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Contrary to common belief, hypersexual or compulsive sexual behaviour disorder is not a current fashion diagnosis. Nevertheless, the introduction of dedicated diagnostic guidelines for International Classification of Diseases 11th Revision (ICD-11) brings an opportunity for more accurate diagnosis and, therefore, improved research into the disorder's aetiology, assessment and therapy. A considerable proportion of both men and women consider themselves to have a problem with pornography and an even greater proportion experience their sexual behaviour as insufficiently controllable. For these people, the interplay between excitatory and inhibitory factors could be in dysbalance. In this context, biological correlates are important, but social factors, such as negative attitudes towards pornography or hostile attitudes to sexuality, also have a role. In patients with compulsive sexual behaviour disorder, excessive pornography consumption, masturbation and/or promiscuity that are out of control and lead to distress and impairment are usually present. Differential diagnoses, such as neuropsychiatric syndromes that can exhibit hypersexuality as a symptom, such as frontal lobe lesions, should be investigated and treated, as should comorbid disorders such as depression. Therapeutic approaches can be based on the Dual-Control Model and the Sexual Tipping Point Model. In each patient, an individualized therapeutic approach is multimodal and includes psychopharmaceuticals such as selective serotonin reuptake inhibitors and naltrexone as well as specific psychotherapeutic approaches. The efficacy of some therapeutic approaches has now also been supported by initial randomized controlled trials in this patient population.

Introduction: Parkinson's disease (PD) is characterized by motor symptoms such as bradykinesia, rigidity, alteration of postural reflexes and tremor at rest and other non-motor symptoms such as changes in sleep patterns and sexual behavior. However, little is known about paraphilic sexual behaviors., Aim: To summarize the number of cases of zoophilic behaviors in patients with PD between January 2000 and December 2017., Development: A review was carried out in PubMed, Scopus and Virtual Health Library. Eleven articles were identified by title; six were excluded because they did not present cases related to zoophilic behavior. We found five cases of men, usually with PD of several years of course, taking dopamine agonists and who presented the zoophilic behaviors followed increasing of the dose. The zoophilic behaviors decreased with reducing doses of dopamine agonists and taking atypical antipsychotic such as clozapine or quetiapine., Conclusions: It is limited the case reports of zoophilic behaviors in patients with PD. The patients reported are men in whom the dose of dopamine agonists was increased. It is important that the clinical follow-up of patients with PD disease includes a careful review of sexual behaviors including those of the paraphilic spectrum.

Like nonaffected adults, individuals with autism spectrum disorders (ASDs) show the entire range of sexual behaviors. However, due to the core symptoms of the disorder spectrum, including deficits in social skills, sensory hypo- and hypersensitivities, and repetitive behaviors, some ASD individuals might develop quantitatively above-average or nonnormative sexual behaviors and interests. After reviewing the relevant literature on sexuality in high-functioning ASD individuals, we present novel findings on the frequency of normal sexual behaviors and those about the assessment of hypersexual and paraphilic fantasies and behaviors in ASD individuals from our own study. Individuals with ASD seem to have more hypersexual and paraphilic fantasies and behaviors than general-population studies suggest. However, this inconsistency is mainly driven by the observations for male participants with ASD. This could be due to the fact that women with ASD are usually more socially adapted and show less ASD symptomatology. The peculiarities in sexual behaviors in ASD patients should be considered both for sexual education and in therapeutic approaches.

Objective: Zoophilia is a rare paraphilic disorder with intense sexual urges involving animals. Autism is characterised by impairments in social communication and repetitive, restricted behaviours (RRB). Reported cases of zoophilia are limited worldwide, and zoophilia in autism is rarer., Method: This is a case report describing this unique and relatively unrecognised association in a male adolescent from Sri Lanka., Results: A 17-year-old boy diagnosed with autism has average intelligence and academic capabilities. He had spent increasing time at his grandparents' cattle house. First, he was found masturbating near the cows and later having penetrative intercourse with a heifer. The shocked parents first sought traditional healing in the form of 'thovil', a demonic ritual of exorcist nature. Later, clinical evaluation found intense sexual urges towards cattle, which had led to marked distress and academic impairment. Sex hormone profile was normal. The adolescent was treated with a combination of cognitive-behaviour therapy and a selective serotonin reuptake inhibitor., Conclusion: We postulate that his persistent social difficulties contributed to the development of a paraphilic disorder. Unlike with his RRBs, he was markedly distressed about this sexual behaviour. Further research is required to explore this rarely reported, potential association.

Background and aims There are significant gaps in knowledge regarding the role of childhood adversity, interpersonal violence, and suicidal behavior in hypersexual disorder (HD). The aim of this study was to investigate interpersonal violence in hypersexual men compared with healthy volunteers and the experience of violence in relation to suicidal behavior. Methods This case-control study includes 67 male patients with HD and 40 healthy male volunteers. The Childhood Trauma Questionnaire - Short Form (CTQ-SF) and the Karolinska Interpersonal Violence Scale (KIVS) were used for assessing early life adversity and interpersonal violence in childhood and in adult life. Suicidal behavior (attempts and ideation) was assessed with the Mini-International Neuropsychiatric Interview (version 6.0) and the Montgomery-Åsberg Depression Rating Scale - Self-rating. Results Hypersexual men reported more exposure to violence in childhood and more violent behavior as adults compared with healthy volunteers. Suicide attempters (n = 8, 12%) reported higher KIVS total score, more used violence as a child, more exposure to violence as an adult as well as higher score on CTQ-SF subscale measuring sexual abuse (SA) compared with hypersexual men without suicide attempt. Discussion Hypersexuality was associated with interpersonal violence with higher total scores in patients with a history of suicide attempt. The KIVS subscale exposure to interpersonal violence as a child was validated using the CTQ-SF but can be complemented with questions focusing on SA for full assessment of early life adversity. Conclusion Childhood adversity is an important factor in HD and interpersonal violence might be related to suicidal behavior in hypersexual men.

Introduction: An increased risk of autistic traits in Klinefelter syndrome (KS) has been reported. In addition, some studies have shown an increased incidence of gender dysphoria (GD) and paraphilia in autism spectrum disorder., Aim: The aim of this study was to evaluate the presence of (i) paraphilic fantasies and behaviors; and (ii) GD symptomatology in KS., Methods and Main Outcomes Measures: A sample of 46 KS individuals and 43 healthy male controls (HC) were evaluated. Subjects were studied by means of several psychometric tests, such as Autism Spectrum Quotient (AQ) and Reading the Mind in the Eyes Revised (RME) to measure autistic traits, Gender Identity/GD questionnaire (GIDYQ-AA), and Sexual Addiction Screening Test (SAST). In addition, body uneasiness psychopathological symptoms were assessed using Symptom Checklist 90 Revised (SCL-90-R). The presence and frequency of any paraphilic fantasy and behavior was assessed by means of a clinical interview based on Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria. Finally, all individuals included were assessed by Wechsler Adult Intelligence Scale-Revised to evaluate intelligence quotient (IQ). Data from a subsample of a previous published series of male to female GD individuals, with the battery of psychological measures useful to provide a psychopathological explanation of GD in KS population available, was also considered., Results: When compared with HC, KS reported significantly lower total, verbal and performance IQ scores and higher SCL-90 obsession-compulsive symptoms (all P < 0.001). In line with previously reported findings, KS showed higher autistic traits according with both RME and AQ tests (P < 0.001). With respect to sexuality, KS showed a significant higher frequency of voyeuristic fantasies during masturbation (52.2% vs. 25.6%) and higher SAST scores (P = 0.012). A mediation role of obsessive symptoms on the relationship between Klinefelter and SAST was confirmed (unstandardized estimate b = 2.75, standard error = 0.43 P < 0.001). Finally, KS individuals showed significantly higher gender dysphoric symptoms than HC (P = 0.004), which were mediated by the presence of autistic traits (Sobel's test; P < 0.05)., Conclusions: KS is associated with hypersexuality, paraphilic behaviors, and GD, which were mediated by obsessive-compulsive and autistic traits., (© 2015 International Society for Sexual Medicine.)

Paraphilias are intense urges or behaviors involving non-normative sexual interests. The newly approved diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have established that, although paraphilias should not be regarded as inherently pathological, they ought to be qualified as paraphilic disorders if resulting in distress, impairment, or harm to the affected individual or others. Recent evidence documents that both phenomena can emerge as relatively uncommon iatrogenic consequences in Parkinson's disease (PD) patients. To outline the clinical characteristics of paraphilias and paraphilic disorders in PD patients, we summarized the available evidence on these phenomena. The review encompasses all studies on paraphilias in PD patients identified by a search on the Pubmed and Scopus online databases through May 2014. Twenty-two case reports on a total of 31 PD patients with paraphilias or paraphilic disorders were identified. These phenomena were typically associated with dopaminomimetic treatment (with a mean levodopa-equivalent daily dose of 1,303 ± 823 mg/d) in male patients with motor complications, young age at PD onset, and long disease duration. Paraphilias were highly concomitant with impulse-control disorders or dopamine dysregulation syndrome. Although evidence on paraphilias and paraphilic disorders in PD patients remains anecdotal, available data point to these phenomena as likely sequelae of high-dose dopaminomimetic treatment. Accordingly, the intensity of paraphilic urges is typically attenuated by the reduction of dopaminomimetic doses, sometimes in association with atypical antipsychotics. Failure to recognize paraphilic disorders may significantly impair the relational functioning of the affected PD patients. Practitioners should routinely inquire about paraphilias during their clinical assessment of PD patients., (© 2015 International Parkinson and Movement Disorder Society.)

Human sexual instincts can become fixated on a wide variety of targets, resulting in behaviours ranging from harmless fetishism to child abuse. The recent flood of investigations into historic cases in the UK has brought child protection issues to the top of the news agenda and shown that society is still far from addressing these problems in a rational, evidence-based way maximising harm reduction.

Introduction: As Parkinson's disease progresses, its non-motor manifestations become increasingly more apparent to the point where, in advances phases of the disease, they are the most important clinical symptoms. A very wide range of non-motor symptoms can appear in Parkinson's disease. Impairment of the urinary function and the sexual function (understood as the capacity to carry out sexual activity) can be seen as belonging to the dysautonomic disorders. Hypersexuality would be included within the group of impulse control disorders., Development: This study reviews the epidemiology, phenomenology and treatment of urinary disorders, sexual dysfunction and hypersexuality as non-motor symptoms of Parkinson's disease., Conclusions: Urinary disorders are the most frequent non-motor symptom in Parkinson's disease. They usually present as nocturia, urgency and increased mictional frequency (pollakiuria). Preferred treatment is with anticholinergic agents. Sexual dysfunction is a frequent complaint in patients with Parkinson. It has a multifactorial aetiology and is more frequent in males than in females. In males it manifests mainly as incapacity to achieve an erection, premature ejaculation or loss of the capacity to ejaculate, whereas in females the predominant signs are decreased libido, lowered arousal and difficulty in reaching an orgasm. Hypersexuality affects young males above all and has been related to the use of dopamine agonists.

Background: Several case series and reports describe paraphilia as occurring after brain damage, mostly in the frontal lobes and diencephalic structures. Hypersexuality and paraphilic behaviors are also documented in a variety of other neurologic disorders, (e.g., Kluver Bucy syndrome, and more rarely in multiple sclerosis). In multiple sclerosis, hypersexual behavior and paraphilias have been associated with various focal brain lesions in the frontal and temporal lesions when inflammatory demyelination involves the hypothalamus and septal regions., Case Report: A case of a patient who developed a particular and progressive sexual deviant behaviour after a head trauma. This men felt sexually aroused from seeing sleeping women as well as from taking care of their hands and nails while they were asleep. The patient was diagnosed with a moderate dysexecutive syndrome characteristic of a frontal disorder and a very specific parietal-related bodily self image disorder characterized by an incomplete mental image of his hands. The clinical hypothesis was that the paraphilia might be related to his post-traumatic disturbed bodily self image and more specifically to its related impulsive needs to complete his hands representation., Conclusions: This case report highlights the potential link between paraphilia, deviant and aggressive sexual behaviour, neurological disturbance and self-representation. The treatment of paraphilias remains very complex, and requires taking into account not only the social and psychological aspects of the disease, but also its organic dimensions.

Based on studies of heterosexual male fetishists, transvestites, and transsexuals, Blanchard (1991) proposed the existence of a hitherto unrecognized paraphilic dimension, erotic target location errors (ETLEs), involving the erroneous location of erotic targets in the environment. ETLEs can involve preferential attention to a peripheral or inessential part of an erotic target, manifesting as fetishism, or mislocation of an erotic target in one's own body, manifesting as the desire to impersonate or become a facsimile of the erotic target (e.g., transvestism or transsexualism). Despite its potential clinical and heuristic value, the concept that ETLEs define a paraphilic dimension is underappreciated. This review summarizes the studies leading to the concept of ETLEs and describes how ETLEs are believed to manifest in men whose preferred erotic targets are women, children, men, amputees, plush animals, and real animals. This review also describes ETLEs in women; discusses possible etiologies of ETLEs; considers the implications of the ETLE concept for psychoanalytic theories of transvestism and male-to-female transsexualism, as well as for the forthcoming revision of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; suggests reasons why the concept of ETLEs has been underappreciated; and describes what might result if the concept were more widely appreciated.

The aim of this study is to systematically review the published literature on pharmacotherapy for inappropriate sexual behaviors in dementia. Literature search of the 5 databases (PubMed, MEDLINE, EMBASE, PsychINFO, and COCHRANE collaboration) and the analysis of the data available for the pharmacotherapeutic treatments of inappropriate sexual behaviors in dementia were carried out. There are no published randomized controlled trials of pharmacotherapy for inappropriate sexual behaviors in dementia, but available data form uncontrolled trials, case series, and individual case reports suggest efficacy for antidepressants, antipsychotics, mood stabilizers, hormonal agents, cimetidine, and pindolol for the treatment of these behaviors. Although there are no controlled data for the treatment of inappropriate sexual behaviors in dementia, available data suggest efficacy for some commonly used pharmacotherapeutic agents.

The authors review the historical main milestones in the legislative aspects of sexual deviances, from ancient times through age of enlightenment to present times, including the factors affecting the Hungarian public attitudes towards it. The evolution of nomenclature of sexual orientation disorders is also evaluated thoroughly, detailing the DSM-IV-TR classification and the attempts and difficulties to further develop the present classification system. The authors also review the difficulties of epidemiological studies and sum up the pioneer work of Alfred Kinsey. The etiology of paraphylias is summed up based on biological, psychodynamic and learning theory approaches. Finally, the pharmacological and psychotherapeutic interventions are evaluated considering also comorbidity, outer control and forensic psychiatric aspects.

Disproportionately high rates of sexual revictimization have been noted among former victims of child sexual abuse (CSA), yet researchers have yet to determine the source of this apparent vulnerability to reexperience sexual violence. This study explores this issue by examining sexual self-esteem, sexual concerns, and sexual behaviors among 402 university women. Compared to women without a history of CSA (n = 348), women with a history of CSA (n = 54) had lower sexual self-esteem, poorer sexual adjustment, and were 2 times more likely to have experienced sexual assault since the age of 14 years. Structural equation modeling indicated that the relationship between child abuse (i.e., CSA and child psychological maltreatment) and sexual revictimization was partially mediated by sexual self-esteem, sexual concerns, and high-risk sexual behaviors. This study emphasizes the need for further research on child maltreatment, revictimization, and women's sexual adjustment.

There is very little professional information on paraphilia and aging in the literature. Much of the literature also is dated. This article explores paraphilias, sexual excitement, and fetishes, and their relationship in the aging population.

People discover rather than choose their sexual interests. The process of discovery typically begins before the onset of puberty and is associated with an increase in the secretion of sex hormones from the adrenal glands. However, the determinants of the direction of sexual interest, in the sense of preferences for the same or opposite sex, are earlier. These preferences, although not manifest until much later in development, appear to be caused by the neural organizational effects of intrauterine hormonal events. Variations in these hormonal events likely have several causes and two of these appear to have been identified for males. One cause is genetic and the other involves the sensitization of the maternal immune system to some aspect of the male fetus. It is presently unclear how these two causes relate to each other. The most important question for future research is whether preferences for particular-aged partners and parts of the male courtship sequence share causes similar to those of erotic gender orientation.

There is a growing consensus among clinicians that sex offenders represent a heterogeneous group of individuals. Assessment and treatment of sex offenders is complicated by phenomenological and etiological differences and the presence of psychopathology, including paraphilias. The authors discusses the most commonly employed psychosocial therapies for sex offenders in general. Pharmacologically based treatments for paraphilic sex offenders are also reviewed.

Background: Sexual dysfunction in patients with multiple sclerosis is typically characterized by diminished libido, erectile and ejaculatory dysfunction in men, and poor lubrication and anorgasmy in women. In contrast, hypersexual behavior and paraphilias are distinctly uncommon in this population of patients, but have been associated with various focal brain lesions., Patient and Methods: We describe a man with clinically definite multiple sclerosis who developed profound and abrupt disinhibition and paraphilic behavior during an exacerbation., Results: Neuroimaging revealed a marked increase in the number of enhancing lesions in the right sides of the hypothalamus and mesencephalon and extending into the right sides of the red nucleus, substantia nigra, and internal capsule. The altered sexual behavior was characterized by an obsessive and insatiable desire to touch women's breasts., Conclusions: Acquired sexual paraphilic behavior is uncommon in patients with multiple sclerosis but may occur when inflammatory demyelination involves the hypothalamic and septal regions of the basal prosencephalon. Our experience with this man illustrates the great difficulty involved in treating such patients when the paraphilic behavior becomes persistent.

This article reviews hypersexuality in individuals with neuropsychiatric disorders and its psychopharmacologic treatment. A brief review of the neurology, neuroendocrinology, and neuropharmacology of sexual behavior is presented. Literature describing the occurrence and treatment of hypersexuality in individuals with neuropsychiatric disorders is reviewed along with literature which discusses the pharmacologic treatment of individuals with hypersexual disorders in nonneuropsychiatric populations. Finally, a clinical algorithm for approaching and treating such disorders in a neuropsychiatric population is presented., (Copyright 2000 Copyright by W.B. Saunders Company)

A number of studies have suggested a relationship between sexually anomalous behavior and brain dysfunction. However, in most cases, the etiology of this dysfunction remains elusive. In this paper, alcohol exposure in utero (fetal alcohol syndrome) is offered as one possible explanation for the neurophysiological abnormalities that appear to characterize a notable proportion of individuals within the paraphilic and sexually aggressive populations. It is noteworthy that the teratogenic effects of alcohol upon humans and animals often leads to a number of the behavioral and physiological abnormalities exhibited by some of these individuals.

Axis I psychiatric disorders generally are considered incompatible with both the issuance and subsequent maintenance of aeromedical clearance certificates. Little doubt exists as to the impact that conditions such as anxiety disorders, mood disorders, or substance-related disorders have on the conduct of safe flight. Nevertheless, different compulsive sexual behaviors (CSBs), which now are thought to share similar origins and associated comorbidity, can similarly affect impulse control, judgment, concentration, and insight. Yet, these conditions frequently are handled administratively (if not legally). Moreover, in practice CSBs fall within a spectrum of behaviors from "normative" nonparaphilic sexuality to more deviant paraphilic behavior. Through the presentation of five selected cases seen at the Naval Operational Medicine Institute, this article explores examiner difficulty in establishing a diagnosis, discusses models useful in understanding the origins of these disorders, and highlights critical elements in establishing aeromedical disposition. The authors conclude that CSBs may be associated with anxiety, dysphoria, a pattern of increased risk taking, a high threshold for arousal, and poor judgment, which may impact the safety of flight. A comprehensive psychiatric evaluation is essential in determining aeromedical disposition, and consideration should be given to reviewing these cases from a medical perspective prior to any administrative disposition.

This article reviews the advances in pharmacotherapy of paraphilias. Antiandrogen hormones, phenothiazines, and lithium therapy of paraphilias is briefly reviewed. Pharmacotherapy of paraphilias with serotonergic drugs such as fluoxetine, clomipramine, sertraline, and fluvoxamine is reviewed in detail. In addition, the use of buspirone hydrochloride in paraphilias is discussed. The final focus of the article is on the etiologic theories of paraphilias and some practical advice for the pharmacotherapy and management of paraphilias.

The current study set out to investigate the structure, determinants, and relationship between lay theories of the etiology and efficacy of "cures" for four types of paraphilia: fetishism, pedophilia, sexual sadism, and voyeurism. One hundred and five participants completed a four-part questionnaire, which was divided into (a) demographic details, (b) perceptions of the etiology, (c) ratings of cure for each paraphilia, and (d) the Eysenck Personality Questionnaire. Previous studies of lay theories have demonstrated a clear and interpretable factor structure similar to that of explicit academic theories, as well as a clear and logical relationship between perceived etiology and cure. A similar structure was expected to emerge in this study, together with positive correlations between the various factors and personality type. A factor analysis revealed a clear and logical factor structure for etiology and cure items. Further, etiology and cure factors correlated strongly with each other but only moderately with demographic details and personality differences. These findings are discussed in relation to growing literature in the field.

By their very nature, disorders of sexual preference (ICD-10) or paraphilias (DSM IV) are bizarre patterns of sexual behaviour that have diverse manifestations and are of complicated sexual orientation. Some are harmless, others are sad, robbing sufferers and possibly their partners of loving sexual relationships. Psychopathology within this group of disorders may lead to criminal behaviour, ranging from infringement of decency to some of the most heinous crimes known. In a lifetime of practice no professional in any sphere of law or medicine will see a full cross-section of these conditions, as some are rare and they do not all present to one professional group. The nomenclature is confusing, with its Greek, Latin, French and Portuguese origins, together with eponymous terms. At least 40 different paraphilias have been named (Money, 1988) but these do not cover the full extent of the field.

In subhuman mammalian species, lovemaps are homogeneous and are more or less biorobotically fixed, whereas in the human species they are emancipated from biorobotism and are personalized, idiosyncratic, and heterogenous-as, for example, in the paraphilias. The evolutionary sexological hypothesis described herein proposes that emancipation of all of the biorobotic mindbrain maps, the mating map included, was essential for, and coincident with the evolution of the human speechmap from the songmap. Accordingly the first human language was a love song rather than a howl of warning. The bare essentials of sexuoerotic arousal and response are in three categories: haptoerotic (cutaneous), morphoerotic (visual), and gnomoerotic (narrative).

The role of serotonin in understanding suicidality, violence, impulse disorders, and paraphilias is described and the current state of our knowledge is reviewed. Clinical research in these areas will provide new understanding of behavior that leads to violations of the law. Forensic psychiatrists need to be more aware of these developments, and they must recognize that the uniqueness of their specialty lies in its clinical and research perspectives.

Sexually inappropriate conduct often accompanies the disinhibition associated with dementia and neuropsychologic deficits. Management of these behaviors is problematic and time consuming. We report two cases in which paraphilias responded to treatment with clomipramine. This effect was not due to the sexual side effects of the drug (e.g., decreased ability to sustain an erection or orgasm). Careful monitoring of the elderly patient is required during treatment with clomipramine, particularly with regard to orthostasis, the increased risk of falls, and worsened confusion secondary to the potential risks of anticholinergic delirium and toxicity.

People who sexually abuse children are diverse in terms of age, occupation, income level, marital status, and ethnic group. At one time it was believed that sex offenders could be easily categorized along three dimensions: offending against either adults or children; offending against either members of their families or against acquaintances and strangers; offending in noncontact ways (for example, exhibitionism) or through bodily contact. There is growing evidence that a number of offenders offend across these categories. Many child sexual abusers are themselves adolescents, and many adult offenders first offended when they were adolescents. A review of the literature reveals a paucity of controlled therapy outcome studies on the effectiveness of treatment, and existing uncontrolled studies are marked by methodological problems. This has led some to conclude that there is insufficient evidence to prove the effectiveness of treatment for child molesters. However, there have been major changes in treatment programs over the years, and some more recent studies provide reason for optimism about the effectiveness of current treatment methods for some offenders.

The Meese Commission Report claimed exposure to sexually explicit material leads to sex offenses and recommended examining developmental patterns and pornography experiences of offenders. This second phase of our study examines developmental patterns and sexually explicit material experiences of sex offenders, a subgroup of child molesters, and controls. Results indicate sex offenders (but not the child molester subgroup) began masturbating at a significantly younger age than controls. Sexually explicit material was used during the first masturbatory experience of 33.3% of sex offenders and 14% of controls. Child molesters were significantly older than controls when exposed to sexually explicit material. Frequency of adult use of sexually explicit material does not differ significantly among groups.

How one develops specific sexual interests (desires, eroticisms, orientation, lust, preferences, etc.) is a basic and essentially unanswered question in sexology. The present paper explores a theoretical relationship between the the development of specific sexual interests and those individuals complaining of lack of desire. The ability of traditional sex therapy to intercede successfully in these problems is discussed.

The term autogynephilia denotes a male's paraphilic tendency to be sexually aroused by the thought or image of himself as a woman. This term subsumes transvestism as well as erotic ideas or situations in which women's garments per se play a small role or none at all. This review article presents clinical examples of the lesser known types of autogynephilia (i.e., those in which the element of cross-dressing is secondary or entirely absent), sketches earlier attempts to label and conceptualize these phenomena, summarizes recent quantitative studies exploring the relationships between autogynephilia and other psychosexual variables (e.g., heterosexual attraction), and speculates on the etiology of autogynephilia and its relationship to transsexualism. It is concluded that the concept of autogynephilia is needed to fill a gap in our current battery of concepts and categories for thinking about gender identity disorders.

The author presents a phenomenological survey of the symptomatic, characterological, and transference manifestations observed in five male and five female patients who had spent the first three to twelve years of their lives in the parental bedroom. While chronic primal scene exposure is seen in these cases as not having produced any single specific psychopathological sequelae, certain sexual disturbances, split self-representation phenomena, etc., seem to have been primarily (though not solely) determined by these early exposures.

This paper deals with clinical material gathered from the long-term, psychoanalytically-oriented treatment of a patient with a shoe fetish. Genetic and dynamic aspects of this problem are emphasized. The combination of a dominating mother and a passive and absent father, the sharing of a bed with an older sister until age eleven, and the receipt of frequent enemas contributed directly to the development of the fetish, the most crucial determinant being the commulative traumatic effect of the enemas. During adolescence, the patient also resorted to transvestism to deal with the intensification of castration fears. Becoming a husband and father threatened to disrupt his tenuous defenses and forced him to seek therapy for two years, during which he was able to gain sufficient insight to forego the fetish and to engage in heterosexual activity in reasonably conflict-free manner. Previous theorectical contributions on the subject are included and theorectical issues are dealt with, particularly the role of the core fantasy of the phallic woman in the perversions.

The problem of bettering sexually deviant persons who have already incurred several penalties is of major importance in social as well as forensic respects. Since the departure from accepted sexual norms is believed by scientists to be due not only to an abnormal disposition, but to distinctive traits acquired at a very early age as well, attempts at treatment with suitable means should not at once be regarded as useless. The authors present a concept that integratevely combines suggestive and behavior-therapeutical methods, that is standardized to a certain extent, and that has yielded encouraging results in addition to being anything but time-consuming. This paper is aimed at colleagues interested in trying to help perfect this concept.

This is a representation of the developing of "Don Juan" from a dramatic figure into a prototype of a particular human behaviour. First was described a general view of the literary dramatic essay on this theme, of the philosophical, psychoanalytic, anthropological, sexual-pathological aspects of the figure of Don Juan and of "Don Juanism". Then a case of Don Juanism was discussed. The special characteristic style of sexual behaviour was not seen isolatedly, but was regarded as an expression of a special structure of social behaviour. Finally an attempt was made to depict the different interpretations of the figure of Don Juan within our cultural reach in a common perspective. The interpretation and evaluation of this phenonmenon essentially refer to the anthropological conception of v. Gebsattel and Giese.