,
respectively. Individuals who exhibit coprophilia achieve high levels of sexual excite-
ment from watching someone defecate or by defecating on someone. In rare instances,
they achieve arousal when someone defecates on them. Urophilia is expressed by uri-
nating on someone or being urinated on. This activity, reflected in the chapter open-
ing anecdote, has been referred to as “water sports” and golden showers. There is no
consensus about the origins of these highly unusual paraphilias.
Coercive Paraphilias
In this section, we first discuss three common forms of coercive paraphilic behaviors:
exhibitionism, obscene phone calls, and voyeurism. Three other varieties of coercive
paraphilias—frotteurism, zoophilia, and necrophilia—are also discussed.
klismaphilia
An unusual variant of sexual expres-
sion in which an individual obtains
sexual pleasure from receiving
enemas.
coprophilia
A sexual paraphilia in which a person
obtains sexual arousal from contact
with feces.
urophilia
A sexual paraphilia in which a person
obtains sexual arousal from contact
with urine.
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Atypical Sexual Behavior497 497
Exhibitionism
Exhibitionism, often called indecent exposure, refers to behavior in which an individ-
ual (almost always male) exposes his genitals to an involuntary observer (usually an
adult woman or a girl) (American Psychiatric Association, 2000; Marshall et al., 1991).
Typically, a man who has exposed himself obtains sexual gratification by masturbating
shortly thereafter, using mental images of the observer’s reaction to increase his arousal.
Some men, while having sex with a willing partner, fantasize about exposing themselves
or replay mental images from previous episodes. Still others have orgasm triggered by
the act of exposure, and some masturbate while exhibiting themselves (American Psy-
chiatric Association, 2000; de Silva, 1999). The reinforcement of associating sexual
arousal and orgasm with the actual act of exhibitionism or with mental fantasies of
exposing oneself contributes significantly to the maintenance of exhibitionistic behavior
(Blair & Lanyon, 1981). Exposure can occur in a variety of locations, most of which
allow for easy escape. Subways, relatively deserted streets, parks, and cars with a door
left open are common places for exhibitionism to occur. However, sometimes a private
dwelling is the scene of an exposure, as revealed in the following account:
One evening I was shocked to open the door of my apartment to a naked man. I
looked long enough to see that he was underdressed for the occasion and then
slammed the door in his face. He didn’t come back. I’m sure my look of total
horror was what he was after. But it is difficult to keep your composure when
you open your door to a naked man. (Authors’ files)
Certainly, many of us have exhibitionistic tendencies: We may go to nude beaches,
parade before admiring lovers, or wear provocative clothes or scanty swimwear. How-
ever, such behavior is considered appropriate by a society that in many ways exploits
and celebrates the erotically portrayed human body. at legally dened exhibitionistic
behavior involves generally unwilling observers sets it apart from these more acceptable
variations of exhibitionism.
Our knowledge of who displays this behavior is based largely on studies of arrested
oenders—a sample that may be unrepresentative. is sampling problem is common
to many forms of atypical behavior that are dened as criminal. From the available data,
however limited, it appears that most people who exhibit themselves are men in their
20s or 30s, and over half are married or have been married (Murphy, 1997). ey are
often shy, nonassertive people who feel inadequate and insecure and suer from prob-
lems with intimacy (Arndt, 1991; Marshall et al., 1991; Murphy & Page, 2008). eir
sexual relationships are likely to have been unsatisfactory. Many were reared in atmo-
spheres characterized by puritanical and shame-inducing attitudes toward sexuality.
A number of factors inuence the development of exhibitionistic behavior. Many
individuals have such powerful feelings of personal inadequacy that they are afraid to
reach out to another person out of fear of rejection (Minor & Dwyer, 1997). eir
exhibitionism is thus a limited attempt to somehow involve others, however eetingly,
in their sexual expression. Limiting contact to briey opening a raincoat before dashing
o minimizes the possibility of overt rejection. Some men who expose themselves may
be looking for armation of their masculinity. Others, feeling isolated and unappreci-
ated, may simply be seeking attention, which they desperately crave. A few feel anger
and hostility toward people, particularly women, who have failed to notice them or who
they believe have caused them emotional pain. Under these circumstances exposure can
be a form of reprisal, designed to shock or frighten the people they see as the source of
their discomfort. In addition, exhibitionism is not uncommon in emotionally disturbed,
Critical Thinking Question
People are typically much less concerned
about female exhibitionism than they are
about male exhibitionism. For example, if a
woman observed a man undressing in front
of a window, the man might be accused
of being an exhibitionist. However, if the
roles were reversed and the woman was
undressing, the man would likely be labeled
a voyeur. What do you think of this sex-based
inconsistency in labeling these behaviors?
exhibitionism
The act of exposing one’s genitals to
an unwilling observer.
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498 CHAPTER 16
intellectually disabled, or mentally disoriented individuals. In these cases the behavior
reects a limited awareness of what society denes as appropriate actions, a breakdown
in personal ethical controls, or both.
In contrast to the public image of an exhibitionist as a person who lurks about in the
shadows, ready to grab hapless victims and drag them o to ravish them, most men who
engage in exhibitionism limit this activity to exposing themselves (American Psychiatric
Association, 2000). Yet the word victim is not entirely inappropriate, in that observers of
such exhibitionistic episodes may be emotionally traumatized by the experience (Cox,
1988; Marshall et al., 1991). Some feel that they are in danger of being raped or oth-
erwise harmed. A few, particularly young children, can develop negative feelings about
genital anatomy from such an experience.
Investigators have noted that some people who expose themselves, probably a small
minority, actually physically assault their victims (Brown, 2000). Furthermore, in some
cases men who engage in exhibitionism may progress from exposing themselves to more
serious oenses, such as rape and child molestation (Abel, 1981; Bradford et al., 1992).
What is an appropriate response if someone exposes himself to you? It is important
to keep in mind that most people who express exhibitionist behavior want to elicit reac-
tions of excitement, shock, fear, or terror. Although it may be dicult not to react in any
of these ways, a better response is to calmly ignore the exhibitionist act and go about
your business. Of course, it is also important to immediately distance yourself from the
oender and to report such acts to the police or campus security as soon as possible.
Obscene Phone Calls
People who make obscene phone calls share characteristics with exhibitionists. Thus
obscene phone calling (sometimes called telephone scatologia) is viewed by some profes-
sionals as a subtype of exhibitionism. People who make obscene phone calls typically
experience sexual arousal when their victims react in a horrified or shocked manner,
and many masturbate during or immediately after a successful” phone exchange. These
callers are typically male, and they often suffer from pervasive feelings of inadequacy
and insecurity (Matek, 1988; Prince et al., 2002). Obscene phone calls are frequently
the only way they can find to have sexual exchanges. However, when relating to the
other sex, they frequently show greater anxiety and hostility than do people inclined
toward exhibitionism, as revealed in the following account:
One night I received a phone call from a man who sounded quite normal until
he started his barrage of filth. Just as I was about to slam the phone down, he
announced, “Don’t hang up. I know where you live (address followed) and that
you have two little girls. If you don’t want to find them all mangled up, you will
hear what I have to say. Furthermore, I expect you to be available for calls every
night at this time.It was a nightmare. He called night after night. Sometimes he
made me listen while he masturbated. Finally I couldn’t take it any longer, and
I contacted the police. Thank heavens, the calls eventually stopped. I was about
to go crazy. (Authors’ files)
Fortunately, a caller rarely follows up his verbal assault with a physical attack on his
victim.
What is the best way to handle obscene phone calls? Information about how to deal
with such calls is available from most local phone company oces. Because these oces
are commonly besieged by such queries, you may need to be persistent in your request.
A few tips are worth knowing; they may even make it unnecessary to seek outside help.
SEXUALHEALTH
SEXUALHEALTH
Exhibitionists often want to elicit
reactions of excitement, shock, fear,
or terror. The best response is to
calmly ignore the act and casually
go about your business.
© Jutta Klee/Corbis
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Atypical Sexual Behavior499 499
First, quite often the caller has picked your name at random from a phone book
or perhaps knows you from some other source and is just trying you out to see what
kind of reaction he can get. Your initial response may be critical in determining his
subsequent actions. He wants you to be horried, shocked, or disgusted; thus the best
response is usually not to react overtly. Slamming down the phone may reveal your
emotional state and provide reinforcement to the caller. Simply set it down gently and
go about your business. If the phone rings again immediately, ignore it. Chances are that
he will seek out other, more responsive victims.
Other tactics may also be helpful. One, used successfully by a former student, is
to feign deafness. What is that you said? You must speak up. I’m hard of hearing, you
know!” Setting down the phone with the explanation that you are going to another
extension (which you never pick up) may be another practical solution. Finally, screen-
ing calls with an answering machine or caller ID might also prove helpful. e caller is
likely to hang up in the absence of an emotionally responding person.
If you are persistently bothered by obscene phone calls, you may need to take addi-
tional steps. Your telephone company should cooperate in changing your number to an
unlisted one at no charge. It is probably not a good idea to heed the common advice to
blow a police whistle into the mouthpiece of the phone (which may be quite painful and
even harmful to the caller’s ear) because you may end up receiving the same treatment
from your caller.
Call tracing, a service oered by many telephone companies, may assist you in deal-
ing with repetitive obscene or threatening phone calls. After breaking connection with
the caller, you enter a designated code, such as star 57. e telephone company then
automatically traces the call. After a certain number of successful traces to the same
number, a warning letter is sent to the oender indicating that he or she has been identi-
ed as engaging in unlawful behavior that must stop. e oender is warned that police
intervention or civil legal action is an option if the behavior continues. Call tracing is
clearly not eective when calls are placed from a public pay phone, and calls made from
cellular phones cannot be traced.
Voyeurism
Voyeurism (voi-YUR-ih-zum) refers to deriving sexual pleasure from looking at the
naked bodies or sexual activities of others, usually strangers, without their consent
(American Psychiatric Association, 2000). Because a degree of voyeurism is socially
acceptable (witness the popularity of sex sites on the Internet), it is sometimes difficult
to determine when voyeuristic behavior becomes a problem (Arndt, 1991; Forsyth,
1996). To qualify as atypical sexual behavior, voyeurism must be preferred to sexual
relations with another person or indulged in with some risk (or both). People who
engage in this behavior are often most sexually aroused when the risk of discovery is
high—which may explain why most are not attracted to such places as nudist camps
and nude beaches, where looking is acceptable (Tollison & Adams, 1979).
Again, people inclined toward voyeurism often share characteristics with people who
expose themselves (Arndt, 1991; Langevin et al., 1979). ey may have poorly developed
sociosexual skills, with strong feelings of inferiority and inadequacy, particularly as directed
toward potential sexual partners (Kaplan & Krueger, 1997). As the common term peeping
Tom implies, voyeurism is typically, although not exclusively, expressed by males (Davison
& Neale, 1993). ey tend to be young men, usually in their early 20s (Dwyer, 1988;
Lavin, 2008). ey rarely peep at someone they know, preferring strangers instead. Most
individuals who engage in such activity are content merely to look, keeping their distance.
However, in some instances such individuals go on to more serious oenses, such as bur-
glary, arson, assault, and even rape (Abel & Osborn, 2000; Langevin, 2003).
Although your initial reaction to an
obscene phone call may be horror,
shock, or disgust, it is usually best not
to respond emotionally. A caller who
doesn’t receive the desired response
from you is less likely to call again.
© David Raymer/Corbis
voyeurism
The act of obtaining sexual gratica-
tion by observing undressed or sexu-
ally interacting people without their
consent.
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500 CHAPTER 16
is behavior more typically includes peering into bedroom windows, stationing
oneself by the entrance to womens bathrooms, and boring holes in the walls of public
dressing rooms. Some men travel elaborate routes several nights a week for the occa-
sional reward of a glimpse, through a window, of bare anatomy or, rarely, a scene of
sexual interaction. A new form of voyeurism has emerged in which small, technologi-
cally advanced video cameras are used to surreptitiously invade the personal privacy of
many unaware victims. It’s perhaps best described as video voyeurism.
Small, aordable video cameras are increasingly being used to invade and record
some of our most private moments. ese images might then be displayed on the Inter-
net or on someones DVD player. High-tech video devices—hidden in such locations as
smoke detectors, exit signs, ceiling xtures, and gym bags—make it easy for unscrupu-
lous individuals with either a penchant for peeping or an eye for a quick buck to victim-
ize people by secretly recording them.
Both local and national media report on a proliferation of various forms of video
voyeurism, which include hidden cameras or cell phones in such places as bathrooms
(“bathroomcams”), shower facilities (“showercams”), locker rooms (“lockerroomcams”),
and bedrooms (“bedroomcams”) and under working womens desks (“upskirtcams”). Cell
phones with video and still photography features have added another disconcerting dimen-
sion to the proliferation of video voyeurism. For example, a male school teacher in Florida
was recently arrested and charged with using a cell phone, placed under a bathroom stall, to
record images of minors and adults using the bathroom facilities (UPI Newstrack, 2011).
In another similar case, an employee of an Illinois hardware business was charged with
unauthorized videotaping via a video camera found in the stores bathroom (Nagle, 2011).
People who use “voyeurcamsdo so either for their own sexual gratication or for
nancial gain. Technological advances in video equipment, together with the Internet,
have allowed the emergence of a disturbing new nancial market in which unethical
entrepreneurs sell secret video invasions of privacy either for home DVD viewing or
for viewing at pay-per-view websites. e number of both unauthorized and autho-
rized occurrences of voyeuristic Internet video displays has exploded. e multiplicity
of websites that appeal to video voyeurs are set up on a pay-per-view or subscription
basis, and a person can log on to watch the activities of people, often attractive women,
who may not know that they are being watched.
Unfortunately, many embarrassed and angry victims of video voyeurism have dis-
covered that they have little legal recourse when secret videos are marketed by unscru-
pulous entrepreneurs based in foreign countries where the legal codes allow them to
function without fear of legal reprisals. Currently all states, with the exception of Iowa,
have some legal prohibitions pertaining to video voyeurism. However, vague legal word-
ing, in conjunction with the dramatic increase in legal video surveillance since 9/11, has
rendered these state laws dicult to interpret and enforce.
We hope that states will become increasingly eective in prosecuting high-tech video
voyeurism and that the general public will become more aware of this serious form of per-
sonal privacy invasion. Furthermore, as we become more knowledgeable about the potential
for this invasive process, we can be more aware and careful in situations where we might
be victimized in this fashion. For example, when changing in a gym or health club, be on
the lookout for clothes bags positioned so that they might allow secret video recording.
A Missouri youth-group leader was recently convicted of producing and possessing child
pornography obtained via secretly taping young boys in various settings (e.g., showers and
bathroom facilities) with a video camera he had hidden inside a backpack (Mann, 2011).
It is dicult to isolate specic inuences that trigger voyeuristic behavior, particularly
because so many of us demonstrate voyeuristic tendencies in a somewhat more controlled
fashion. e adolescent or young adult male who displays this behavior often feels great
curiosity about sexual activity (as many of us do) but at the same time feels inadequate or
Are strippers and dancers who perform
partially or totally nude engaging in a
genuine form of exhibitionism? Why or
why not? What about people who observe
these performances? Are they voyeurs?
What, if anything, differentiates diagnosed
exhibitionists and voyeurs from exotic
dancers and people in the audience?
Critical Thinking Question
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Atypical Sexual Behavior501 501
insecure. His voyeurism, either while physically present or by means of hidden video cam-
eras, becomes a vicarious fulllment because he may be unable to engage in sexual activity
without experiencing a great deal of anxiety. In some instances voyeuristic behavior is also
reinforced by feelings of power and superiority over those who are secretly observed.
Other Coercive Paraphilias
We conclude our discussion of coercive paraphilias with a few brief comments about
three additional varieties of these coercive or invasive forms of paraphilia. The first
two, frotteurism and zoophilia, are fairly common. The third variant form, necrophilia,
is a rare and extremely aberrant form of sexual expression.
Frotteurism
Frotteurism (frah-toor-IH-zum) is a fairly common coercive paraphilia that goes largely
unnoticed. It involves an individual, usually a male, who obtains sexual pleasure by press-
ing or rubbing against a fully clothed female in a crowded public place, such as an eleva-
tor, a bus, a subway, a large sporting event, or an outdoor concert. The most common
form of contact is between the mans clothed penis and a womans buttocks or legs. Less
commonly, he may use his hands to touch a womans thighs, pubic region, breasts, or
buttocks. This form of contact, called “toucherism, may seem to be inadvertent, and the
woman who is touched may not notice or may pay little heed to the seemingly casual
contact. On the other hand, she may feel victimized and angry (Freund et al., 1997).
A man who engages in frotteurism may achieve arousal and orgasm during the act.
More commonly, he incorporates the mental images of his actions into masturbation fanta-
sies at a later time. Men who engage in this activity have many of the characteristics mani-
fested by those who practice exhibitionism. ey are frequently plagued by feelings of social
and sexual inadequacy. eir brief, furtive contacts with strangers in crowded places allow
them to include others in their sexual expression in a safe, nonthreatening manner.
As with other paraphilias, it is dicult to estimate just how common this variety of
coercive paraphilia is. One study of reportedly typical or normal college men found that
21% of the respondents had engaged in one or more frotteuristic acts (Templeman &
Sinnett, 1991).
Zoophilia
Zoophilia (zoh-oh-FILL-ee-uh), sometimes called bestiality, involves
sexual contact between humans and animals (American Psychiatric
Association, 2000). You may wonder why we classify this as a coer-
cive paraphilia, because such behavior does not involve coercing other
people into acts that they would normally avoid. In many instances of
zoophilia, it is reasonable to presume that the animals involved are also
unwilling participants, and the acts performed are often both coercive
and invasive. Consequently, assigning this paraphilia to the coercive
category seems appropriate.
In Kinsey’s sample populations, 8% of the males and almost 4%
of the females reported having had sexual experiences with animals at
some point in their lives. e frequency of such behavior among males
was highest for those raised on farms (17% of these men reported expe-
riencing orgasm as a result of animal contact). e animals most fre-
quently involved in sex with humans are sheep, goats, donkeys, large
fowl (ducks and geese), dogs, and cats. Males are most likely to have
contact with farm animals and to engage in penile–vaginal intercourse
or to have their genitals orally stimulated by the animals (Hunt, 1974;
Critical Thinking Question
Is it ethically acceptable to visit websites
that offer video feeds from hidden cameras
or unauthorized videos of people’s private
lives? Why or why not?
Frotteurism is a fairly common paraphilia practiced in
crowded public places, such as buses, subways, and
outdoor concerts.
AP Photo/Laurent Rebours
frotteurism
A fairly common paraphilia in which
a person obtains sexual pleasure by
pressing or rubbing against another
person in a crowded public place.
zoophilia
A paraphilia in which a person has
sexual contact with animals.
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502 CHAPTER 16
Kinsey et al., 1948; Miletski, 2002). Women are more likely to have contact with house-
hold pets, involving an animal in licking their genitals or masturbating a male dog. Less
commonly, some women have trained a dog to mount them and engage in coitus (Gen-
del & Bonner, 1988; Kinsey et al., 1953).
Sexual contact with animals is commonly only a transitory experience of young
people to whom a human sexual partner is inaccessible or forbidden (Money, 1981).
Most adolescent males and females who experiment with zoophilia make a transition
to adult sexual relations with human partners. True, or nontransitory, zoophilia exists
only when sexual contact with animals is preferred, regardless of what other forms of
sexual expression are available. Such behavior, which is rare, may be expressed only by
people with deep-rooted psychological problems or distorted images of the other sex.
For example, a man who has a pathological hatred of women may be attempting to
express his contempt for them by choosing animals in preference to women as sexual
partners. However, some men who engage in zoophilia do not appear to t this prole.
An anonymous Internet questionnaire study of 114 self-dened zoophile” men found
that while the majority of respondents indicated preferring animal sex to human sex, a
desire for aection and pleasurable sex, and not hatred of women, were presented as the
major reasons for sexual interest in animals (Williams & Weinberg, 2003).
Necrophilia
Necrophilia (ne-kruh-FILL-ee-uh) is an extremely rare sexual variation in which a
person obtains sexual gratification by viewing or having intercourse with a corpse. This
paraphilia appears to occur exclusively among males, who may be driven to remove
freshly buried bodies from cemeteries or to seek employment in morgues or funeral
homes (Tollison & Adams, 1979). However, the vast majority of people who work in
these settings do not have tendencies toward necrophilia.
ere are a few cases on record of men with necrophilic preferences who kill some-
one to gain access to a corpse (Milner & Dopke, 1997). e notorious Jerey Dahmer,
the Milwaukee man who murdered and mutilated his young male victims, is believed
by some experts in criminal pathology to have been motivated by uncontrollable nec-
rophilic urges. More commonly, the diculties associated with gaining access to dead
bodies lead some men with necrophilic preferences to limit their deviant behavior to
contact with simulated corpses. Some prostitutes cater to this desire by powdering
themselves to mimic the pallor of death, dressing in a shroud, and lying very still during
intercourse. Any movement on their part may inhibit their customers sexual arousal.
Men who engage in necrophilia almost always manifest severe emotional disorders
(Goldman, 1992). ey may see themselves as sexually and socially inept and may
both hate and fear women. Consequently, the only “safe” woman may be one whose
lifelessness epitomizes a nonthreatening, totally subjugated sexual partner (Rosman &
Resnick, 1989; Stoller, 1977).
Sexual Addiction: Fact, Fiction,
or Misnomer?
Both the professional literature and the popular media have directed considerable
attention to a condition commonly referred to as sexual addiction. The idea that people
can become dominated by insatiable sexual needs has been around for a long time,
as exemplified by the terms nymphomania, applied to women, and satyriasis or Don
Juanism, applied to men. Many professionals have traditionally reacted negatively to
these labels, suggesting that they are disparaging terms likely to induce unnecessary
necrophilia
A rare sexual paraphilia in which a
person obtains sexual gratication by
viewing or having intercourse with a
corpse.
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Atypical Sexual Behavior503 503
guilt in individuals who enjoy an active sex life. Furthermore, it has been argued that
one cannot assign a label implying excessive sexual activity when no clear criteria estab-
lish what constitutes normal levels of sexual involvement. The criteria often used to
establish alleged subconditions of hypersexuality—nymphomania and satyriasis—are
subjective and value laden. Therefore these terms are typically defined moralistically
rather than scientifically, a fact that has generated harsh criticism from a number of
professionals (Klein, 1991, 2003; Levine & Troiden, 1988). Psychotherapist Marty
Klein (2003, 2012b) is especially critical of the sex addiction movement, which in his
view both exploits peoples fear of their own sexuality and pathologizes sexual behav-
ior and impulses that are not unhealthy. Nevertheless, the concept of sexual addiction
achieved a heightened legitimacy with the publication of Patrick Carnes’s book The
Sexual Addiction (1983), later retitled Out of the Shadows: Understanding Sexual Addic-
tion (2001, 3rd ed.).
According to Carnes, many people who engage in some of the atypical or para-
philic behaviors described in this chapter (as well as extreme coercive behaviors, such as
child molestation) are manifesting the outward symptoms of a psychological addiction
in which feelings of depression, anxiety, loneliness, and worthlessness are temporarily
relieved through a sexual high not unlike the high achieved by mood-altering chemicals
such as alcohol and cocaine.
e concept of sexual addiction has generated considerable attention in the pro-
fessional community. While Carnes and his supporters argue for acceptance of sexual
addiction as a legitimate diagnostic category, detractors point to a continuing tradition
in the sex addiction literature of forgoing empirical research and presenting conjectures
as fact” (Chivers, 2005, p. 476). Many sexologists do not believe that sexual addiction
should be a distinct diagnostic category, because it is rare and lacking in distinction
from other compulsive disorders, such as gambling and eating disorders, and because
this label negates individual responsibility for uncontrollable” sexual compulsions that
victimize others (Levine & Troiden, 1988; Satel, 1993).
Despite the skepticism of many sexologists about including sexual addiction as a
diagnostic category, Americans are being diagnosed as sex addicts in record numbers
(C. Lee, 2011, p. 50). Recent media attention to two cases of alleged sexual addiction,
one involving Tiger Woods and the other Dominique Strauss-Kahn, has focused the
nations attention on this type of behavior.
A number of professionals recognize that some people become involved in patterns
of excessive sexual activity. Noteworthy in this group is sexologist Eli Coleman (1990,
1991, 2003), who prefers to describe these behaviors as symptomatic of sexual com-
pulsion rather than addiction. According to Coleman, a person manifesting excessive
sexual behaviors often suers from feelings of shame, unworthiness, inadequacy, and
loneliness. ese negative feelings cause great psychological pain, and this pain then
causes the person to search for a x, or an agent that has pain-numbing qualities, such
as alcohol, certain foods, gambling, or, in this instance, sex. Indulging oneself in this x
produces only a brief respite from the psychological pain, which returns in full force,
thus triggering a greater need to engage in such behaviors to obtain further temporary
relief. Unfortunately, these repetitive compulsive acts soon tend to be self-defeating;
that is, they compound feelings of shame and lead to intimacy dysfunction by interrupt-
ing the development of normal, healthy interpersonal functioning.
Other sexologists, notably John Bancroft and Zoran Vukadinovic (2004), believe
that because of a lack of empirical research, the currently fashionable concepts of sexual
addiction and compulsive sexual behavior are of uncertain scientic value. ese authors
suggest that until we have more data to evaluate the scientic validity of these concepts,
it is preferable to use the more general descriptive term out of control to describe such
problematic sexual behavior.
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504 CHAPTER 16
We can expect that professionals in the eld of sexuality will continue to debate for
some time how to diagnose, describe, and explain problems of excessive or uncontrolled
sexuality. Even as this discussion continues, professional treatment programs for com-
pulsive or addictive sexual behaviors have emerged throughout the United States (more
than 2,000 programs at last count), most modeled after the 12-step program of Alco-
holics Anonymous (Kafka, 2009; National Council on Sexual Addiction and Compul-
sivity, 2002). Data pertaining to treatment outcomes for these programs are still too
limited to allow evaluation of therapeutic eectiveness. Besides formal treatment pro-
grams, a number of community-based self-help organizations have surfaced throughout
the United States. ese groups include Sex Addicts Anonymous, Sexaholics Anony-
mous, Sexual Compulsives Anonymous, and Sex and Love Addicts Anonymous.
Because sex has become a highly sought-out topic among users of the Internet, some
professionals have suggested that a new variety of sexual addiction or sexual compulsiv-
ity has emerged. e issue being debated is whether cybersex addiction and compulsiv-
ity is a harmless sexual outlet or problematic sexual behavior. We examine this issue in
the nal paragraphs of this chapter.
A prominent physician in our home state recently lost his position and sta privi-
leges at a local hospital when it was discovered that he was using a hospital computer to
visit sexually explicit Internet sites that specialize in child pornography. An investigation
revealed that this individual spent an inordinate amount of time, both on the job and
at home, compulsively surng sexually oriented websites, especially those with explicit
sexual content dealing with children. is case illustrates a variety of behavior, spawned
by the Internet, that has raised the concern of a number of mental health specialists.
Sexually oriented Internet sites are among the most widely visited topical areas of
the World Wide Web. Does the widespread incidence of surng for sex” indicate prob-
lematic behavior and warrant societal concern? Some suggest the opposite—that pur-
suing cybersex is a harmless recreational pursuit oering anonymous access to sexually
oriented material that provides sexual outlets (such as chat room sex or masturbating
to sexual images) that are safe from the dangers of STIs and other relationship risks
(Waskul, 2004). In addition, the Internet can be useful to people who wish to explore
sexual fantasies online in the safety and privacy of their homes (Quittner, 2003).
A less benign view of Internet sex emerges from a growing awareness that for a
small but ever-increasing number of individuals who surf the Internet primarily for
erotic stimulation and sexual outlets, the aordability, accessibility, and anonymity of
the Internet are creating a new breed of sexual compulsives addicted to cybersex (M.
Ross et al., 2011). Many of these individuals are using cybersex to the exclusion of
personal relationships (Ayres & Haddock, 2009; Cooper, 2002, 2003; Dew & Chaney,
2004; Philaretou, 2005).
It is dicult to accurately estimate how many Internet users in the United States
experience problems associated with visiting Web sex sites. A large majority of people
who access the Internet for sexual purposes do not appear to experience adverse con-
sequences (Waskul, 2004). However, some research indicates that 6–10% of Internet
users do report being concerned about the possible negative consequences of their
online sexual activities (Dew & Chaney, 2004). Furthermore, studies indicate that 1%
of sex site surfers are so hooked on or addicted to cybersex that their capacity to func-
tion eectively in their everyday lives is severely damaged (Carnes, 2001; Cooper et
al., 2000). Such individuals are likely to spend endless hours each day surng sex sites,
masturbating to sexually explicit images, or engaging in mutual online sex with someone
contacted through a chat room.
e sexual excitement, stimulation, and orgasmic outlets provided by a virtually
innite variety of Internet sexual opportunities may lead to a compulsive pursuit of
Which of the atypical sexual behaviors
discussed in this chapter do you nd the
most unacceptable? Why?
Critical Thinking Question
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Atypical Sexual Behavior505 505
cyberspace sex that can have a devastating eect on a cybersex addict’s life and family
(Cooper, 2002; Woodward, 2003). Partners of these individuals report feeling ignored,
abandoned, devalued, or betrayed as a result of their mates compulsive pursuit of
cybersex (Brody, 2000; Cooper, 2002). Some people devote so much time to forays into
cybersex that they end up neglecting family members or job responsibilities, or both
(Philaretou, 2005).
An additional hazard faced by some cybersex addicts and compulsives who pursue
online sexual relationships is that they may progress to arranging o-line meetings that
can have seriously adverse consequences, including exposure to STIs and sexual assault
(Cooper, 2002; Genuis & Genuis, 2005).
Mental health professionals have expressed concern about teenage addiction to
cybersex (Abelman, 2007; Fleming & Rickwood, 2004; Jancin, 2005). Some clinicians
believe that teenagers, especially males, are becoming addicted to sex on the Internet.
According to psychotherapist Ann Freeman, it is common to encounter youths who are
addicted to masturbating to Web sex sites three or four times daily (in Jancin, 2005).
Such excessive Internet-based sexual behavior may lead to social isolation, unhealthy
sexual attitudes, loneliness, depression, and possible “stranger-danger” in the form of
being tracked and lured by cybersex pedophile predators (Fleming & Rickwood, 2004;
Jancin, 2005; Subrahmanyam & Greeneld, 2008). (See Chapter 17 for a discussion of
pedophiles in cyberspace.)
We hope that future studies of cybersex will provide a clearer answer to the ques-
tion,Is compulsive exploration of online sex a relatively harmless sexual outlet or a
potentially harmful variety of problematic sexual behavior?” For the present, a number
of professionals have raised our awareness of the potentially adverse consequences of
getting hooked on cybersex.
Summary
What Constitutes Atypical Sexual
Behavior?
Atypical, paraphilic sexual behavior involves a variety of
sexual activities that, in their fully developed form, are sta-
tistically uncommon in the general population.
Such behaviors exist in many gradations, ranging from mild,
infrequently expressed tendencies to full-blown, regularly
manifested behaviors.
Paraphilias are usually expressed by males, are sometimes
harmful to others, may be preludes to more serious sexual
oenses, and tend to occur in clusters.
Noncoercive Paraphilias
Noncoercive paraphilias are often solo activities or behav-
iors that involve the participation of adults who agree to
engage in, observe, or just put up with the particular variant
behavior.
Fetishism, transvestic fetishism, sexual sadism, sexual mas-
ochism, autoerotic asphyxia, klismaphilia, coprophilia, and
urophilia are all varieties of noncoercive paraphilias.
Fetishism is a form of atypical sexual behavior in which
an individual obtains arousal by focusing on an inanimate
object or a part of the human body.
Fetishism is often a product of conditioning, in which
the fetish object becomes associated with sexual arousal
through the reinforcement of masturbation-produced
orgasm.
Transvestic fetishism involves obtaining sexual excitement
by cross-dressing. It is usually a solitary activity, expressed
by a heterosexual male in the privacy of his own home.
Sadomasochism can be dened as obtaining sexual arousal
through receiving or giving physical or mental pain, or both.
Most participants in sadomasochism view it as a form of
sexual enhancement that they voluntarily and mutually
choose to explore.
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506 CHAPTER 16
People who engage in sadomasochistic behavior may be
seeking additional nonsexual stimuli to achieve sucient
arousal. ey may also be acting out of deeply rooted beliefs
that sexual activity is sinful and immoral.
For some participants, sadomasochism acts as an escape
valve that allows them temporarily to step out of the rigid,
restrictive roles they play in their everyday lives.
Individuals who engage in sadomasochism sometimes
describe early experiences that may have established a con-
nection between sex and pain.
Autoerotic asphyxia is a rare and life-threatening para-
philia in which an individual, almost always a male, seeks to
enhance sexual excitement and orgasm by pressure-induced
oxygen deprivation.
Klismaphilia is a paraphilia that involves achieving sexual
pleasure from receiving enemas.
Coprophilia and urophilia are paraphilias in which a person
obtains sexual arousal from contact with feces or urine,
respectively.
Coercive Paraphilias
Coercive paraphilias are invasive, in that they involve unwill-
ing recipients of behavior such as voyeurism or exhibition-
ism. Coercive acts may harm their targets, who may be
psychologically traumatized by the experience.
Exhibitionism, obscene phone calls, voyeurism, frotteur-
ism, zoophilia, and necrophilia are all varieties of coercive
paraphilias.
Exhibitionism is behavior in which an individual, almost
always a male, exposes his genitals to an involuntary
observer.
People who exhibit themselves are usually young adult
males who have strong feelings of inadequacy and insecurity.
Sexual relationships, either past or present, are likely to be
unsatisfactory.
Gratication is usually obtained when the reaction to
exhibitionism is shock, disgust, or fear. Physical assault is
generally not associated with exhibitionism.
e characteristics of individuals who make obscene phone
calls are similar to those of exhibitionists.
Although there may be an element of hostility in obscene
phone calls, the caller rarely follows up his verbal assault
with a physical attack on his victim.
Voyeurism is obtaining sexual pleasure from looking at
the exposed bodies or sexual activities of others, usually
strangers.
People inclined toward voyeurism, typically males, are often
sociosexually underdeveloped, with strong feelings of inferi-
ority and inadequacy.
Video voyeurism is a form of voyeurism in which video cam-
eras are used to surreptitiously invade the personal privacy
of unaware victims.
Frotteurism involves a person obtaining sexual pleasure by
pressing or rubbing against another person in a crowded
public place.
Zoophilia involves sexual contact between humans and
animals; it occurs most commonly as a transitory experience
of young people to whom a sexual partner is inaccessible or
forbidden.
Necrophilia involves obtaining sexual gratication by view-
ing or having intercourse with a corpse.
Sexual Addiction: Fact, Fiction,
or Misnomer?
e concept of sexual addiction suggests that some people
who engage in excessive sexual activity are manifesting
symptoms of a psychological addiction, in which feelings of
depression, anxiety, loneliness, and worthlessness are tempo-
rarily relieved through a sexual high.
Many sexologists do not believe that sexual addiction
should be a distinct diagnostic category, because it is rare
and lacking in distinction from other compulsive disorders,
such as gambling and eating disorders, and because this label
negates individual responsibility for “uncontrollable sexual
compulsions that victimize others.
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