A Case Series of Women Evaluated for Paraphilic Sexual Disorders
Fedoroff, J. Paul, Fishell, Alicja, Fedoroff, Beverley, The Canadian Journal of Human Sexuality
ABSTRACT: The scientific literature on paraphilias has focussed almost exclusively on men. When women whose behaviour might imply paraphilia are discussed, it is mainly in terms of their victimization at the hands of men with paraphilic disorders. The purpose of this report is to review the current literature on female paraphilias and to present the clinical features of 14 women who sought treatment for presumed paraphilic sexual disorders. Social and personal history characteristics of the 14 women were compared to those of 118 men similarly assessed for presumed paraphilic sexual disorders. The 12 women classified as having at least one paraphilia were similarly compared with an age-matched subsample of these men with diagnoses of paraphilia. Cases were drawn from the clinical records of a Forensic Psychiatrist who has conducted outpatient clinics for assessment and treatment of paraphilic disorders in three countries. The three most common paraphilic disorders in the female study group were: pedophilia (36%), sexual sadism (29%), and exhibitionism (29%). Co-morbid psychiatric disorders diagnosed among these women included major depression (36%), generalized anxiety disorder (14%), post traumatic stress disorder (7%) and erotomania (7%). There were no significant differences between women and men in terms of age, number of victims, employment status, sexual orientation, education, history of substance abuse, history of non-sexual criminal behavior, history of personal sexual abuse, frequency of incestuous assaults, or referral source.
Key words: Paraphilia Sexual disorder Female
Since most of the research on paraphilias is derived from studies of convicted sex offenders, and since most convicted sex offenders are male, there is a clear research bias excluding females. Of the reports on females with paraphilias, most have involved selected single case reports of particularly unusual cases (e.g., Richards, 1990; Sass, 1975; Zaviacic, 1994); or studies involving reports by convicted male sex offenders of their childhood experiences allegedly involving female offenders (e.g., Groth & Burgess, 1980). Books that might be expected to deal with the issue of female paraphilias do not address the topic (e.g., Anderson & Struckman-Johnson, 1998; Bjorkquist & Niemela, 1992). When women are discussed, it is mainly in terms of their involvement in paraphilic activities at the behest of men with paraphilic disorders (e.g., Hazelwood, Warren, & Dietz, 1993; Warnes, 1986). This situation suggests a bias against the study of paraphilias in women in terms of both research and diagnosis.
For example, the text of the American Psychiatric Association Diagnostic and Statistical Manual (DSMIV) indicates that:
Except for Sexual Masochism, where the sex ratio is estimated to be 20 males for each female, the other paraphilias are almost never diagnosed in females, although some cases have been reported (DSM-IV, 1994, p. 524).
Eight specific paraphilias are listed in the manual, together with a ninth category, "paraphilia not otherwise specified" (see Table 1; for diagnostic criteria and definitions pertinent for the present study, see Methods section). Of the nine subcategories of paraphilias listed in Table 1, the DSM describes two of them (exhibitionism and frotteurism) using the masculine pronoun. In addition, the diagnostic criteria for transvestic fetishism require that the individual not only be male, but also heterosexual. The DSM-IV thus reinforces the widespread acceptance in sexology that paraphilias in women are rare to nonexistent. There are, nevertheless, historical case reports of women who appear to meet the criteria for every known paraphilia (see Fedoroff & Fishell, in press), including (with the exception of being female) transvestic fetishism (Stoller, 1982). Evidence of paraphilias in women is also reflected by reports in the non-academic literature (e. …