SCIENCE / MEDICINE : Paraphilia Spans Extremes of Sexual Disorders : Mental illness: Unusual behaviors range from obscene phone calls to rape and child abuse. Their cause may lie in the brain, not immorality.
It takes a tragedy like the abrupt end of a successful, decade-long presidency at a major university to focus public attention on the problems of unusual sexual behaviors that, in the extreme, are considered to be a form of mental illness.
Recently, it was disclosed that Richard E. Berendzen, 51, resigned as president of American University because of accusations that he made obscene phone calls to women running day-care centers in Northern Virginia. No formal charges have been filed against him.
Berendzen is now undergoing treatment at the sexual disorders clinic at Johns Hopkins University School of Medicine in Baltimore. At his request, the hospital has declined to release any information about his treatment or condition.
Society once viewed behavior such as making obscene phone calls in moral terms, calling it a sexual deviation or perversion. Mental health experts who study sexual disorders now refer to a range of problems from voyeurism to sexual violence by the scientific term, paraphilia.
Broadly defined, paraphilias are sexually arousing behaviors that for most people are repulsive and not sexually gratifying. In extreme forms, they include having sex with animals, sexual abuse of children and rape.
Some paraphilias, however, are considered harmless. They may involve wearing a certain piece of clothing or a special smell. Although there are no reliable statistics about how many people suffer paraphilia, John Money, a clinical psychologist who has pioneered the treatment of sexual disorders, said that although he believes that serious paraphilias are rare, “the minor ones that don’t hurt anybody probably are intensely common.”
Obscene phone calls are not uncommon. C&P; Telephone Co. reports that 22,000 complaints about such calls were filed last year in the Washington area; many more are never reported to authorities. Most callers, experts say, never take any action beyond just making a phone call.
The majority of paraphilics are men, and much of what is known about paraphilias comes from studies of sex offenders identified by the criminal justice system. Experts agree that there are female paraphilics as well, but little is known about them.
In the last few years, scientists who study sexual behavior have begun to trace the origins of paraphilias to suspected physical changes in the brain and to sexual or emotional trauma usually experienced during childhood.
“I think that we are just learning that people who commit these crimes are not necessarily just sex perverts or oversexed or morally degenerate, but they have neuropsychiatric problems,” said Eli Coleman, a psychologist in the human sexuality program at the University of Minnesota School of Medicine in Minneapolis.
The evidence for a brain abnormality is preliminary. Some paraphilias may be related to hormone systems within the brain, Money said.
In a recent study of only one patient, Ronald Langevin at the Clark Institute in Toronto used radioactive tracers to show a difference in brain activity between a man diagnosed as being a sadist and two normal volunteers.
Some researchers see a parallel between certain paraphilias and obsessive-compulsive disorders. In studies of obsessive-compulsive patients, Judith L. Rapoport, a psychiatrist at the National Institute of Mental Health, has shown that there are neurological alterations in parts of the brain. Some patients respond to drug treatments that alter the biochemistry of the brain and relieve the need to repeat obsessive-compulsive behaviors, such as frequent hand-washing.
Paraphilias may be related to obsessive-compulsive disorders in which “reason and rationality are lost,” said Coleman. “When the behavior is compulsive, it is driven by an attempt to reduce stress.”
For some paraphilics, the behavior “may initially be driven by the sexual excitement and may still have some of that element. But the primary motivation is the reduction of stress and anxiety,” he said. “There is usually a short-lived feeling of relief, followed by the recurrence of the anxiety. So the person is compelled to seek the behavior again and again. It is overwhelming.”
Traditionally, scientists have believed that compulsive sexual behavior has psychosocial roots that reflect a major problem within the person’s emotional makeup.
Studies of people with sexual disorders suggest that problems may arise not only from childhood sexual abuse or trauma but in families where sex was either never discussed or regarded as evil. In these cases, normal erotic development was blocked.
Paraphilics commonly share certain characteristics. They tend to have low self-esteem. Many are extremely angry at women and have great difficulty with intimacy, especially when it becomes erotic.
Individuals with serious sexual disorders may exhibit more than one type of paraphilic behavior, according to Judith V. Becker, director of the sexual behavior clinic at the New York State Psychiatric Institute in New York City. She studied 500 male sex offenders who had been arrested and were at the clinic for treatment. The men volunteered to be part of the study that examined all aspects of their sexual behavior.
“When a person engages in one type of paraphilic behavior, there might be some other sexual disorders also,” she said.
Becker’s research focuses only on the most serious sexual disorders, so it cannot be generalized to all paraphilics. Most researchers in this field see paraphilias as a continuum of behavior much like addiction to alcohol or drugs.
Treatments for paraphilics range widely, from traditional psychotherapy and group therapy to highly aggressive, confrontational approaches that force the paraphilic to face the impact of his activity on others.
Therapy is also aimed at making sex offenders aware of feelings of their own that may be hidden, said William Samek, a sex therapist in private practice in Miami.
“They are trying to escape their anger, their hostility, their insecurity, their fear of rejection, their dislike of themselves,” Samek said.
Mental health experts have begun using different kinds of drugs, in addition to psychotherapy, to help change paraphilic behavior.
“We have some promising evidence to indicate that drugs for obsessive-compulsive disorders are effective,” Coleman said. These include fluoxetine (Prozac), a new antidepressant drug that helps reduce obsessive behavior.
