Sexual Deviance. Theory, Assessment, and Treatment. Second Edition
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ANNALS OF CLINICAL PSYCHIATRY BOOKBOOK REVIEWS REVIEWS beginning of this review and provides SSexualexual DDeviance.eviance. TTheory,heory, a thoughtful critique of some issues. It starts by discussing defi nitional AAssessment,ssessment, aandnd TTreatment.reatment. matters and rightfully mentions that the DSM-IV-TR approach is an insti- SSecondecond eeditiondition tutional rather than scientifi c resolu- tion to the defi nition problem in this and other areas (as the authors note, SECOND EDITION of this encyclopedical volume— “there are no votes by the American both editors are psychologists and Chemical Association to determine there are only 4 MDs among the 50 whether oxygen or hydrogen is inside chapter authors. or outside this taxonomy” [p 1]). Th e The second, revised edition of authors and editors also are critical this book consists of 32 chapters. of development of treatments for The first 3 chapters—“Introduc- sexual deviations. Th ey say “we now tion,” “An integrated theory of sex- have a 50-year history of such treat- ual offending,” and “Sexual devi- ments, and it is entirely reasonable to ance over® Dowden the lifespan: reductions Health in Mediaask: What have we got to show for it? deviant sexual behavior in the aging Th e answer, sadly, is very little.” Th e sex off ender”—address some gen- authors state that we must do better Copyrighteral issues. All paraphilias, rape, and and suggest that we “ought to look Edited by D. Richard Laws and William T. For personal use only O’Donohue; The Guilford Press; New York, online sex off ending—including at a macro-organizational level and New York; 2008; ISBN 13: 978-1-59385- exhibitionism, fetishism, frotteur- plan strategies (as opposed to letting 605-2; pp 642; $70.00 (hardcover). ism, pedophilia, sexual sadism, sex- this remain a laissez-faire process) ual masochism, transvestic fetish- so that in the coming years more exual deviations or para- ism, voyeurism, rape, paraphilias progress will be made.” Th ey propose philias attract considerable not otherwise specifi ed, and online development of new interventions, S attention from the public, the sex off ending—are covered in 22 such as the self-regulation model, media, and law enforcement, yet are following chapters. Each of these the good-lives model, and desistance at the periphery of most psychia- paraphilias is addressed in 2 chap- (which unfortunately they do not trists’ interest. Th is is unfortunate ters, “Psychopathology and theory” explain very well). because like other sexual problems, and “Assessment and treatment.” Th e chapter on integrated the- these disorders—and for that matter, Th e remaining 7 chapters focus on ory of sexual off ending is the usual many mental disorders—are at the issues that usually are not addressed fare found in many textbooks and crossroads of biology, psychology, in general textbooks (2 chapters on encyclopedias—a lot of theory and and social sciences. Maybe because “Sexual deviance in females,” and no answers. On the other hand, the these disorders require a complex chapters on “Multiple paraphil- chapter on sexual deviance across therapeutic approach is the reason ias,” “Sexual deviance and the law,” the lifespan off ers more interesting for the lack of interest among psy- “Neurobiological processes and arguments. Th e authors propose that, chiatrists or maybe it is the lack of comorbidity in sexual deviance,” “although some individual traits and training and progress in research in “Medical models and interventions predispositions underlying sexual this area. It seems that other mental in sexual deviance,” and “Th e public deviance, such as sexual preferences health professionals are more inter- health approach: a way forward?”). or antisocial traits, may persist to the ested and involved in this area, as Th e Introduction addresses end of life, the expression or perfor- refl ected by the editors and authors some areas I touched upon at the mance of sexually deviant behavior 118 May 2009 | Vol. 21 No. 2 | Annals of Clinical Psychiatry For mass reproduction, content licensing and permissions contact Dowden Health Media. 1118_AACP050918_AACP0509 111818 44/14/09/14/09 33:36:04:36:04 PPMM ANNALS OF CLINICAL PSYCHIATRY BOOK REVIEWS decreases with age” (p 37). Th e chap- chapter on paraphilias not otherwise tioners are guided in what to look for, ter also contains a solid discussion of specifi ed contains an exhaustive list given encouragement and support to the well-known role of testosterone in and discussion of more and less known recognize and identify sexually inap- male sexual behavior. or sensational sexual deviations, from propriate conduct by females, and Chapters on particular sexual abasiophilia (lame or crippled con- given clear guidance on what to do deviances provide standard, well- dition of partner) to zoophilia. Th e in response” (p 504). Th e chapter on written summaries of each paraphilia, interesting discussion of online sexual sexual deviance and the law addresses its psychopathology, theory, assess- off ending includes the COPINE Scale issues such as the forensic relevance ment, and treatment, in many cases (as usual, COPINE is not defi ned)—a of sexual deviance, standards of prac- with not much to say. I will touch on a typology of Internet child pornogra- tice, diagnosis of sexual deviance in few interesting points only. For those phy images for the COPINE organiza- the forensic setting, and assessment not familiar with Kurt Freund’s theo- tion ranging from Level 1: Indicative of volitional impairment. Th e chapter ries and proposals,1 the discussion of to Level 10: Sadistic/bestiality. Th e on neurobiology, although well and his conceptualization of some devia- chapter also discusses the legal issue heavily referenced, does not provide tions as courtship disorders may be of “pseudoimages,” ie, digitally altered much new insight. interesting. Th e authors of the chapter images without a clear-cut identifi ca- Th is is a solid, worthwhile vol- on frotteurism summarize Freund’s tion of the subject. Th e discussion on ume for clinicians interested in para- theory of courtship disorders (p 137) treatment of online sex off ending is philias. It is well organized and con- as “aberrations of the behavioral inter- similarly interesting and important. tains a wealth of information. It is a actions that precede and initiate sex- Th e authors propose a useful typology useful addition to any mental health ual intercourse: 1) the fi nding phase, of cybersex users or “cybersex user clinician’s library or university librar- consisting of locating and appraising categories” (p 471-473), including ies as a reference book. Th e text has a potential partner (ie, voyeurism); 2) recreational users (some of them may its weaknesses, such as some overlap an affi liative phase, characterized by use cybersex to enhance their current among chapters. Th e biggest weak- nonverbal and verbal overtures such relationship), sexual harassers, dis- ness, in my opinion, is the lack of as looking at, smiling at, and talking to covery users, predisposed users, life- practical advice. Th is is not your prac- a potential partner (ie, exhibitionism); long sexually compulsive users, and tical manual to guide you when man- 3) a tactile phase, in which physical sex off enders. aging sexual deviances. Rather it is, as contact is made (ie, frotteurism); 4) Chapters on sexual deviations I wrote, a reference book. Maybe the a copulatory phase, in which sexual in women are useful and interesting. next edition could be more practical intercourse occurs (ie, rape).” Most of us might not pay attention to if we succeed in getting more infor- Some of the authors seem to paraphilias in women, as “paraphil- mation on the macro-organizational assume that the reader knows the ias are mostly a male aff air.” Interest- level and new strategies. Neverthe- defi nitions and theories and resort ingly, the majority of sexual assaults less, for anyone interested in this area, to analysis of various issues and pro- perpetrated by women are commit- the book is worth buying. cedures without describing them ted against young people (p 487). Th e Richard Balon, MD well. An example is Viewing Time, authors discuss various classifi cations Wayne State University an attractive alternative to measuring of “female abusers,” such as self-initi- Detroit, MI, USA penile tumescence in pedophilia. Th e ated abusers (“predisposed abusers” authors state that this test is easier to and “teacher/lovers”) and accom- REFERENCE 1. Freund K. Courtship disorders. In: Marshall WL, administer, but do not explain how panied abusers (“male-coerced Laws DR, Barbaree HE, eds. Handbook of sexual as- to do it—ie, show various pictures to abusers” and “male-accompanied sault: Issues, theories, and treatment of the off ender. New York, NY: Plenum Press; 1990:195-207. a suspected off ender and measure abusers”). Th e authors also suggest the time spent over various pictures that “rates of reported female sexual to classify the off ender’s interest. Th e off ending are likely to rise as practi- AACP.com Annals of Clinical Psychiatry | Vol. 21 No. 2 | May 2009 119 1119_AACP050919_AACP0509 111919 44/14/09/14/09 33:36:09:36:09 PPMM ANNALS OF CLINICAL PSYCHIATRY BOOK REVIEWS Dr. Fink emphasizes that “elec- EElectroconvulsivelectroconvulsive TTherapy.herapy. troconvulsive therapy has under- gone fundamental changes since A GGuideuide fforor PProfessionalsrofessionals its introduction 75 years ago. It is no longer the bone-breaking, aandnd TTheirheir PPatientsatients memory-stealing, fearsome treat- ment pictured in fi lms. Anesthesia, controlled oxygenation, and mus- Max Fink, who has been practic- cle relaxation make the procedure ing, studying, popularizing, and so safe that the risks are less than publishing about ECT for more those accompanying the use of sev- than half a century? He revised and eral psychotropic drugs.