The diagnosis is made when the cross-dressing is associated with sexual arousal. It is a part of the person’s urges, fantasies, and behaviors. Some will have intense distress because of this. It needs to be present for a minimum of six months. Most cross-dressers do not request treatment unless their spouse is markedly distressed. Support groups and psychotherapy can be helpful in treating the disorder. There is an increased risk of substance abuse, depression, and gender dysphoria in this group. There are no drugs that can be used for this problem. Exhibitionism is the achievement of sexual arousal through exposure of one’s genitals to an unsuspecting stranger. There may also be the desire to be observed by others when they are sexually active. The person who acts on these urges is considered to be engaging in illegal activity. Not every exhibitionist meets the criteria for a paraphilic disorder. It requires a victim or interpersonal distress or impairment in functioning. This is true of all paraphilias. About 2 to 4 percent have this disorder, which is rare in females. The media in fact sanctions some exhibitionism in females. Masturbation can be a part of the exposure process and there often needs to be some type of shock factor. The victim is often a child of either gender or a female adult. Actual contact is not usually desired. Exhibitionism has a high recidivism rate with up to 50 percent arrested again. Most of these men are married but often do not have a healthy marriage. Conduct disorder and antisocial personality disorder are more common with this disorder. Those who want to be sexually observed usually are not looking for a shock factor but wish for consenting adults to watch. Some will make pornographic videos. The treatment involves SSRI drugs, support groups, and psychotherapy. Antiandrogens to reduce libido have often been found to be effective in treating the disorder. Patients are monitored through arrest records and penile plethysmography.
SOME SPECIFIC PARAPHILIAS These are a few of the many specific paraphilias: •
Algolagnia—this involves attraction to pain associated with an erogenous zone.
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