Principles and Practice of Structural Equation Modeling (2nd ed.)

Hypersexual Disorder is proposed as a new psychiatric disorder for consideration in the Sexual Disorders section for DSM-V. Historical precedents describing hypersexual behaviors as well as the antecedent representations and proposals for inclusion of such a condition in the previous DSM manuals are reviewed. Epidemiological as well as clinical evidence is presented suggesting that non-paraphilic “excesses” of sexual behavior (i.e., hypersexual behaviors and disorders) can be accompanied by both clinically significant personal distress and social and medical morbidity. The research literature describing comorbid Axis I and Axis II psychiatric disorders and a purported relationship between Axis I disorders and Hypersexual Disorder is discussed. Based on an extensive review of the literature, Hypersexual Disorder is conceptualized as primarily a nonparaphilic sexual desire disorder with an impulsivity component. Specific polythetic diagnostic criteria, as well as behavioral specifiers, are proposed, intended to integrate empirically based contributions from various putative pathophysiological perspectives, including dysregulation of sexual arousal and desire, sexual impulsivity, sexual addiction, and sexual compulsivity.

Hypersexual Disorder: A Proposed Diagnosis for DSM-V

This chapter represents an attempt to integrate a widely disparate literature concerning factors which play a role in the etiology of sex offending and lead to its persistence. In particular we are concerned that most researchers seem to take a rather narrow perspective of this behavior, stressing their own preferred processes (i.e., psychological, biological, or sociological) to the virtual exclusion of others. We have previously emphasized the role of learning experiences (Marshall and Barbaree, 1984a), sociocultural factors (Marshall, 1984a), and biological processes (Marshall 1984b) in the etiology of rape, but this represents our first attempt at integration and the first time we have extended our theorizing to account for other sex offenses. We believe that a proper understanding of sex offending can only be attained when these diverse processes are seen as functionally interdependent.

An Integrated Theory of the Etiology of Sexual Offending

OBJECTIVE: Violent behavior among individuals with severe mental illness has become an important focus in community-based care. This study examines the joint effect of substance abuse and medication noncompliance on the greater risk of serious violence among persons with severe mental illness. METHOD: Involuntarily admitted inpatients with severe mental illness who were awaiting a period of outpatient commitment were enrolled in a longitudinal outcome study. At baseline, 331 subjects underwent an extensive face-to-face interview. Complementary data were gathered by a review of hospital records and a telephone interview with a family member or other informant. These data included subjects' sociodemographic characteristics, illness history, clinical status, medication adherence, substance abuse, insight into illness, and violent behavior during the 4 months that preceded hospitalization. Associations between serious violent acts and a range of individual characteristics and problems were analyzed by using m...

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Violence and severe mental illness: the effects of substance abuse and nonadherence to medication.

According to cultural stereotypes, men are more eager for sex than are women; women are more likely to set limits on such activity. In this paper, we review the work of theorists who have argued in favor of this proposition and review the interview and correlational data which support this contention. Finally, we report two experimental tests of ihis hypothesis. In these experiments, conducted in 1978 and 1982, male and female confederates of average attractiveness approached potential partners with one of three requests: "Would you go out tonight?" "Will you come over to my apartment?" or "Would you go to bed with me?" The great majority of men were willing to have a sexual liaison with the women who approached them. Women were not. Not one woman agreed to a sexual liaison. Many possible reasons for this marked gender difference were discussed. These studies were run in 1978 and 1982. It has since become important to track how the threat of AIDS is affecting men and women's willingness to date, come to a...

Gender Differences in Receptivity to Sexual Offers

BACKGROUND Recent research from North America has demonstrated higher than expected rates of drug and alcohol abuse among the seriously mentally ill. Schizophrenics appear to be particularly susceptible to the negative effects of substance abuse. These include psychiatric and social complications, with antisocial behaviour, particularly violence emerging as one of the most worrying features. This review examines the strength of the association and explores the possible explanations for the apparent link between schizophrenia, substance abuse and violence.

METHOD The literature was searched using Medline, supplemented with a manual literature search.

RESULTS Very few articles specifically approached the problem of violence among substance abusing schizophrenics, but over 80 papers were identified which were helpful in exploring the link between dangerous behaviour and substance abuse by schizophrenics.

CONCLUSIONS While there is circumstantial evidence to support the hypothesis that schizophrenics who abuse drugs or alcohol are at an increased risk of behaving violently, longitudinal studies are required to facilitate a better understanding of the mediating mechanisms.

Schizophrenia and substance abuse.

Autoerotic asphyxia is the practice of self-inducing cerebral anoxia, usually by hanging, strangulation, or suffocation, during masturbation. This study investigated the relationships between: asphyxiators' ages; two paraphilias commonly accompanying autoerotic asphyxia, bondage and transvestism; and various other types of simultaneous sexual behaviour. Subjects were two concurrent series totalling 117 males aged 10-56 who died accidentally during autoerotic asphyxial activities. Data concerning sexual paraphernalia at the scene of death or among the deceased's effects were extracted from coronors' files using standardised protocols. Anal self-stimulation with dildos, etc., and self-observation with mirrors or cameras were correlated with transvestism. Older asphyxiators were more likely to have been simultaneously engaged in bondage or transvestism, suggesting elaboration of the masturbatory ritual over time. The greatest degree of transvestism was associated with intermediate rather than high levels of bondage, suggesting that response competition from bondage may limit asphyxiators' involvement in a third paraphilia like transvestism.

Age, Transvestism, Bondage, and Concurrent Paraphilic Activities in 117 Fatal Cases of Autoerotic Asphyxia

This study tested parts of the hypothesis that voyeurism, exhibitionism, toucheurism and frotteurism, obscene telephone calling, and at least some cases of the preferential rape pattern are all based on the same disturbance. In Part One, a frequency count of patients referred for one of these activities who subsequently reported having engaged in others of this same class was in accord with the clinical impression that there is a high degree of concomitance among at least some of these activities. In Parts Two and Three, relative preference for anomalous vs. normal erotic interactions was assessed by monitoring penile volume changes during verbally presented descriptions of corresponding situations. Part Two demonstrated that patients who suffered from one of the disorders in question other than voyeurism and who denied voyeuristic activity or tendencies, nonetheless responded more to narratives describing voyeuristic situations than did controls. Part Three showed that exhibitionists who denied toucheuristic activity or tendencies responded more to toucheuristic stimuli than did controls.

The courtship disorders

Psychopathic personality disorder and sexual sadism share several common characteristics, such as emotional detachment from the suffering of others or the preparedness to inflict pain or injuries. Based on a sample of 100 male forensic patients (all of them sex offenders, half of them sadistic), the concept of psychopathy and sexual sadism as a unified construct was tested empirically. Pooling indicator variables for psychopathic and sexually sadistic disorders showed that a two-factorial solution yielded a better fit than a single-factor model. The two factors identified psychopathy and sexual sadism as separate latent variables. More specifically, the data were compatible with a path model in which affective deficits and behavioral disinhibition of the psychopathy domain are precursors to sexually sadistic conduct.

Stephen J. Hucker

Papers

Schizophrenia and substance abuse.

Age, Transvestism, Bondage, and Concurrent Paraphilic Activities in 117 Fatal Cases of Autoerotic Asphyxia

The courtship disorders

Psychopathy and Sexual Sadism

A comparison of typical death scene features in cases of fatal male and female autoerotic asphyxia with a review of the literature