Emotional, Physical and Sexual Abuse: Impact in Children and Social Minorities

115 Pages·2014·1.21 MB·English

by  Giovanni Corona

Emotional, Physical
and Sexual Abuse
Impact in Children
and Social Minorities
Giovanni Corona
Emmanuele A. Jannini
Mario Maggi
Editors
123
Emotional, Physical and Sexual Abuse
ThiSisaFMBlankPage
Giovanni Corona (cid:129) Emmanuele A. Jannini (cid:129)
Mario Maggi
Editors
Emotional, Physical and
Sexual Abuse
Impact in Children and Social Minorities
Editors
GiovanniCorona EmmanueleA.Jannini
EndocrinologyUnit DepartmentofSystemMedicine
Maggiore-BellariaHospital UniversityofRomeTorVergata
MedicalDepartment Rome
Azienda-UslBologna Italy
Bologna,Italy
MarioMaggi
SexualMedicineandAndrologyUnit
UniversityofFlorence
Florence
Italy
ISBN978-3-319-06786-5 ISBN978-3-319-06787-2(eBook)
DOI10.1007/978-3-319-06787-2
SpringerChamHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2014945566
#SpringerInternationalPublishingSwitzerland2014
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Preface
Emotional, physical, and sexual abuse may have devastating effects on victims.
This is particularly true when victims are socially vulnerable individuals, such as
children,disables,orsexualminorities.Emotionalandphysicalabusehasacorro-
sive impact on mental health and well-being, exacerbating the low self-esteem,
poorcopingbehaviors,andsocialrelationshipsofindividuals.Indeed,sexualabuse
whenoccurringinacrucialperiodfordevelopingemotion,matureself-representa-
tion, personality and social relationship—such as childhood is—may result in
severesexualandmentalhealthdisorders.
Prevention of offences towards these vulnerable categories includes social
educational plans. However, when offenders suffer from a paraphilic disorder, a
comprehensive approach based on psychological and medical treatment (such as
hormonalcastration)isrecommended.
The present book describes the characteristic of maltreatment towards socially
frail individuals focusing on both victims and perpetrators aspects. Moreover, it
illustratessocialandtreatmentinterventionsaimedtodecreasetherecidivismrisk
ofabuse.
Florence,Italy AlessandraD.Fisher
v
ThiSisaFMBlankPage
Contents
1 Pedophilia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
AbhiShetty,AyanangshuNayak,RayTravers,HasitVaidya,
andKevanWylie
2 TreatmentofParaphilicSexOffenders. . . . . . . . . . . . . . . . . . . . . . 17
AlessandraD.FisherandMarioMaggi
3 NegativeAttitudestoLesbiansandGayMen:Persecutors
andVictims. .. . . . . . . . . .. . . . . . . . . .. . . . . . . . . .. . . . . . . . . .. . 33
VittorioLingiardiandNicolaNardelli
4 Transphobia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
ElisaBandiniandMarioMaggi
5 SexualAbuseandSexualFunction. . . . . . . . . . . . . . . . . . . . . . . . . . 61
AlessandraH.Rellini
6 ChildhoodSexualAbuseandPsychopathology. . . . . . . . . . . . . . . . . 71
GiovanniCastellini,MarioMaggi,andValdoRicca
7 AtypicalSexualOffenders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
DanieleMollaioli,ErikaLimoncin,GiacomoCiocca,
andEmmanueleA.Jannini
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
vii
1
Pedophilia
Abhi Shetty, Ayanangshu Nayak, Ray Travers, Hasit Vaidya,
and Kevan Wylie
1.1 Introduction
Very few topics of public debate evoke as many feelings of revulsion and moral
disgust as pedophilia. Practising clinicians are not immune from such reactions.
Publicperceptionisinfluencedbymediastoriesofpedophilerings,extremeabuse,
maltreatmentandsignificantharmincludingmurderofchildrenbyadultswhoalso
hadsexualcontactwiththem.Itishenceimportanttodistinguishpedophiliafrom
pedophilicdisorderasdefinedbytheDiagnosticandStatisticalManualofMental
DisordersFifthEdition(DSM-5)[1]anddifferentiatethisfromchildsexualabuse
whichisfocusedonharmcausedtothechild[2].
Pedophilia and pedophilic disorder are psychiatric diagnoses according to the
International Statistical Classification of Diseases and Related Health Problems
10thRevision(ICD-10)andDSM-5,respectively.Itiscategorisedasa“disorderof
adultpersonalityandbehaviour”intheICD-10underthesubcategoryof“disorder
ofsexualpreference”[3].ICD-10definesitasasexualpreferenceforchildren,boys
orgirls orboth, usually of prepubertal or early pubertal age [3].DSM-5 classifies
thisasaparaphilicdisorder(i.e.sexualpreferencedisorder)andconfinesthesexual
A.Shetty(*)•A.Nayak
LiaisonPsychiatry,SheffieldHealthandSocialCareNHSFoundationTrust,
NorwoodGrangeDrive,Sheffield,SouthYorkshireS57JT,UK
e-mail:[email protected];[email protected]
R.Travers•H.Vaidya
ForensicDirectorate,RotherhamDoncasterandSouthHumberNHSFoundationTrust,
TickhillRoad,Doncaster,SouthYorkshireDN48QN,UK
e-mail:[email protected];[email protected]
K.Wylie
SexualMedicine,SheffieldHealthandSocialCareNHSFoundationTrust,75OsborneRoad,
Sheffield,SouthYorkshireS119BF,UK
e-mail:k.r.wylie@sheffield.ac.uk
G.Coronaetal.(eds.),Emotional,PhysicalandSexualAbuse, 1
DOI10.1007/978-3-319-06787-2_1,#SpringerInternationalPublishingSwitzerland2014
2 A.Shettyetal.
preference in pedophilia to prepubertal children only and defines this as children
generallyaged13yearsoryounger[1].
This chapter aims todescribevariouscharacteristics ofthis paraphilicdisorder
includingitsdefinition,subtypes,currentdiagnosticcriteria,genderbias,onsetand
course, epidemiology, aetiology and its assessment. As pedophilia is closely
associated with crimes against children as well as significant public stigma espe-
cially in recent times this aspect will also be briefly explored. Fictionalised case
vignettes will be presented to illustrate the problem further. Therapeutic concerns
willbeaddressedinthenext chapter.Theconsequencesofchild sexualabuse are
addressedinsubsequentchapters.
Much of what we know about pedophilia is through studies of clinical
populations particularly of child sexual offenders in prison or forensic settings.
Mostofthesestudiesinvolvemenonlyandhaverelativelysmallsamplesizes.As
noted by Quinsey (1986), identified pedophile offenders are almost always male.
Almostnothingiswrittenaboutwomenwhocommitincestuousandnon-incestuous
sex crimes [4]. There are some population-based surveys based on anonymous
responses from predominantly male college students but some have female
respondents as well. Hence any scientific discourse on pedophilia is essentially
limited by its lack of generalisability. It also suffers from minimisation and
concealment bias due to potential stigma and fear of self-incrimination among
studyrespondents.
1.2 Definition, Subtypes and Diagnostic Criteria
Krafft-Ebing’s Psychopathia Sexualis in 1886 was one of the early publications
wherepedophiliaasadiagnosticterminologywasmentioned (pedophilia erotica)
[5]. He had classified pedophilia as a “sexual perversion” based on
non-procreationalnatureofthesexualcontact[5].ThisVictorianmedicalpsycho-
pathologyconstructedamalefiguredrivenbyforcesbeyondhiscontrol.Itdidnot
placeafemalevoiceinthenarrative[6].Onepartofhiscasedefinition,however,
survivestothisdayasacentralfeatureofthiscondition,namely,thatitisasexual
preference disorder. DSM-5 reminds the reader that Paraphilic Disorders occur
almost exclusively in men [1]. DSM-5 retains the diagnostic criteria of DSM-IV-
TR [7] but makes the important distinction between pedophilic disorder from
pedophilicsexualinterestonly(satisfyingCriterionAonlyinTable1.1)[1].Cur-
rently,allthreeparameters(CriteriaA,BandCinTable1.1)havetobefulfilledfor
the diagnosis of a pedophilic disorder. Individuals who have predominant or
marked sexual interest in children but do not show any subjective or objective
evidence of personal distress, of functional limitation or of having acted on their
interestsarenownotconsideredtobementallyillbuttohaveapedophilicsexual
orientation[1].
BothICD-10andDSM-5criteriaforthisconditionarenotwithoutcontroversies.
Much of the debate has focused on distinguishing mental disorder from illegal or
immoral behaviour [8]. Most individuals with pedophilia do not voluntarily seek