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A sex caused inconsistency in DSM-III-R: the definition of mental disorder and the definition of paraphilias.

The DSM-III-R definition of mental disorder is inconsistent with the DSM-III-R definition of paraphilias. The former requires the suffering or increased risk of suffering some harm while the latter allows that deviance, by itself, is sufficient to classify a behavioral syndrome as a paraphilia. This inconsistency is particularly clear when examining the DSM-III-R account of a specific paraphilia, Transvestic Fetishism. The author defends the DSM-III-R definition of mental disorder and argues that the DSM-III-R definition of paraphilias should be changed. He recommends that the diagnostic criteria for specific paraphilias, particularly that for Transvestic Fetishism, be changed to make them consistent with the DSM-III-R definition of mental disorder.

Female↗

Hormone and hormonal agents in the treatment of aggression.

Evidence for the role of androgens in the male aggressive and sexual behavior is reviewed. Medroxyprogesterone acetate (MPA; Provera, Upjohn) has a marked antiandrogen property; it is effective in lowering the testosterone level and controlling certain otherwise intractable sex deviations. The finding in 6 patients treated for sex deviation are summarized. The effects of MPA in the treatment of 11 temporal lobe epileptics and 5 other patients with severe angry-aggressive behavior disorder are reported. Most temporal lobe epileptics responded well to MPA. Weight gain and earlier sleep were consistent side effects. The values of plasma testosterone, serum luteinizing hormone, and urinary 17-ketosteroids were decreased by the treatment. Four patients were XYY individuals with lack of control over their sexual-aggressive or angry-aggressive impulses.

17-Hydroxycorticosteroids↗

Pedophilia occurring after onset of cognitive impairment.

Four married patients are reported who first manifested pedophilia and other signs of disinhibition after sustaining illnesses that led to cognitive impairments. Although pedophilia may often be related to a long-standing inadequacy of sexual functioning, the onset of pedophilia in an individual without a previous histroy of sexual perversion may indicate the presence of recently sustained cognitive impairments.

Adult↗

The sexually exploited child.

Sexual exploitation of children (under 14 years of age) is a common occurrence, although actual numbers are unknown. There are three major forms of sexual abuse: (1) incest, ie, sexual activity between consanguineous family members; (2) sexual assault, such as rape or molestation by adults not related to the child; and (3) habitual sexual exploitation for purposes of financial reward or perverse sexual satisfaction. Brother-sister incest has the highest incidence in the middle and upper socioeconomic levels and is probably the least damaging, psychologically, to sexual adjustment later in life. Father-daughter incest is more common in the lower socioeconomic levels and is thought to produce major disorders in the psychosexual area. Sexual assault of children, if handled supportively and with understanding by the surrounding adults, including parents, physicians, teachers, law enforcement officers, and others, can result in minimal sequelae; however, often the situation is handled with emotional reactions ranging from disgust to hysteria which result in the child's being victimized and traumatized unnecessarily. These latter situations lead to sexual acting-out in adolescence, promiscuity, perversions, or frigidity in adult sexual life. Teachers, physicians, and child welfare workers need to be attuned to the possibility to sexual abuse in the children they serve.

Adaptation, Psychological↗