Perverse curse or worse? Survival of the fetish

Any regular readers of this blog will no doubt be aware that fetishes refer to the obtaining sexual excitement primarily or exclusively from a non-living (inanimate) object or a particular part of the body that is not conventionally viewed as being particularly sexual in nature (e.g., a sexual attraction by males to feet is more likely to be viewed as a sexual fetish than a sexual attraction towards breasts). Attraction to a very particular body part is typically classed as ‘partialism’. The word ‘fetish’ was first coined by the French psychologist Alfred Binet (1857-1911), who is arguably best known for inventing the earliest IQ tests. Fetishes rarely develop into an offence that harms anyone although offences may include things like theft (of underwear) or cutting hair from an unwilling victim.

Sexual fetishes may also involve some kind of enhancement of a sexual act such as a person being asked to wear a particular piece of clothing by the fetishist during sex (e.g., leather outfit or fishnet stockings). Fetishists (usually male) are often unable to orgasm without the fetish present, and can be established as young as 4 years old. Fetishes in and of themselves are not considered to be disorders of sexual preference unless the fetishistic behaviour causes significant negative detriment and/or psychosocial distress for the individual. If the fetish does cause significant distress it would be diagnosed as a paraphilia in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Furthermore, it is sometimes difficult to draw the line between normal and paraphilic behaviours. Dr Martin Kafka (McLean Hospital, Belmont, USA) pointed out in a recent review about the DSM criteria that fetishes can be “non-clinical manifestations of a normal spectrum of eroticization or clinical disorders causing significant interpersonal difficulties”. The etiology of fetishes is also complicated by the fact that empirical research such as that by Dr Chris Gosselin and Dr Glenn Wilson (Institute if Psychiatry, London, UK) that some fetishists report their behaviour is relaxing rather than arousing (such as some from of fetishistic transvestism).

Psychological research has shown that many fetishes appear to be the result of early imprinting and conditioning experiences in childhood or adolescence (for instance, where sexual excitement and/or orgasm is paired with non-sexual objects or body parts) or as a consequence of strong traumatic, emotional and/or physical experience. Fetishes may in part be influenced by rejection of the opposite sex and/or by youthful arousal being channelled elsewhere (deliberately or accidentally). Some children have been said to associate sexual arousal with objects that belong to an emotionally significant person like a mother or older sister and is known as symbolic transformation. However, there is also evidence that some fetishes have more biological origins such as those people whose fetish results from conditions such as temporal lobe epilepsy.

Empirical research by Gosselin and Wilson has also indicated that the most prevalent body fetishes are for feet, hands, and hair, and that the most prevalent fetish objects are shoes, gloves, and (soiled) underwear. However, there may be differences in relation to sexual orientation. Most fetishism research concerns heterosexual men who have fetishistic desires for feminine items such as high-heeled shoes, lingerie, and hosiery. Among homosexual men, the fetishistic objects tend to be highly masculine.

As with many other sexual disorders, there is very little reliable epidemiological data for fetishism. In a study from the 1950s, only 0.1% of 4,000 patients in private practice were recorded as having fetishism as a primary problem (Curren, 1954). Another study carried out among 561 non-incarcerated sex offenders (and all paraphiliacs) by Dr Gene Abel and colleagues (1998) reported that only 3.4% were diagnosed with fetishism. Another study (1992) led by Dr Gene Abel investigated the comorbidity rates of various paraphilic behaviors in a group of 859 male paraphiliacs. Of the 859 subjects, only 12 were diagnosed with fetishism as either a primary or a secondary diagnosis. In a recent review of fetishism by Dr. Shauna Darcangelo (Forensic Psychiatric Services Commission, Victoria Regional Program, Victoria, British Columbia, Canada), noted that fetishism, transvestic fetishism, and homosexuality have often been linked. Darcangelo’s review also noted that fetishism has also been linked with other psychiatric behaviours including kleptomania, borderline personality disorder, obsessive-compulsive personality, and attention-deficit /hyperactivity disorders.

My favourite study in this area was one that was led by Dr G. Scorolli (University of Bologna, Italy) in 2007 on the relative prevalence of different fetishes (probably because it used an online methodology to collect the large amounts of data). Most studies on fetishistic behaviour are either case studies or small-scale surveys where sample sizes are rarely above 100 participants. Additionally, data from the studies examining rare fetishes are typically from psychiatric patients, sex offenders, and/or those who have sought (or have been referred to) a therapist.

Scorolli and colleagues examined the content found in fetish discussion groups. Via a search of Yahoo! groups online, the research team located 2,938 groups whose name or description text contained the word ‘fetish’. They then applied a number of inclusion and exclusion criteria.

• First, the identified groups that dealt with sexual topics and discarded groups that used ‘fetish’ in a non-sexual context (e.g., fetish for a rock band).
• Secondly, they excluded groups that used ‘fetish’ to deny that the group was about sex (e.g., a support group for pregnant women stated explicitly that the group did not discuss ‘pregnancy fetish’).
• Thirdly, some groups were excluded because the sexual nature of the topic could not be established with confidence (e.g., there was no description text of what the fetish was).
• Fourthly, groups were excluded if the group discussed ‘sex’ or ‘fetishism’ generically and therefore couldn’t be categorized.
• Fifthly, groups that had no identified members were excluded

Following the application of the inclusion and exclusion criteria, 381 fetish discussion groups were left for analysis. The average number of posts per month within the groups was over 4,000 that included over 150,000 members. The authors argued that figure was inflated, because many fetishists would be subscribed to more than one group. It was estimated (very conservatively in the authors’ opinion), that their sample size comprised at least 5000 fetishists (but was likely to be a lot more). The authors devised a classification scheme whereby fetish preference was assigned to one or more categories. Three main categories were: body, objects and behaviours, and then further sub-divided to describe a:

• Part or feature of the body (e.g., feet, fat people) and body modifications (e.g., tattoos).
• Object associated with some part of the body (e.g., shoes).
• Object not associated with some part of the body (e.g., candles).
• Person’s own behaviour (e.g., biting fingernails).
• Behaviour of other persons (e.g., smoking).
• Behaviour requiring interaction with others (e.g., humiliation role-play).

Approximately 70% were assigned to just one of these categories. The relative frequency of each fetish was estimated by taking into account (a) the number of groups devoted to the particular fetish, (b) the number of individuals participating in the fetish groups and (c) the number of messages exchanged within the group forum. Their results showed that body part fetishes were most common (33%), followed by objects associated with the body (30%), preferences for other people’s behavior (18%), own behavior (7%), social behavior (7%), and objects unrelated to the body (5%). Feet (and objects associated with feet) were by far the most common fetishes.

From this brief overview it’s evident that research is biased towards small-scale studies with biased samples. Therefore, as Dr Shauna Darcangelo concludes in her recent literature review, in order to increase the understanding surrounding fetishistic behaviour, future empirical research needs to focus on large, population-based, representative samples.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Abel, G.G., Becker, J.V., Mittelman, M., Cunningham-Rathner, J., Rouleau, J.L. & Murphy, W.D. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153-168.

Abel, G. G., & Osborn, C. A. (1992). The paraphilias: The extent and nature of sexually deviant and criminal behavior. Psychiatric Clinics of North America, 15, 675-687.

Chalkley, A.J. & Powell, G.E. (1983). The clinical description of forty-eight cases of sexual fetishism. British Journal of Psychiatry, 142, 292–295.

Curren, D. (1954). Sexual perversion. Practitioner, 172, 440-445.

Darcangelo, S. (2008). Fetishism: Psychopathology and Theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (Second Edition) (pp.108-118). New York: Guildford Press.

Gosselin, C. & Wilson, G. (1980). Sexual variations. London: Faber & Faber.

Kafka, M. (2010). The DSM diagnostic criteria for fetishism. Archives of Sexual Behavior, 39, 357–362

Milner, J. S., & Dopke, C. A. (1997). Paraphilia not otherwise specified: Psychopathology and theory. In D. R. Laws & W. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (pp. 393-423). New York: Guilford Press.

Scorolli, C., Ghirlanda, S., Enquist, M., Zattoni, S. & Jannini, E.A. (2007). Relative prevalence of different fetishes. International Journal of Impotence Research, 19, 432-437.

Wiederman, M.W. (2003). Paraphilia and fetishism. The Family Journal, 11, 315-321.

Wilson, G. & Gosselin, C. (1980). Personality characteristics of fetishists, transvestites and sadomasochists. Personality and Individual Differences, 1, 289–295.

Eaten to death: A beginner’s guide to vorarephilia

Vorarephilia – usually shortened to vore – is a sexual paraphilia in which people are sexually aroused by the idea of being eaten, eating another person, or observing this process for sexual gratification. Since the behaviour is unlikely to actually be carried out by the vorarephiliac, the behaviour is more likely to be fantasy-based via different media (e.g., fictional stories, fantasy art, fantasy videos, and bespoke video games). The behaviour doesn’t necessarily involve digestion and/or pain. Probably because it is both rare and fantasy-based, it doesn’t appear in any psychiatric manuals such as the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Vorarephilia can sometimes co-exist with other fetishistic behaviour such as masochism (sexual arousal from receiving pain), hypoxyphilia (sexual arousal from suffocation and oxygen restriction), and ‘snuff’ fetishes (sexual arousal from seeing someone die). In some cases vorarephilia has been argued to be a variant of macrophilia (i.e., sexual fascination and/or fantasy relating to giants). Most of the fantasies of vorarephiliacs involve the person being the ones being eaten (i.e., the ‘prey’, although a few like to be the ‘pred’ taken from the word ‘predator’). Some vorarephiliacs are known to derive pleasure – sometimes sexual – from watching some animals (e.g., snakes) eating other animals whole.

There have been many different types of vorarephilia documented including ‘hard vore’ and ‘soft vore’. Being primarily fantasy-based, almost any orifice or body part can be capable of vore (e.g., ‘vaginal vore’, ‘anal vore’ and ‘cock vore’). Very briefly:

• Hard vore (sometimes simply called ‘gore’) is where the person is often subjected to horrific injuries and involves lots of blood because of the ripping, cutting, biting, tearing and/or chewing of flesh. It is not typically thought of as either sensually or sexually motivated.
• Soft vore is where the person (that may not necessarily be a willing victim) is consumed alive and whole and is typically unharmed before reaching the stomach but then may be asphyxiated and/or digested. Compared to ‘hard vore’, soft vore is usually seen as more sensual and sexually oriented because of its relatively non-violent nature.
• Female genital vore (vaginal vore) is where the person is consumed by the vagina and taken into the womb (and often referred to as ‘unbirthing’ or a ‘reverse birth’).
• Male genital vore (cock vore) is where the person is consumed by the urethral opening of the penis and taken into the scrotum, prostate, or bladder.
• Anal vore is where the person is consumed by the anus and taken into the rectum, colon, or stomach.
• Breast vore is where the person is consumed by the nipples and taken into the breast.

Here’s a confessional piece I found on a psychology forum discussion group:

“I’m almost 17 now. But since I was really young, I’ve been a phagophile (with a specific interest in being swallowed whole). I’ve had a few girlfriends now, but my present one is by far the most engaging and interesting person I have ever met. She’s the only one I’ve engaged in any real sexual contact with. After meeting her, my interests expanded somewhat; she’s the only person I’ve ever been interested in eating. Fortunately this was impossible, for obvious reasons: I was still thinking in terms of “soft vore”, in which no damage is done to either party. This is where things get difficult. We’ve been together a while now and within the past few weeks, I’ve begun to shift towards “hard vore”. This includes cannibalism: I’ve been attracted especially to biting at her neck, hands, and nose. I feel that I’ve done a good job at communicating this to her, so I haven’t crossed any lines because I’ve controlled myself.”

The motivational driving force underlying vorarephilia is some ways appears to resemble that of sadomasochism from a dominance and submission perspective. Devouring someone could be viewed as the ultimate act of dominance by a predator, and the ultimate act of submission by the prey. Paradoxically, most vorarephiliacs have no real interest in cannibalism, although a few do. Possible vorarephiliacs include the Japanese man (Issei Sagawa) who in 1981 killed and then ate a Dutch woman (Renée Hartevelt), and the serial killer Jeffrey Dahmer who killed 17 men and boys and engaged in both cannibalistic and necrophilic acts with his many victims between 1978 and 1991.

However, the most infamous vorarephiliac is arguably the German Armin Meiwes. His case was referred to at length in a 2008 essay in the Archives of Sexual Behavior, by Dr Friedemann Pfafflin (a forensic psychotherapist at Ulm University, Germany). Meiwes, a computer technician, gained worldwide media attention as the ‘Rotenburg Cannibal’ for killing and eating a fellow German male victim (also a computer technician). Meiwes had allegedly been fantasizing about cannibalism since his childhood and frequented cannibal fetish websites and posted around 60 advertisements asking if anyone would like to be eaten by him. Meiwes claimed around 200 men responded to his request but only one finally met face-to-face.

In March 2002, Bernd Jürgen Brandes responded to Meiwes’ advertisement on the Internet. At their one and only meeting at Meiwes’ house, their first cannabilistic act was for Meiwes to bite off Brandes’ penis and then jointly cook and eat it. Brandes then drank lots of alcohol, cough syrup, and took sleeping pills, and was stabbed to death by Meiwes in his bath (and videotaped). The body was then stored and over time, Meiwes ate large amounts of it (about 20 kg). The one aspect that shocked most people was not the fact that Meiwes ate a lot of Brande’s body but that Brandes appeared to consent to being eaten. Email exchanges between Meiwes and Brandes were later shared in the court case:

Brandes: “Thanks for your mail. You really turn me on…Winter with the temperature at around 5 to 15 degrees below freezing is good weather for slaughter. Great to be naked and tied in weather like that and to be driven to the slaughter. Where you then stun me and I collapse. You then hang me up, jerking, and cut my carotid artery. Warm blood flows. Everything goes routinely. I don’t have any chance to escape my slaughter at the last moment. It’s a real turn-on, the feeling of being at your mercy being in your possession. Having to give up my flesh”

Meiwes: “It’ll be awesome, anyway. Your tasty body on show like that. Spicing it…Tying you up will be no problem, I’ve got rope and some cuffs for your hands and feet. I’ll really enjoy the bit with the needles. I’ll see if I can get hold of some really long ones. I can’t wait for you to be here”

It wasn’t until about 18 months after Brande had been killed that the German police started to investigate Meiwes. An Austrian student had seen Meiwes boasting that he had successfully killed and eaten another man. The police then arrested Meiwes and found human body parts in the freezer and the videotape of the killing. In court, Brandes’ consent to being killed was accepted by the jury and Meiwes was given an eight and a half year prison sentence for manslaughter. Neither Meiwes or Brandes were deemed mentally ill by the court appointed psychiatrists. Dr Klaus Beier (Institute of Sexology and Sexual Medicine, Free and Humboldt-University of Berlin, Germany) was the expert witness who twice provided forensic expertise on Miewes. He said that:

“Armin suffered neither from a psychosis nor any other mental illness or any personality disorder. Quite the contrary, he had a normal IQ and his social competence was high. To everybody who had private or professional contact with him, Armin seemed to be an open-minded and friendly contemporary man who, in the forming of contacts, appeared pleasant-natured, flexible, and socially competent, even agile. Even extremely experienced police officers, who could not believe what he had done, had to put on record that, if they had not known about the offence, Armin M. never offered anything conspicuous during the entire period of investigation.”

A later paper by Dr Beier in response to Dr Pfafflin noted that:

“Before the age of 11 years [Armin] was preoccupied by the idea of incorporating another male by eating his flesh. This paraphilia caused him to seek unsolicited partners who pretended to mirror his desire insofar that they should have the wish of being incorporated. It took him years to find such a counterpart using the frighteningly developed subculture on the internet for that purpose, where people with this special inclination can encourage each other.”

Dr Pfafflin outlined some other cases of German cannibalism including cases he was personally involved in. he said that:

“From my intensive knowledge of both these case histories just referred to, I have no doubt that every form of cannibalism, excepting at most those which happen in times of extreme hunger and whose only purpose is to secure survival, has a pathological, perverse background.”

Little is known about how prevalent this type of behaviour is although Meiwes claimed that based on his internet activity on cannibal fetish websites that there were at least 800 Germans that shared his passion for wanting to eat another person. The number of people that have a desire to be eaten and actually go through with it is likely to be incredibly small – but the internet helped Meiwes locate a willing victim.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Adams, C. (2004). Eat or be eaten: Is cannibalism a pathology as listed in the DSM-IV? The Straight Dope, July 2. Located at: http://www.straightdope.com/columns/read/2515/eat-or-be-eaten

Beier, K. (2008). Comment on Pfafflin’s (2008) “Good enough to eat”. Archives of Sexual Behavior, 38, 164-165

Brundage, S. (2002).  Fetish confessions. The Wave Magazine 2(15). Located at: http://web.archive.org/web/20070927061721/http://www.thewavemag.com/pagegen.php?articleid=22026&pagename=article

Pfafflin, F. (2008). Good enough to eat. Archives of Sexual Behavior, 37, 286-293.

Pfafflin, F. (2009). Reply to Beier (2009). Archives of Sexual Behavior, 38, 166-167.

Faecal attraction: A beginner’s guide to coprophilia

Coprophilia (also known as coprolagnia) is a paraphilia where people get sexual pleasure from faeces. Sexual excitement typically comes from either (i) watching somebody defecate on somebody else or (ii) they themselves defecating on somebody else. In rare instances, some people may become sexually aroused when they are defecated upon by somebody else. As Dr Judith Milner and colleagues wrote in the 2008 book ’Sexual Deviance: Theory, Assessment and Treatment’:

“Although some authors have defined the focus of coprophilia as the act of elimination (McCary, 1967), others have defined it as the act of consumption of excrement (Allen, 1969). To complicate the definition further, it appears that some individuals may have an interest in eliminating on one’s partner or in playing with the fecal matter. According to Smith (1976), a common analytic interpretation is that the excrement symbolically represents the penis and that the presence of the fecal matter serves as a defense against castration anxiety”

In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), it is classified under ‘Paraphilia Not Otherwise Specified’ (PNOS) along with other paraphilias such as necrophilia, zoophilia, klismaphilia, and telephone scatophilia. As with all paraphilias in the PNOS category, diagnosis is only made “if the behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning…Fantasies, behaviors, or objects are paraphilic only when they lead to clinically significant distress or impairment (e.g., are obligatory, result in sexual dysfunction, require participation of non-consenting individuals, lead to legal complications, interfere with social relationships)”. The psychologist Dr Tamara Penix (Eastern Michigan University, USA) says there are no data indicating successful treatment of coprophilia.

Surprisingly little scientific research has been carried out on coprophilia, probably because it is so rare. There are certainly pornographic films that include sexual defecation acts (notably some Japanese pornography). Some of these films include coprophiliacs engage in coprophagia (i.e., the eating of faeces and typically referred to more commonly as ‘scat’) which can provides a significant health risk in the form of hepatitis (perhaps another reason as to why the act is so rare). The psychiatrist, Dr Charles Lake (University of Kansa Medical Center, USA) notes that both coprophilia and coprophagia are traditionally considered characteristics of schizophrenia. However, there are case reports in the literature of non-psychotic coprophiliacs with normal intelligence such as one published in the Journal of Sex and Marital Therapy in 1995.

The most infamous copraphiliac was allegedly Adolf Hitler. This was alluded to in a recent 2011 biography of Hitler’s lover Eva Braun by Heike B. Gortemaker. However, other books on Hitler have been more explicit. For instance, Greg Hallet in his chapter ‘Hitler’s Sexuality’ (from his 2008 book ‘Hitler was a British Agent’) wrote:

“Hitler’s close boyhood friend from Linz, August Kubizek, wrote Adolf Hitler, Mein Jugendfreund (My Youth Friend), ‘Adolf did not engage in love affairs or flirtations. He always rejected the coquettish advances of girls or women. Women and girls took an interest in him but he always evaded their endeavours’…During deconstruction, it is customary that the person is sexually abused in the manner which is most embarrassing to that person. In Hitler’s case, he was sodomised, creating a submissive distant respect for homosexuals like his bodyguards and some of his highest-placed leaders. His natural bent was developed into coprophilia (being shat on)…With each deconstruction an embarrassing addiction is developed and filmed. With Hitler it was sadomasochism, coprophilia and homosexuality. That is, he liked to be verbally abused and slapped around, to have his head urinated on, his chest shat on, and to have sex with men”

The few studies that have been carried out have tended to be done on sadomasochist individuals (although even for sadomasochists this appears to be a rare activity for them to engage in). A study led by psychologist Dr Kenneth Sandnabba (Åbo Akademi University, Turku, Finland) and published in the Journal of Sex Research surveyed 164 Finnish male sadomasochists and reported that that 18% of them had engaged in at least one coprophilic act (6% as a masochist, 3% as a sadist, and 9% as both). There was no difference in sexual orientation with 18% of heterosexual sadomasochists and 17% of homosexual sadomasochists having engaged in at least one coprophilic act. The results also showed that the sadomasochists were socially well-adjusted and that their SM behavior was mainly a facilitative aspect of their sexual lives.

In a follow-up study published in the journal Deviant Behavior, Sandnabba and colleagues analysed data from a subset of twelve men from their study of sadomasochists who had also engaged in zoophilic activities. This group was then compared with a control group of sadomasochists from the same data set but who had not engaged in zoophilic activities. Results showed seven out of twelve zoophilic sadomasochists had engaged in coprophilic acts whereas only one in twelve non-zoophilic sadomasochists had engaged in coprophilic acts. In fact, the zoophilic sadomasochists were more likely to engage in a wide range of sexual behaviours including spanking, gagging, biting, urophilia (urinating on or being urinated on for sexual pleasure), fisting, coprophilia, skin branding, and transvestism (i.e., cross-dressing). The authors concluded that zoophilic sadomasochists were more sexually experimental than the non-zoophilic sadomasochistic controls.

An earlier study on a much bigger sample of paraphiliacs also reported that zoophiles appear to engage in many paraphilic behaviours including coprophilia. In their survey of 561 non-incarcerated paraphiliacs seeking treatment, Dr Gene Abel and colleagues found that all of the 14 zoophiles in their sample reported more than one paraphilia and seven of them reported at least five other paraphilas including coprophilia, urophilia, pedophilia, exhibitionism, voyeurism, frotteurism, telephone scatophilia, transvestic fetishism, fetishism, sexual sadism, and/or sexual masochism.

There doesn’t appear to be any consensus as to the origins of these highly unusual paraphilias although (as with most paraphilic behaviour) operant and classical conditioning would appear to play a major role. The following example is a self-report that I found in an online discussion group:

“It all started when I was young. I hated white underwear for some reason and when I wore them I’d be turned on. Eventually it felt odd and good that I urinated in them. I wet my bed for days when I was a young boy and stopped when my parents found out about it. When I was young, I hated bowel movements. It felt gross and stuff. After discovering masturbation, I eased my bowel movements by masturbating. It felt good, and my bowel movements weren’t so gross. I don’t know how it happened but the two finally caught up to each other and I became accustomed to the smell when I masturbated. Everything escalated as time went on, I’ve been in this fetish for a while now – since I was 12 years old. I am 18 now”

The origins of the coprophilic behaviour certainly appear (in this case) to be as a result of both classical and operant conditioning. However, other people suggest different etiological factors may contribute in the development of coprophilia. For instance, in Canada, Dave Hingsburger published a case study of an institutionalized and mentally handicapped man who engaged in coprophilic acts approximately three times a week. It was argued that the cause of the coprophilia was the patient’s maladaptive response to a severely limited institutional environment rather than any behavioural conditioning.

Whatever the origins, it is evident that compared to many other paraphilic behaviours, there is a dearth of empirical and clinical data relating to the acquisition, development, and maintenance of coprophilia.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M. S., & Rouleau, J. L. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153–168.

Allen, C. (1969). A textbook of psychosexual disorders (2nd ed.). London: Oxford University Press.

Denson, R. (1982). Undinism: The fetishizaton of urine. Canadian Journal of Psychiatry, 27, 336–338.

Hallett, G. (2008). Hitler was a British agent. London: Progressive Books.

Hingsburger, D. (1989). Motives for coprophilia: Working with individuals who had been institutionalized with developmental handicaps. Journal of Sex Research, 26,139-140.

Karpman, B. (1948). Coprophilia: A collective review. Psychoanalytic Review, 35, 253–272.

Karpman, B. (1949). A modern Gulliver: A study in coprophilia. Psychoanalytic Review, 36, 260-282.

Lake, C.R. (2008). Hypothesis: Grandiosity and guilt cause paranoia; Paranoid schizophrenia is a psychotic mood disorder; a review. Schizophrenia Bulletin, 34, 1151-1162.

McCary, J. L. (1967). Human sexuality. New York: Van Nostrand Reinhold.

Milner, J.S., Dopke, C.A. & Crouch, J.L.  (2008). Paraphilia not Otherwise Specified: Psychopathology and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (pp.384-418). New York: Guildford Press.

Penix, T.M. (2008). Paraphilia not Otherwise Specified: Assessment and treatment. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (pp.419-438). New York: Guildford Press.

Sandnabba, N.K., Santtila, P. & Nordling, N. (1999). Sexual behavior and social adaptation among sadomasochistically-oriented males. Journal of Sex Research, 36, 273-282.

Sandnabba, N.K. Santtila, P., Nordling, N. Beetz, A.M., Alison, L. (2002). Characteristics of a sample of sadomasochistically-oriented males with recent experience of sexual contact with animals. Deviant Behavior, 23, 511-529.

Smith, R. S. (1976). Voyeurism: A review of the literature. Archives of Sexual Behavior, 5, 585–608.

Wise, T.N. & Goldberg, R.L. (1995). Escalation of a fetish: Coprophagia in a nonpsychotic adult of normal intelligence. Journal of Sex and Marital Therapy, 21, 272-275.

Enema of the state of mind: A beginner’s guide to klismaphilia

Klismaphilia – a term coined by Dr Joanne Denko in the reporting of two case studies early 1970s (‘klisma’ is the Greek word for ‘enema’) – is a very unusual variant in sexual expression in which an individual obtains sexual pleasure from receiving enemas (i.e., the cleansing of the colonic canal via anal douching). Less commonly, some people also get sexual pleasure from the giving of enemas to other people. Typically, it is warm water that is used to clean the lower rectum although other substances have been reported including coffee, yogurt, air, whisky, wine, beer, cocaine, epoxy resin and even cement (see case study below). For instance, Dr Anil Hernandas and colleagues from Medway Maritime Hospital (in Gillingham, UK) reported a unique case of a unemployed 27-year old patient self-administering epoxy resin (a liquid used as a masonry adhesive) for anal sexual gratification. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders classifies it under the diagnosis of “Paraphilias, Not Otherwise Specified”.

Dr Alfred Kinsey’s surveys of sexual behaviour of males and females in the late 1940s and early 1950s research specifically mentioned women using enemas as a masturbatory aid but no such practice was reported by males. Although Kinsey’s research provided evidence that klismaphilia was engaged in by women, as with most paraphilias, it is typically males who are more likely to be klismaphiliacs. Published research on klismaphiliacs is rare and it is thought that most klismaphiliacs keep their engagement in this activity very secret.

The little research into klismaphilia suggests that the act of receiving enemas can cause intense stimulation and produce pleasurable sensations (e.g., gaining pleasure from a large, water distended belly or the feeling of internal pressure). Enemas cause mechanical distension of rectum that then cause stimulation of nerve endings supplying the pelvic organs (i.e., stimulating the rectal stretch receptors). It has also been reported that drugs that are administered rectally (including aqueous and alcoholic solutions) are absorbed very rapidly and has a “mainlining effect” similar to that of intravenous drug injection.

Typically, klismaphiliacs retrospectively report discovering these very particular sexual desires after being given enemas sometime in their childhood. Published case studies suggest that klismaphilia ost likely arises in those children who received them as children by a loving and affectionate mother. This association 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 for or necessary prerequisite to genital intercourse.

Following the publication of her two case studies, Dr Joanne Danko published a study in the mid-1970s on 15 klismaphiliacs. Based on these limited data, she concluded that klismaphiliacs comprised one of three groups she labeled Type A, Type B and Type C.

• Type A: These individuals were unhappy, believed their klismaphilic behaviour as abnormal, and kept the behaviour compartmentalized. The behaviour originated in childhood and the enemas were usually self-administered. Some of the cases in this group also engaged in other paraphilic behaviour (e.g., fetishism, masochism, coprophilia).
• Type B: These individuals were similar to Type A individuals, but accepted the condition and were more likely to engage in klismaphilia with their sexual partner.
• Type C: These individuals engaged in multiple paraphilic behaviours with other similar like-mined individuals, and their klismaphilia was integrated with a range of other praphilic behaviours (e.g., transvestism, masochism).

Back in 1991, the American sexologist Dr William Arndt placed advertisements in sex magazines to recruit klismaphiliacs. He managed to survey 22 individuals (all males except for one female) and aged 25 to 54 years. Most were homosexual (80%; the other 20% were bisexual) although nearly two-thirds were married (or had been married). They typically engaged in enema use twice a week and half of the klismaphiliacs reported the enemas were self-administered. The remainder gave and/or received enemas from their sexual partner. Just over one-third of the sample (40%) had other paraphilic interests that typically revolved around sexual masochism (e.g., being spanked).

In a 1982 American Journal of Psychotherapy paper, Jeremy Agnew (1982) provided a physiological perspective on klismaphilia concentrating on the ritualization of insertion, filling, and expulsion components. He compared the physiological similarities between rectal stimulation and vaginal intercourse and said that the behaviour was reinforcing. This observation – taken together with the work of Dr Danko – suggests that much of the klismaphiliac’s behaviour is maintained by both classical and operant conditioning. In a later 2000 paper, Agnew also noted that some individuals receive such extreme pleasure from the practice that they reach orgasm. He also links klismaphilia with sadomasochistic activities.

Accidental rectal trauma and the lodging of foreign bodies in the gastrointestinal tract have been widely reported in the medical literature. Arguably the most notorious case of klismaphilia is that reported by Dr Peter Stephens and Dr Mark Taff in the American Journal of American Pathology. They wrote about a young man who turned up at the hospital complaining of rectal pain. After an examination by the doctor, it became apparent that there was a stony hard mass lodged in the man’s rectum. Upon further questioning, the patient revealed that four hours earlier, he and his boyfriend had been “fooling around” and that after stirring a batch of concrete mix, the patient had laid on his back with his feet against the wall at a 45 degree angle while his boyfriend poured the mixture through a funnel into his rectum. The concrete had set and was eventually removed. On removal, a ping-pong ball was also found. The reason a ping-pong ball was also found in the rectum was because klismaphiliacs use the ball as a plug to promote retention and increase stimulation. The use of such a device suggests the person was an experienced klismaphiliac.  As Dr Anil Hernandas and colleagues conclude “as the exploration of anal eroticism increases in popularity, more and more cases of complications as a direct result of their abuse are likely to be encountered”.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Agnew, J. (1982). Klismaphilia: A physiological perspective. American Journal of Psychotherapy, 36, 554–566.

Agnew, J. (2000). Klismaphilia. Venereology, 13(2), 75-79

Arndt, W.B. (1991). Gender disorders and the paraphilias. Madison, CT: International Universities Press.

Boglioli, L.R., Taff, M.L., Stephens, P.J. & Money, J. (1991). A case of autoerotic asphyxia associated with multiplex paraphilia. American Journal of Forensic Medicine and Pathology, 12, 64– 73.

Denko, J.D. (1973). Klismaphilia: Enema as a sexual preference. American Journal of Psychotherapy, 27, 232–250.

Denko, J.D. (1976). Klismaphilia: Amplification of the erotic enema deviance. American Journal of Psychotherapy, 30, 236–255.

Hemandas, A.H., Muller, G.W. & Ahmed, I. (2005). Rectal Impaction With Epoxy Resin: A Case Report. Journal of Gastrointestinal Surgery, 9, 747–749.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., Gebhard, P.H. (1953). Sexual Behavior in the Human Female. Philadelphia, PA: W.B. Saunders Company.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., (1948). Sexual Behavior in the Human Male. Philadelphia, PA: W.B. Saunders Company.

Stephens, P. & Taff, M. (1987). Rectal impaction following enema with a concrete mix. American Journal of Forensic Medicine and Pathology, 8, 179–182

Sexy sadism: Entertainment through pain

Sadism (the act of obtaining sexual arousal through the giving of physical or psychological pain) and masochism (the act of obtaining sexual arousal through the receiving of physical or psychological pain) are paraphilias that are often viewed as two variations of the same phenomenon. However, this blog briefly examines sexual sadism in isolation.

The psychiatrist Richard von Krafft-Ebing is often credited with introducing the term “sadism” in his 1886 sexology book Psychopathia Sexualis deriving the name from the Marquis de Sade, whose French novels often featured such behaviour. Despite the increase in knowledge of (and theorizing about) sexual sadism, the psychopathology of the behaviour is still uncertain, and an all encompassing theory of the etiology of sexual sadism has yet to be developed and empirically tested. Furthermore, the labelling and defining of sexually sadistic behaviour is further complicated by the fact that many people enjoy some form of aggressive behaviour during sex (e.g., spanking, the gentle biting of nipples, love bites) making the label sadomasochism seem somewhat inappropriate.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders that sexual sadists require “psychological or physical suffering (including humiliation)” of their victims to induce sexual excitement, whereas the World Health Organization’s International Classification of Diseases defines sadism as the “preference for sexual activity that involves bondage or the infliction of pain or humiliation”. However, those that have carried out research in the field claim that such definitions are difficult to apply in practice, resulting in experienced clinicians interpreting screening criteria inconsistently in the diagnosis of sexual sadism.

The situation was complex even when Krafft-Ebing first wrote on the topic. For instance, he described what he believed were distinct subtypes of sexual sadism including (i) lust murder (where sexual arousal is integral to the act of killing), (ii) necrophilia (discussed in a previous blog), (iii) injury to women through flagellation or stabbing, (iv) defilement of women; (iv) other types of assaults on women, such as cutting off their hair; (v) whipping of boys; (vi) sadism toward animals; and (vii) sadistic fantasies without the occurrence of any actual sadistic acts. Another sadistic act that has been reported in more recent times is ‘piqeurism’ where the assailant stabs a female victim (typically breasts or buttocks) and then runs away.

The true prevalence of sexual sadism among the general population is unknown. Alfred Kinsey’s seminal studies of human sexual behaviour in the late 1940s and early 1950s reported that 22% of the males and 12% of the females responded erotically to stories with sadistic themes. Other research studies estimate that 10-20% of couples have engaged in sadomasichistic activities during sex but that much of this is symbolic. However, most of the little research that has been published on sexual sadism tends to be based on sex offenders and sexual killers.

Among sex offenders, the prevalence of sexual sadism is estimated to occur in between 2% and 5% of offences. However, these estimates have been reported to be much higher (as much as 50%) depending upon the criteria that are used to define and diagnose sexual sadism in the first place. Prevalence estimates are further complicated because some in the area note that sadism and masochism are complementary disorders or separate poles of the same disorder. There is certainly a lot of empirical support that sadism and masochism often co-occur such as psychiatrist Dr Andreas Spengler’s study of 245 German sadomasochists published in the Archives of Sexual Behavior. Spengler’s study reported that among his sample, 30% were heterosexual, 31% bisexual and 38% homosexual. Just under a half (43%) developed their sadomasochistic desires after adolescence, and – perhaps surprisingly given the link to compulsive behaviour – sado-masochism was low frequency activity (with a median average of only five SM experiences per year among the respondents).

In a study led by Dr Gene Abel (now Director of the Behavioral Medicine Institute of Atlanta, US), it was reported that 18% of sadists were also masochistic, 46% had raped, 21% had exposed themselves, 25% had engaged in voyeurism and frottage, and 33% had molested children. Similarly, other researchers the Institute of Psychiatry, London) have noted an overlap among various paraphilias. Their sample comprised 87 rubberites, 38 leatherites, 133 sadomasochists, 205 transvestites (including transsexuals) and 25 dominant females. They found that 4% of sadomasochists were also transvestites, 29% of sadomasochists were also fetishists, and 35% of sadomasochists were also fetishists and transvestites. Gosselin and Wilson also reported that the most common objects used by sadists to inflict pain on their sexual partners were belts, whips, canes, shoes and paddles.

There is a wide variety of psychological explanations relating to the etiology of sexual sadism although most recent reviews have claimed there has been little new contemporary theorizing. Most branches of psychology (psychophysiological, psychodynamic, cognitive, behavioural) have developed their own theories but little research has confirmed them. Psychobiological explanations of sexual sadism (including serial sex murderers) that have examined chromosomal, endocrine, hormonal, and/or neurological abnormalities have typically been based on single case studies or very small samples. Therefore results remain tentative and inconclusive.

Early behaviourist theories argued that sexual sadism begins during childhood development. Through both operant and classical conditioning, sexual urges, excitation, and/or arousal are consistently paired with aggressive stimuli. Sexual fantasy and masturbation then reinforce and maintain the sadistic behaviour. Other psychologists claim that personality may play a role in the conditioning process, along with social modelling and disinhibition.

More recently, Dr Malcom MacCulloch (probably best know as Moors murderer Ian Brady’s psychiatrist) claimed that behavioral explanations of the development of sadistic sexual fantasy don’t adequately explain the initial development of sadistic sexual fantasy. McCullogh and his colleagues attempted to explain the initial development of sexual sadism using research on early childhood abuse and animal models of conditioning. They claimed that sadistic fantasies resulted from a combination of early childhood abuse, classical conditioning, and operant conditioning.

Back in 1986, Katie Busch and James Cavanagh (who were both at Rush-Presbyterian-St. Luke’s Medical Center, US) stated that most of the work in this area consisted of unfounded statements unsupported by data, unevaluated case reports lacking rigorous evaluation of other contributory factors, and scientific case reports of individuals or small groups. A recent literature review by Canadian consultant Dr Pamela Yates and colleagues of the current research concluded that: “Regrettably, the same can be said today, over 20 years later”.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Abel, G. G., Becker, J., Cunningham-Rathner, J., Mittelman, M., & Rouleau, J. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153–168.

Busch, K.A., & Cavanagh, J.R. (1986). The study of multiple murder: Preliminary examination of the interface between epistemology and methodology. Journal of Interpersonal Violence, 1, 5–23.

Gosselin, C. C. (1987). The sado-masochistic contract. In G.D. Wilson (Ed.), Variant sexuality: Research and theory (pp. 229–257). Baltimore: Johns Hopkins University Press.

Gosselin, C. C., & Wilson, G. D. (1980). Sexual variations. London: Faber & Faber.

Kinsey, A., Pomeroy, W. B., Martin, C. E., & Gebhard, P. H. (1953). Sexual behavior in the human female. Philadelphia: Saunders.

Langevin, R. (2003). A study of the psychosexual characteristics of sex killers: Can we identify them before it is too late? International Journal of Offender Therapy and Comparative Criminology, 47, 366–382.

MacCulloch, M., Gray, N., & Watt, A. (2000). Brittain’s sadist murderer syndrome reconsidered: An associative account of the aetiology of sadistic sexual fantasy. Journal of Forensic Psychiatry, 11, 401–418.

MacCulloch, M., Snowden, P., Wood, P., & Mills, H. (1983). Sadistic fantasy, sadistic behavior, and offending. British Journal of Psychiatry, 143, 20–29.

Marshall, W. L., & Kennedy, P. (2003). Sexual sadism in sexual offenders: An elusive diagnosis. Aggression and Violent Behavior, 8, 1–22.

Marshall, W. L., & Yates, P. M. (2004). Diagnostic issues in sexual sadism among sexual offenders. Journal of Sexual Aggression, 10, 21–27.

Spengler, A. (1977). Manifest sadomasochism of males: Results of an empirical study. Archives of Sexual Behavior, 6, 441–456

Yates, P.M., Hucker, S.J. & Kingston, W.A. (2008). Sexual sadism: Psychopathology and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment. pp.213-23o. New York: Guildford Press.

Flash dance: A psychological overview of exhibitionism

Exhibitionism typically refers to an intense desire or compulsion to expose sexual parts of the body (i.e., genitals, buttocks, breasts) to unwilling observers in public (or semi-public) places. If the behaviour is anti-social or threatening it is typically defined as ‘indecent exposure’ and becomes a matter for the law. Non-threatening exposure of sexual body parts (such as women showing their breasts during the Mardi Gras festival) is usually termed flashing as opposed to indecent exposure. However, there is a whole range of different terms used to describe various exhibitionist acts including (in alphabetical order):

• Anasyrma: Typically refers to the lifting of a skirt or dress by a woman when not wearing any knickers and exposing her genitals.
• Candaulism: Specifically refers to those people who expose themselves to their partners in a sexually explicit way.
• Flashing: Typically the brief display of bare female breasts or the brief showing of genitals by a man or woman.
• Martymachlia: Specifically refers to a paraphilic behaviour that involves being sexually aroused by having others watch the sexual act.
• Mooning: Typically refers to the displaying of bare buttocks by pulling down trousers and/or underwear. Evidence suggests that when performed by women the primary motivation may be sexual whereas for males it may be done for the sake of mockery or humour.
• Streaking: Typically refers to running naked (usually men) or topless (usually female) in a public place (e.g., a cricket or football match).

The American Psychiatric Association defines exhibitionism as “sexual gratification, above and beyond the sexual act itself, that is achieved by risky public sexual activity and/or bodily exposure [and can also include] engaging in sex where one may possibly be seen in the act, or caught in the act.” Exhibitionism is not necessarily a compulsive or impulsive behaviour but in its most extreme and compulsive form it is called apodysophilia. Furthermore, exhibitionism is only considered a psychological disorder if it interferes with a person’s quality of life or their normal functioning capacity.

Apodysophilia, like most paraphilic behaviour, is almost exclusively male and some exhibitionists will even go as far to expose themselves and then masturbate at a later point and/or or replay fantasies while engaging in sex with partner. One recent literature review on exhibitionism found only four papers published with a total of 14 female case studies across a period of 25 years.

Because data about exhibitionists typically come from either those caught offending and/or those that are receiving treatment, the true incidence and prevalence of exhibitionism is unknown. Data from the criminal justice system, small-scale community surveys, and victim surveys, suggest that exhibitionism occurs relatively frequently. A German study published in 1999 found that over a four-year period there were 8,000 to 12,000 reports of exhibitionism to the police, and 16% of those sentenced for sex crimes were exhibitionists. Clearly, such data totally underestimate the incidence of exhibitionism, as research carried out among the general public and victims appears to indicate that most people (approximately 75% in some surveys) don’t report these incidents to the police.

Very few studies have examined the prevalence of exhibitionism among non-sex offender populations. In 1991, Terrel Templeman and Ray Stinnett (Eastern Oregon State University) found that 2% of a very small convenience sample of college males reported exhibitionism. More recently (in 2006), Niklas Långström (Karolinska Institutet, Stockholm, Sweden) and Michael Seto (Centre for Addiction and Mental Health, Toronto, Canada) reported that 3.1% of their national probability sample (2,450 people aged 18 to 60 years) had exposed their genitals to a stranger for sexual pleasure (4.3% for males and 2.1% for females) although there is a high likelihood that very few of these were genuine paraphilic behaviour. Respondents who reported exhibitionistic behaviour were also significantly more likely to report other atypical sexual behavior (sadomasochism and transvestism).

This latter finding seems to be supported by some other evidence that exhibitionists may be generally hypersexual. Dr Martin Kafka and Dr John Hennen (McLean Hospital, affiliated with Harvard University, US) reported on a sample of 143 individuals with paraphilias, of whom 37% were exhibitionists. Of these 143 individuals, 123 also reported paraphilia-related disorders, which include compulsive masturbation, protracted heterosexual/homosexual promiscuity, dependence on pornography or telephone sex, and severe sexual desire in- compatibility.

Gene Abel and Joanne Rouleau reported an American study examining 142 exhibitionists in an outpatient clinic at the at the University of Tennessee Center for the Health Sciences in Memphis, and at the New York State Psychiatric Institute in New York City. They reported that 50% of the exhibitionists reported the onset of their sexual interest before the age of 18 years and that there was little evidence that exhibitionists had high rates of physical or sexual abuse. They also reported that the average number of victims they had exposed themselves to was 500.

A seminal study published in the 1970s by Graham Rooth in the British Journal of Psychiatry suggested there were two distinct groups of exhibitionists based on the case studies he had come across:

• Type 1 (80%): Aged 15-25 years; Inhibited immature and close to their mother; struggle against the impulse to expose and experience guilt; expose flaccid penis
• Type 2 (20%): Aged 20 upwards; Sociopathic tendencies taking sadistic pleasure in exposing erect penis and masturbating; may contact victims afterwards.

According to the American Psychiatric Association, exhibitionists rarely do anything else but expose themselves. However, Some victims are traumatised by the experience. Graham Rooth claims only 20% of those convicted re-offend (and they are usually the Type 2 offenders outlined above)

Although there is no evidence that exhibitionists have a preference for exposing, there is some limited evidence that exhibitionists may be generally hypersexual. A study led by one of the world’s leading experts on paraphilias, Dr Martin Kafka (affiliated to Harvard University, US) reported that in a sample of 143 paraphiliacs (of whom 37% were exhibitionists), a large majority (n=123) also reported paraphilia-related disorders, that included compulsive masturbation, protracted heterosexual/homosexual promiscuity, dependence on pornography or telephone sex, and severe sexual desire in- compatibility.

There are a number of theories as to how exhibitionism develops. Some claim it is the reinforcement of sexual arousal associated with exhibitionism that promotes maintenance of behaviour. others claim the disorder is caused by a disturbance of the pre-tactile interaction phase. More specifically, Kurt Freund, the late Czech-Canadian sexologist wrote numerous papers claiming that behaviours such as exhibitionism are caused by “courtship disorders”. According to Freund, normal courtship comprises four phases: (i) location of a partner, (ii) pre-tactile interactions, (iii) tactile interactions, and (iv) genital union. Freund claims that paraphilias such as voyeurism, exhibitionism, and frotteurism can be viewed as distortions in each of these courtship phases. Freund also proposed that obscene telephone calling, (often viewed as a variant of exhibitionism) is a disturbance of the second phase of the courtship disorder. Freund and his colleagues reported significant correlations between the presence of exhibitionism and the presence of frotteurism or voyeurism (the highest correlation being that between voyeurism and exhibitionism).

Freund also published papers examining the self-reports about the development of exhibitionists’ patterns of erotic behavior. Freund and his associates reported that among exhibitionists: (i) up to a half masturbated while exposing and during fantasies about exposing; (b) nearly two-thirds admitted they had also masturbated in a public place in a place no-one could see them; and (iii) more than half experienced the act of exposing as an invitation to intercourse and about a third as a substitute for intercourse with the target person. The study also confirmed that obscene telephone calling, which occurs also with other anomalous erotic preferences, was particularly associated with exhibitionism.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Abel, G. G., & Rouleau, J.-L. (1990). The nature and extent of sexual assault. In W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 9-21). New York: Plenum Press.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: Author.

Freund, K., Watson, R., & Rienzo, D. (1988). The value of self-reports in the study of voyeurism and exhibitionism. Annals of Sex Research, 2, 243–262.

Freund, K. (1990). Courtship disorder. In W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.), Hand- book of sexual assault: Issues, theories, and treatment of the offender (pp. 331–342). New York: Plenum Press.

Kafka, M. P., & Hennen, J. (2003). Hypersexual desire in males: Are males with paraphilias different from males with paraphilia-related disorders? Sexual Abuse: A Journal of Research and Treatment, 4, 307–321.

Långström, N., & Seto, M. C. (2006). Exhibitionistic and voyeuristic behavior in a Swedish national population survey. Archives of Sexual Behavior, 35, 427–435.

Murphy, W.D. & Page, I.J. (2008). Exhibitionism: Psychopathology and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (pp. 61-75). New York: Guildford Press.

Pfäfflin, F. (1999). Issues, incidence, and treatment of sexual offenders in Germany. Journal of Interpersonal Violence, 14, 372–395.

Riordan, S. (1999). Indecent exposure: The impact upon the victim’s fear of sexual crime. Journal of Forensic Psychiatry, 10, 309–316.

Rooth, G. (1973). Exhibitionism, sexual violence and paedophilia. British Journal of Psychiatry, 122, 705–710.

Templeman, T. L., & Stinnett, R. D. (1991). Patterns of sexual arousal and history in a “normal” sample of young men. Archives of Sexual Behavior, 20, 137–150.

Animal passions: The strange world of zoophilia

Of all the sexual paraphilias, arguably the two most repelling are necrophilia (covered in a previous blog) and zoophilia. Zoophilia (also more commonly know as bestiality) is typically defined as relating to recurrent intense sexual fantasies, urges and sexual activities with non-human animals.

The Kinsey Reports (of 1948 and 1953) arguably shocked its readers when it reported that 8% of males and 4% females had at least one sexual experience with an animal. As with necrophiliacs who are often employed in jobs that provide regular contact with dead people, the Kinsey Reports provided much higher prevalence for zoophilic acts among those who worked on farms (for instance, 17% males had experienced an orgasmic episode involving animals). The most frequent sexual acts engaged in with animals comprised calves, sheep, donkeys, large fowl (ducks, geese), dogs and cats. Males were most likely to engage in penile-vaginal intercourse or to have their genitals orally stimulated by the animals. Female zoophilia was most likely to involve household pets licking genitals. Less commonly, women have trained dogs to mount them and engage in intercourse. The sexologist Professor John Money asserted that zoophilic behaviours were usually transitory occurring when there is no other sexual outlet available.

The most recent studies of zoophilia since 2000 have typically collected their data online from non-clinical samples. This has included studies by Dr Andrea Beetz (University of Erlangen, Germany; 32 zoophiles), Dr Colin Williams and Dr Martin Weinberg (of Indiana University, USA; 114 zoophiles), and Dr Hani Miletski (Institute for Advanced Study of Human Sexuality, San Francisco, USA; 93 zoophiles). For instance, Hani Miletski used the internet to find zoophiles, and recruited them via advertisements in a zoophile magazine (i.e., Wild Animal Review). These studies all reported that both male and female self-identified zoophiles were attracted to animals out of either a desire for affection, a sexual attraction toward, and/or a love for animals. Many of the zoophiles in these three studies had a preference for sex with non-human animals.

Miletski’s study comprised 82 male and 11 female zoophiles. The most reported sexual fantasies of the sample were having sex with animals (76 % males and 45% females) and watching other humans have sex with animals (35% males and 40% females). The reasons that men said they engaged in sex with animals was sexual attraction to the animal (91%), love and affection for the animal (74%), the animals being accepting and easy to please (67%). Only 12% said it was because no human partners were available, and only 7% said it was because they were too shy to have sex with humans. For the females, the main reasons for having sex with animals was because they were sexually attracted to the animal (100%), love and affection for the animal (67%) and because they said the animal wanted it (67%). Most of the sample preferred sex with dogs (87% males; 100% females) and/or horses (81% males; 73% females). Only 8% of males wanted to stop having sex with animals and none of the females.

Hani Miletski went as far as to claim that zoophilia could perhaps be considered as an alternative sexual orientation. Interestingly, Miletski’s study – which I should add has never been published in a peer reviewed academic journal – noted that her participants differentiated themselves from the bestialists who used animals as sex objects without emotional attachment.

Andrea Beetz’ study comprised 32 male zoophiles. Sex had occurred with dogs (78%), horses (53%), cats (13%) and farm animals (19%). Over half (56%) had never been in therapy. Many of the zoophiles had a very close emotional attachment to their animals and reported that they love their animal partner as others love their human partner (and are devastated when their animal partner dies). They also claimed they cared about the sexual pleasure of their animal partner as well as their own. Beetz also examined how the interest in zoophilia began. She reported:

“Some have always been interested in their preferred animal and only later developed sexual fantasies about them, some read in books/magazines about zoophilia (e.g. the Sex Atlas), some found it very exciting to watch animal matings on TV (especially on the Discovery Channel in the US) and fantasized about that. Others started to touch the genitals of their pet-dog out of curiosity, in some cases the dog came up and licked the person`s genitals. Others did not remember when their fantasies started, but the behavior often started with nonsexual cuddling with the animal and then became sexual. So we see that there are a lot of ways that can lead up to the first sexual experience with an animal”

In all three studies, the most commonly preferred animals were either dogs or horses. However, it must be noted that these three studies, while extensive compared to the case reports published since Alfred Kinsey’s pioneering studies, collected data from non-clinical samples. Therefore, and unlike case study reports, the participants did not appear to be suffering any significant clinical significant distress or impairment as a consequence of their behaviour.

There may, of course, be other more idiosyncratic explanations for zoophilic behaviour. There are several medical conditions accounting for zoophilic behaviour (e.g., cerebral tumors located in the frontal lobe or in the lymbic system or hypothalamus). A very recent case reported in the journal Romanian Neurosurgery described the late onset of zoophilia in a 42-year old man who suddenly started engaging in zoophilic behaviour following an aneurysm in the posterior cerebral artery. More specifically, he developed a sexual interest towards the hens in his garden, and his wife found him several times having sex with the hens. Unfortunately, the man died a few weeks later following a rupture of the aneurysm. Another report published in the Annals of Pharmacotherapy highlighted the case of a 74-year old man who developed zoophilic tendencies five days after the start of his dopaminergic therapy for his Parkinson’s Disease.

Finally, it’s worth noting that there have also been papers and editorials published in the Veterinary Journal (VJ) about the violent sexual abuse of female calves. Vets – who often have to deal with the animals that have been sexually abused by humans – do not like the term ‘zoophilia’ as it tends to focus on the human perpetrator, with no attention being paid to the harm that might result for the animal. A 2006 editorial in the VJ claimed that the sexual abuse of animals is almost a last taboo – even to the veterinary profession. As Piers Beirne (University of Sothern Maine, USA) argues, the sexual abuse of an animal should be understood as sexual assault because: (i) human–animal sexual relations almost always involve coercion; (ii) such practices often cause pain and even death to the animal; and (iii) animals are unable either to communicate consent to us in a form that we can readily understand, or to speak out about their cause.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Beetz, A.M. (2000, June). Human sexual contact with animals: New insights from current research. Paper presented at the 5th Congress of the European Federation of Sexology, Berlin.

Beirne, P., 1997. Rethinking bestiality: towards a concept of interspecies sexual assault. Theoretical Criminology, 1, 317–340.

Ene, S., A. Sasaran, A. (2011). Zoophilic behavior in a patient with posterior cerebral arterial aneurysm. Romanian Neurosurgery, 18, 349-355.

Hvozdık, A., Bugarsky, A., Kottferova, J., Vargova, M., Ondrasovicova, O., Ondrasovic, M., & Sasakova , N. (2006). Ethological, psychological and legal aspects of animal sexual abuse. The Veterinary Journal, 172, 374-376.

Jimenez-Jimenez F.J., Sayed Y., Garcia-Soldevilla M.A. & Barcenilla B. (2002). Possible zoophilia associated with dopaminergic therapy in Parkinson disease. Annals of Pharmacotherapy, 36, 1178-1179.

Kafka, M.P. (2010). The DSM Diagnostic Criteria for Paraphilia Not Otherwise Specified. Archives of Sexual Behavior, 39, 373-376.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., Gebhard, P.H. (1953). Sexual Behavior in the Human Female. Philadelphia, PA: W.B. Saunders Company.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., (1948). Sexual Behavior in the Human Male. Philadelphia, PA: W.B. Saunders Company.

Miletski, H. (2000). Bestiality and zoophilia: An exploratory study. Scandinavian Journal of Sexology, 3, 149–150.

Miletski, H. (2001). Zoophilia – implications for therapy. Journal of Sex Education and Therapy, 26, 85–89.

Miletski, H. (2002). Understanding bestiality and zoophilia. Germantown, MD: Ima Tek Inc.

Munro, H.M.C. (2006). Animal sexual abuse: A veterinary taboo? The Veterinary Journal, 172, 195-197.

Williams, C. J., & Weinberg, M. S. (2003). Zoophilia in men: A study of sexual interest in animals. Archives of Sexual Behavior, 32, 523–535.

Sexual perversions and paraphilias: Compulsion, obsession or addiction?

Back in 1986, during the second year of my undergraduate psychology degree, we had a psychiatrist called Dr Alex Oswald come in give a guest lecture on sexual paraphilias. It was the best (and most interesting) lecture I have ever seen. I had always taken an interest in human sexual behaviour but this was unlike any lecture I had ever had before. It was also the stimulus for my (now) lifelong academic interest in extreme sexual behaviours.

The German psychiatrist Richard Von Krafft-Ebing is usually credited with first identifying paraphilias in his 1886 book Psychopathia Sexualis (Sexual Psychopathy). Paraphilias (from the Greek “beyond usual or typical love”) are uncommon types of sexual expression and often more commonly described as sexual deviations, sexual perversions or disorders of sexual preference. To many people, the may appear bizarre and/or socially unacceptable, and represent the extreme end of the sexual continuum. They are typically accompanied by intense sexual arousal to unconventional and/or non-sexual stimuli. In some cases, the behaviour may only occur sporadically whereas for others it may be compulsive and/or addictive. Many sexologists (such as the late Professor John Money of the John Hopkins University) have described some paraphilic behaviours as “fixated” and for those affected the desire is insistent and demanding.

It is thought that paraphilias are rare and affect only a very small percentage of adults. It has been difficult for researchers in the field to estimate the proportion of the population that experience paraphilic behaviours because much of the scientific literature is based on case studies (which suffer from problems around reliability because of their self-report nature). As paraphilias typically offer pleasure, many individuals affected do not seek psychiatric treatment. Furthermore, reliable statistics are further compounded by the fact that many paraphilic acts are illegal. Because of the illegality, paraphiliacs often experience high levels of shame and guilt and (like those who experience pleasure from the behaviour) may not seek medical or psychiatric help. For those that do seek professional help the disorders are often difficult to treat. Therapeutic success is more likely to be related to curbing or suppressing the behaviour rather than eliminating it altogether.

Although the statistics are biased by differential reporting and prosecution, there is general agreement among the psychiatric community that all paraphilias are male dominated (with at 90% of all those affected being men and with some estimates suggesting the ratio is as high as 30 to 1). Research also indicates that some paraphilias appear to be more common than others. For instance, the most common paraphilias reported in the scientific literature appear to be masochism, sadism and fetishism. Within clinics that treat sex offenders, the most common paraphilias are (perhaps unsurprisingly) paedophilia, voyeurism and exhibitionism.

It is also known that atypical sexual behaviours often cluster and/or overlap (either simultaneously or sequentially). For instance, some research has reported that paraphiliacs commonly experience two to three concurrent paraphilas with around 5% experiencing up to 10 concurrently. The onset of paraphilic behaviour is typically initiated during early adolescence through a complex biopsychosocial network of causes. The behaviour usually reaches its full development by the age of 20 years. Some of the causes of paraphilic behaviour are known to include various genetic and hormonal abnormalities, pre-natal neuro-developmental factors, neuro-cognitive and brain dysfunctional, maladaptive learning, and dysfunctional family life during childhood.

Paraphilas are rarely described as addictions as most of the debate surrounds whether they are impulse control disorders or whether they fall within the spectrum of obsessive-compulsive disorders. Arguably, the best criteria for diagnosis of a paraphilia is found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). In the DSM-IV-TR, a paraphilic disorder has to meet two essential criteria. The first criterion is that the essential features of a paraphilia are recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving (i) non-human objects, (ii) the suffering or humiliation of oneself or one’s partner, or (iii) children or other non-consenting persons that occur over a period of at least six months. The second criterion is that a diagnosis is made if the behaviour, sexual urges, and/or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The element of coercion is another key distinguishing characteristic of paraphilias. Some paraphilias (e.g., sadism, masochism, fetishism, hypoxyphiilia, urophilia, coprophilia, klismaphilia) – which I will be discussing in future blogs – are engaged in alone, or include consensual adults who participate in, observe, or tolerate the particular paraphiliac behaviour. These atypical non-coercive behaviours are considered by many in the psychiatric community to be relatively benign or harmless because there is no violation of anyone’s rights. Atypical coercive paraphilic behaviours are considered much more serious and almost always require therapeutic intervention (e.g., exhibitionism, voyeurism, frotteurism, necrophilia, zoophilia).

Finally, it is also worth noting that some practitioners working in the field have made distinctions between what are referred to as optional, preferred and exclusive paraphilias. An optional paraphilia is a behaviour that provides an alternative route to becoming sexually aroused. For instance, a male with fairly normal sexual interests might occasionally enhance their sexual arousal by wearing women’s high-heeled shoes and fishnet stockings while having sex. In preferred paraphilias, a person prefers the paraphilia to conventional sexual activities, but is still able to engage in conventional sex. For instance, a male might prefer – whenever possible – to wear women’s high-heeled shoes and fishnet stockings during sex. In exclusive paraphilias, a person is unable to become sexually aroused in the absence of the paraphilia. In this case, a male would be unlikely to get sexually aroused during sex unless he was wearing high-heeled shoes and fishnet stockings.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Abel, G. G., & Osborn, C. (1992). The paraphilias: The extent and nature of sexually deviant and criminal behavior. Psychiatric Clinics of North America, 15, 675–689.

Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M., & Rouleau, J.-L. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153–168.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revised). Washington, DC: Author.

Krueger, R. B., Kaplan, M. (2001). The paraphilic and hypersexual disorders: An overview. Journal of Psychiatric Practice, 7, 391-403.

Money, J. (1994). Principles of Developmental Sexology. New York: Continuum.

Raymond, N.C., & Grant, J.E. (2008). Sexual disorders: Dysfunction, gender identity, and paraphilias. The Medical Basis of Psychiatry, 1, 267-283.

Wiederman, M.W. (2003). Paraphilia and fetishism. The Family Journal: Counseling and Therapy for Couples and Families, 11, 315-321.