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Money/Pranzarone, Para. in Child, 8/07/92.
Development of Paraphilia in Childhood and Adolescence
Child and Adolescent Psychiatric Clinics of North America: Sexual and Gender Identity
Disorders. July 1993, Vol 2 (3), 463-475.
John Money, PhD,* and G.F. Pranzarone, PhD+
*Professor Emeritus of Medical Psychology and Professor Emeritus of Pediatrics, The Johns
Hopkins University and Hospital; and Director, Psychohormonal Research Unit, The Johns
Hopkins University and Hospital, Baltimore, Maryland
+Professor of Psychology, Department of Psychology, Roanoke College, Salem, Virginia
Reprint requests to:
G.F. Pranzarone, PhD
Professor
Department of Psychology
Roanoke College
Salem, VA 24153-3794
(540) 375-2475
Development of Paraphilia in Childhood and Adolescence 1
Money/Pranzarone, Para. in Child, 8/07/92.
Synopsis for the Table of Contents
Paraphilias, formerly named perversions, are multivariate in origin and sequential in
development, beginning in childhood and coming into full flower in adolescence or later. Prior
to being practiced, a paraphilia exists in the ideation and imagery of dream and fantasy. Neither
male nor female can decide voluntarily to become a paraphile, nor to become not one. A
paraphilia is not caught by social contagion, e.g., from example or pornography. Rather it is
induced by noxious child-rearing experiences, nonsexual as well as sexual, that pathologize
normophilic development. There are upwards of forty named paraphilias.
Development of Paraphilia in Childhood and Adolescence 2
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Terminology
In the United States the age of childhood was changed from 16 to 18 by act of Congress
in 1984. In pediatric practice, childhood generally extends up to the age of puberty and the onset
of adolescence. Adolescence, by convention ends at 18 to 20 years, although it has been
extended up to the 25th year in some actuarial statistics.
This chapter addresses itself to the development of paraphilias in childhood, through
adolescence into adulthood. Although paraphilias are generally regarded as adult phenomena,
they have their antecedents in childhood. In prepuberty, a paraphilia is best characterized as a
protoparaphilia. It comes into full bloom in adolescence and adulthood.
To assure consensus of understanding, there are four formal definitions that follow.
Except for "gendermap" which is a new term, these definitions are taken from Money (1988,
Glossary), which can be consulted for additional definitions as required.
Paraphilia (Greek, para-, altered + -philia, or love beyond the usual): a condition
occurring in men and women of being compulsively responsive to and obligatorily dependent on
an unusual and personally or socially unacceptable stimulus, perceived or in the ideation and
imagery of fantasy, for optimal initiation and maintenance of sexuoerotic arousal and the
facilitation or attainment of orgasm. Paraphilic imagery may be replayed in fantasy during solo
masturbation or intercourse with a partner. Its antonym is normophilia.
The term sexuoerotic is used instead of sexual and erotic so as to provide a singular noun,
sexuoeroticism. Sexuoeroticism is a unity that combines events between the legs with events
between the ears. The singular term is a reminder that one should not consider the one without
saying something about the other.
In paraphilia, sexuoerotic functioning becomes biased or skewed with respect to, in
particular, the ideation and imagery of the proceptive phase, that is, the arousal phase of
sexuoeroticism. Paraphilia signifies that sexuoerotic arousal and orgasm are contingent on a
rehearsal in imagery and ideation of eccentric or unusual practices or rituals that may also be
carried out during masturbation or in actual behavior with a partner. No absolute criterion
standard exists by which to separate paraphilia as a personal, harmless and playful eccentricity,
from paraphilia as a social nuisance, or a noxiously morbid or lethal syndrome as is the case in
some extreme forms of paraphilic sadism. In current biomedical usage, paraphilia has largely
displaced the terms, perversion and deviancy. In legal usage, perversion still persists. In the
vernacular the synonym is kinky or bizarre sex. Some but not all paraphilias are criminalized.
Only a minority of the forty or more paraphilias come under the jurisdiction of the law. For
example, being paraphilically dependent upon being administered an enema for sexuoerotic
arousal and orgasm (klismaphilia) is not a criminal sex offense.
Normophilia (Greek, norma, carpenter's square, rule + -philia, love): the condition that
is antipodean to paraphilia. In normophilia there is no obligatory and immutable dependency on
Development of Paraphilia in Childhood and Adolescence 3
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a fixated partner, object, or ritualized activity. The possible range of acceptable and
sexuoerotically arousing activities is greater in a normophilic than in a paraphilic person. The
criteria of normophilia are not absolute but are variable, statistically, transculturally, and
ideologically. The ideological norm is imposed by those in power, be it parent, peer, clergy, or
police.
Gendermap: a developmental representation or template existing synchronously in the
mind and brain (mindbrain) and depicts the details of one's gender-identity/role (G-I/R)--the self-
identification as male or female and the culture's expectation of behavior for a male or female.
The gendermap includes the lovemap (defined below), but is broader than only specifying
sexuoerotic content insofar as the gendermap also incorporates whatever is gender coded
vocationally, educationally, recreationally, sartorially, and legally as well as in matters of
etiquette, grooming, body language, and vocal intonation.
Lovemap: a developmental representation or template synchronously in the mind and
brain (mindbrain) depicting the idealized lover, the idealized love affair, and the idealized
program of sexuoerotic activity projected in imagery or actually engaged in with the lover.
The lovemap is subsumed within the gendermap and comprises its sexuoerotic
component. The lovemap is always gender-coded as male, female, or to some degree
androgynous. The lovemap may be heterophilic, homophilic, or bisexual. It is usually quite
specific as to details of the physiognomy, build, race, color and demeanor of the ideal lover, not
to mention sports and academic achievement, financial status, and so on. Like native language, a
person's lovemap, like the face, fingerprints, or accent, bears the mark of his unique
individuality.
Human sexuoerotic diversity coded in the lovemap is comparable with, by analogy, with
the varieties of native language; both require the preparatory development in embryonic and fetal
life of a brain that is both healthy and human. The detailed coding and configuration of a native
language map, a gendermap, and a lovemap is mediated by and contingent on informational
input from the social environment through the senses - haptic, olfactory, and to some extent
gustatory, and predominantly auditory and visual. Input into lovemap development occurs from
the first pairbonding with the mother or caregiver possibly under the governance of the hormone
oxytocin (Pedersen et al., 1992, see p.122) through the limerent pairbonding affairs of the
adolescent period and later. In adulthood, gendermap and lovemap coding in the mindbrain is
complete and relatively immutable. Once a lovemap has formed it is, like a native language
map, extremely resistant to change. If changes should occur, as is possible in the years of
senescence, or after intercranial neuropathy or head injury, they do so chiefly by decoding what
has already been encoded.
Lovemap Development
Lovemap development is multivariate and sequential from conception, when the genetic
code is set down, through infancy, childhood, prepuberty, and adolescence into adulthood.
Development of Paraphilia in Childhood and Adolescence 4
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Development first begins with the differentiation of what will become the gendermap, which will
eventually include the lovemap as one of its components. Lovemap genesis is presently
understood only in terms of temporal sequences, not causal sequences. Lovemap development
as normophilic, hypophilic, hyperphilic, or paraphilic, is concurrent with the development of the
gendermap as masculine or feminine. Hypophilia signifies troublesome insufficiency or
incompleteness of sexuoerotic arousal and genital function, up to and including orgasm.
Hypophilic syndromes may be called the Masters and Johnson (1970) syndromes. Hyperphilia
signifies a vexatious excess of sexuoerotical arousal and genital function in either duration or
frequency. Hyperphilic syndromes are poorly named. They include nymphomania, satyriasis
and erotomania (the Clerambault-Kandinsky syndrome). Hyperphilia is also a secondary
characteristic of many of the paraphilic syndromes.
There is no evidence that paraphilia is preformed or ready made in the mindbrain at birth
except perhaps as a predisposition. When the lovemap develops so as to not be normophilic, it
may then be considered to have been marred, flawed, or damaged. It has then been called a
vandalized lovemap (Money & Lamacz, 1989). A paraphilia is the expression of a vandalized
lovemap, the details of which are the outcome of displacements, deletions, or inclusions of
sexuoerotic elements in the developmental coding of the lovemap from infancy through
prepuberty and later. Miscoding, or lovemap vandalization, is a stratagem for wresting triumph
from tragedy, in this case the triumph of saving carnal lust from the tragedy of extinction or
threat of extinction in the wake of sexuoerotic trauma (see below). The stratagem works by
disassociating carnal lust from affectional love.
Catch-22, Opponent-Process
At about age eight, children grasp the significance of the double entendre in jokes and
puns. They grasp also the significance of the no-win entrapment of the Catch-22 in which you're
damned if you do and damned if you don't take action. Sexologically, it is a Catch-22 to confess
or to not confess to having obtained forbidden sexual knowledge, or to having engaged in
prohibited sexual behavior, consensually or otherwise, especially in juvenile sexual rehearsal
play (JSRP). Children so entrapped are threatened with severe sanctions. To quit would bring
ostracism and agemate rejection. Not to quit brings the risk of parental discovery and reprisal.
To ask for help brings both consequences. Sex is thus a minefield of Catch-22s, namely either/or
propositions, with no compromise in between.
In the sexological development of childhood, the Catch-22s of sexual information or
pursuits generate unspeakable monsters which, being unspeakable, are monstrously traumatizing,
in many instances more so than the actual occurrence which must be kept hidden in silence. The
more intense the societal sanctions against what a child knows or has pursued sexuoerotically,
the more intense the power of the unspeakable monster, as in the case of incest, for example. For
a girl of eleven who becomes the lover of her father, the Catch-22 is to tell, say, the mother who
possibly will call her daughter a liar, or to tell the authorities and have her family torn apart, or to
tell nothing and endure the continuance of incest. The same may apply to a boy.
Development of Paraphilia in Childhood and Adolescence 5
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The penalties and penances that the adult world imposes on children for being entrapped
in a sexual Catch-22 constitute, albeit paradoxically, the most prevalent manifestation of child
sexual abuse and neglect, and the major source of errancy in lovemap development.
Not enough is known about the concatenation of factors that go into the development of a
paraphilically vandalized lovemap to make diagnostic predictions about which boy or girl, if
exposed to similar vandalizing experiences, will or will not emerge with a paraphilia. There are
no effective diagnostic tests. An allowance must be made, as aforesaid, for a vulnerability
factor, of which one example might be an intracranial neuropathy or history of head injury.
There is no established contingency between paraphilia and hormonal functioning. Pedigree
genetics are noncontributory. Chromosomal genetics may be contributory, notably in the
supernumerary Y syndrome (47,XYY) in males. A facility or propensity to experience the
opponent-process phenomenon (Solomon, 1980) also may be contributory.
According to opponent-process theory, the outcome of being caught in a Catch-22 is that
negative and aversive converts to positive and appetitive. In other words, aversion converts to
addiction, after which one repeats ad infinitum that which once was forbidden, prohibited, and
punished, no matter how dangerous or self-sabotaging. With the development of a paraphilic
lovemap: that which once was horrible and unthinkable flip-flops and enthralls. If the flip-flop is
into masochism, then the pain of being paddled and whipped that others would avoid becomes
transmogrified into erotic ecstasy.
To be smitten with a paraphilia is to be fixated on the partner and the paraphernalia of the
paraphilia. Fixation is an essential feature of the formula whereby a normophilic lovemap
converts to a paraphilic one: triumph is snatched from the jaws of tragedy, and carnal lust is
preserved, but at the cost of its separation from affectional love.
As paradoxical as it appears, corporal punishment may affect the genitals and their
sensations. In boys the evidence is visible, for they get a panic erection. The best explanation of
this reaction is in terms of an arousal of the autonomic nervous system that generalizes the
response to bodily injury from being noxious to being sexuoerotic.
A letter from a student in a British-style school in India, with a tradition of corporal
punishment, demonstrates an opponent-process transformation in the lovemap (Money, 1987,
p.273-274).
...During my schoolhood in a Christian missionary Anglo-Indian Institute in Calcutta we
were (all boys) often caned on our upturned, upraised buttocks by the headmaster (with his
attractive wife sometimes looking on and passing humiliating, sarcastic comments). Needless to
say, this brutalized our lovemaps and in certain cases brought about orgasms and a sickening
addiction to the rod and a good whipping.
I was nine when the canings began, and seventeen when I left school. For the others it may
have started earlier, slightly. I got sexual feelings from around the age twelve, especially if she
Development of Paraphilia in Childhood and Adolescence 6
Money/Pranzarone, Para. in Child, 8/07/92.
was watching. We usually collected five or six cuts of the cane, but once I got eighteen....
This addiction has resulted in certain friends hiring Anglo-Indian prostitutes to spank them.
One is going through a divorce because his wife can't stand an emotional, sexual cripple pervert,
and leper (her words, not mine)!.... Men should be trained in auto-eroticism and to accept their
buttocks/derriere and anus as means to pleasure themselves....
This account indubitably demonstrates the formula wherein tragedy becomes triumph.
Aversive pain becomes addictive pleasure. Lust is reconciled with hurt and humiliation by the
paradoxical erotization of suffering into the ecstasy of orgasmic masochism. The price of this
reconciliation is the severance of lust from pairbonded love. It is typical of paraphilia that the
affectional love partner (Madonna) and the carnal lust partner (whore) are not the same person.
That is why it is more accurate to say that paraphilias are affectional love disorders rather than
carnal lust or sex disorders.
As with any injury, a vandalized lovemap attempts to heal itself and function
sexuoerotically. Nevertheless, in the process it becomes scarred, skewed, and misshapen. Some
of the sexuoerotic features of the lovemap become, as aforesaid, omitted, some become
displaced, and some become replaced by substitutes that would not otherwise be included.
Omission of sexuoerotic features more likely transforms an ordinary heterosexual lovemap into a
hypophilic one, whereas displacements and inclusions of sexuoerotic features more often
transform it into a paraphilic or hyperphilic one, sometimes concurrently.
The paraphilic transformation seems at the time to be a satisfactory compromise. It
disassociates lust from its place alongside love in the lovemap, and relocates it. In the long run,
however, this relocation proves to be a compromise that is too costly. In a paraphilic lovemap,
lust is attached to fantasies and practices that are forbidden, disapproved, ridiculed or penalized,
in the extreme case with the death penalty.
Males are more likely to become aroused through vision, and females are more likely to
become aroused through the sense of touch. This sex difference is very likely phyletically
determined. Paraphilically its significance is that paraphilic imagery in males is highly visile,
whereas in females it is highly tactile. Another possibly related sex difference, not yet
adequately explained, is that paraphilias are more often reported in males than in females,
whereas in female’s hypophilias, especially anorgasmia predominate.
Taxonomy of Paraphilia
The human species is phyletically designed in such a way as to permit many variations in
the basic sexuoerotic imagery of mammalian mating. Whether heterophilic or homophilic,
normophilic, hypophilic, hyperphilic, or paraphilic, mating is subdividable into three phases:
proceptive (attraction and courtship), acceptive (bodily and genital union), and conceptive
(conception, gestation and parturition). Proceptivity in humans may be manifested as a species-
shared stereotypical ritual of courtship and of what is called foreplay. Human proceptivity exists
Development of Paraphilia in Childhood and Adolescence 7
Money/Pranzarone, Para. in Child, 8/07/92.
not only as behavior, but also as the rehearsal of that behavior in the totality of imagery and
ideation of dreams, daydreams, fantasies, and thoughts projected from an individual's lovemap.
This projection can be ascertained not only through observation, but also through verbal report.
Paraphilias are preeminently phenomena of proceptivity. Some paraphilic manifestations
are thematically simplex, and others are thematically duplex or multiplex, compounded with
features of two or more simplex ones merged into one complex whole. Paraphilias may occur
concurrently with heterophilia, or with the gender transpositions of transvestism, transexualism
or homophilia, or with neither heterophilia or homophilia. Whereas transvestophila (fixation on
cross-dressing for sexuoerotic arousal and orgasm) is one of the paraphilias, transexualism and
homophilia alone are not considered paraphilic.
The forty-plus named paraphilias are categorized under seven grand stratagems. The
term stratagem is used, rather than strategy, because a stratagem has the quality of a ruse or
trickery. It deceives and circumvents the enemies of lust, regardless of the costs, which may be
exorbitant. The taxonomy of the stratagems delineates what may happen to human beings as a
species so that the outcome is a paraphilic lovemap. The taxonomy does not, however, delineate
the personal ontogeny of paraphilic lovemap formation. The issue is not one of nature versus
nurture, but of nature and nurture converging and interacting at a critical period of development
and leaving persistent or immutable sequelae in the mindbrain lovemap.
The seven grand stratagems are as follows.
The sacrificial/expiatory stratagem requires reparation or atonement for the sin of lust by way of
penance and sacrifice.
The marauding/predatory stratagem requires that, insofar as saintly lovers do not consent to the
sin of lust, a partner in lust must be stolen, abducted, or coerced by force.
The mercantile/venal stratagem requires that sinful lust be traded, bartered, or purchased and
paid for, insofar as saintly lovers do not engage consensually in its free exchange.
The fetishistic/talismanic stratagem spares the saintly lover from the sin of lust by substituting a
token, fetish, or talisman instead.
The stigmatic/eligibilic stratagem requires that the partner in lust be, metaphorically, a pagan
infidel, disparate in religion, race, color, nationality, social class, or age, from the saintly lovers
of one’s own social group.
The understudy/subrogation stratagem requires one to rescue and deliver, another person from
suffering and being the victim of defiling lust, by nobly and altruistically taking that other
person's place.
The solicitational/allurative stratagem protects the saintly lover by displacing sinful lust from the
Development of Paraphilia in Childhood and Adolescence 8
Money/Pranzarone, Para. in Child, 8/07/92.
act of copulation in the acceptive phase to an invitational gesture or overture in the proceptive
phase.
For a complete exposition of the stratagems see Money (1986; 1988) and Money and
Lamacz (1989).
Juvenile Sexual Rehearsal Play (JSRP)
A cross-species examination of primate juvenile sexual rehearsal play (JSRP), reveals
parallels to the human experience. The role of JSRP is essential as an antecedent of normophilic
lovemap development.
In comparison with sheep, whose mating behavior is governed in large part by hormonal
preprograming of the brain before birth (Clarke, 1977), the mating maps or lovemaps of primates
at birth are relatively unfinished.
In the young rhesus monkey (Macaca mulatta), play, which includes JSRP, is an essential
precursor of successful breeding in adulthood. Rhesus monkeys deprived of JSRP by being
reared in social isolation grow up unable to position themselves for copulation, and so fail to
reproduce their kind (Harlow & Mears, 1979; Harlow & Harlow, 1962). By contrast, among
monkeys that were not totally isolated, but allowed a playtime as short as half an hour a day, one
third were successful in adult mating, but they were slow achievers and were poor breeders with
a low birthrate (Goldfoot, 1977).
Bonobos (Pan paniscus) are also known as pygmy chimpanzees. Their sexual behavior
is closer to that of human beings than is that of other primates (de Waal, 1989). As in the human
female, a female bonobo's sexuality is independent of her ovulatory cycle. Very young bonobos
are seen to engage in extensive JSRP with each other, both homosexually and heterosexually
(Small, 1992). These observations, together with comparable JSRP data on common
chimpanzees (Pan troglodytes), orangutans (Pongo pygmaeus abelii), and the immature wild
mountain gorilla (Gorilla gorilla beringei), support the thesis that JSRP is a species-typical
antecedent for the behavioral development of normophilia in the great apes (Nadler, 1984).
The contingency of normophilic lovemap development on JSRP in human children is no
exception to the primate pattern. Ethnographic evidence from societies that do not taboo
children's sexuoerotic development supports the cross-species evidence. In the majority, if not in
all of the children in these taboo-free societies, the lovemaps are normophilic and heterosexual
(Money & Ehrhardt, 1972). Paraphilias may be nonexistent as, indeed, appeared to be the case
in aboriginal Arnhem Land (Money, et al., 1970). Taken together, the primate and transcultural
human data suggest the essential role of JSRP for normophilia.
Lovemap development is vulnerable to vandalism by diverse traumas and stresses in
childhood that need not necessarily be explicitly sexual. For example, in the Kaspar Hauser
syndrome (Money, 1992) of psychosocial dwarfism induced by child abuse and neglect, the
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Money/Pranzarone, Para. in Child, 8/07/92.
incidence in adulthood (N = 16) of sexuoerotic disorders, including paraphilia, was 69% (N = 11;
Money et al., 1990). When the precipitating trauma or stress is identifiably sexual, it is
classifiable into four categories, namely, explicit neglect of attention to sexual learning and to
healthy JSRP; abusive punishment and humiliation of children for engaging in JSRP; premature
induction of children into JSRP out of synchrony with the developmental age; and coercion of
children into age-discrepant sexual rehearsal play, with or without inflicting bodily injury. Each
of these child-rearing policies fails to recognize JSRP as a statistically normal primate
phenomenon, and are effective in inducing lovemap pathology. They lend themselves to the
production of Catch-22 entrapments.
Clinical Retrospective Studies
Evidence for the childhood origins of paraphilia may be derived from retrospective
clinical studies. A childhood biographical history of the development of a paraphilic lovemap
may be reconstructed retrospectively from personal recall. Ideally, such experiences should be
authenticated with evidence such as confirmation from the recall of others. In forensic matters,
authentication is imperative. Retrieved memories are invariably subject to omission, distortion
and confabulation. Additional information may be found fortuitously preserved in the
pediatrician's record and confirmed in subsequent long-term follow-up. The clinic thus provides
preliminary evidence from which to develop hypotheses for future investigation. However, the
association of socioerotic events to paraphilic syndrome signifies only what is antecedent, as
subjectively construed, and not necessarily causal.
With surprising regularity, in the biographies of paraphiles, events experienced as
sexuoerotically traumatic are reported as having occurred at or around the developmental age of
eight. One is surprised at how often eight years of age, or thereabouts, emerges as a crucial age
for the incorporation of a paraphilic omission, intrusion or displacement into the developing
lovemap, so as to distort or vandalize it, as in the following examples.
For example, a woman told of abuse at age six by her stepmother who had beaten her
hands until they were "blood red and swelled up," to extract a confession of masturbation. At
age eight, the stepmother found the girl masturbating in the bathtub, accused her of being a "bad
little girl" with the boys at school, brought in a needle and thread, pricked the girl's labia, drew
blood, and said she would sew them up if she ever caught her doing it again. When the girl was
eleven, the stepmother died of cancer. Shortly thereafter, she was sexually abused by her
stepfather until her menses began. At age thirteen she ran away from the domestic trauma at
home and entered into collusional relationships and two marriages in which she manifested the
paraphilic syndrome of masochistic abuse-martyrdom, in which she in effect stage-managed her
own oppression and suffering at the hands of her partners (Money, 1981).
Antecedents even earlier than age eight in paraphilic fetishism may be implicated.
Fetishism is an example of an inclusion, namely of the fetish, into a lovemap, so that there exists
a fixation upon the specific object or material. Without the fetish, sexuoerotic arousal and
orgasm are impaired. Fetish objects are associated with infantile tactile or olfactory stimuli from
Development of Paraphilia in Childhood and Adolescence 10
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the human body. Fetishes are hyphephilic when they are akin in tactile quality to human skin or
hair. When they are akin to human odors, they are olfactophilic.
A median of nine years of age (N = 109, M = 10) was reported by Gosselin and Wilson
(1980) as the age of first awareness of sexuoerotic fixation to rubber in a sample of rubber
fetishists. Sargent (1988), a rubber fetishist and professional psychotherapist, recalled that his
earliest memory was of a woman playing with his penis by stroking it with soft rubber panties
and her long dark hair. As a child of two or so, he enjoyed the skin of his face, stomach and
penis coming into contact with the rubber sheet placed under the cotton one. He could date a gift
of rubber animals received on his third birthday.
Lovemap Mismatching
During the developmental years of JSRP, matching of the lovemaps for age synchrony
and image reciprocity has a healthy developmental outcome more often than does mismatching.
One of the primary criteria of matching, insofar as one can judge from the available evidence of
comparative ethnography and comparative primate ethology, as aforementioned, is age
synchrony. That is to say, early JSRP takes place predominantly between infants or juveniles
whose lovemaps are developing in synchrony. Primate young may learn from the sexual
activities of older juveniles, or of adolescents and adults, but they do so from the periphery, with
or without playful participation, rather than by reciprocating as an equal in status with the older
partner. Synchrony of lovemap age in reciprocal sexuoerotic rehearsal play continues through
the juvenile years, but may be less strictly adhered to with the approach of puberty.
Age-discrepant sexuoerotic interaction between children is, for the most part, rare, unless
one of the children involved has experienced overt sexual activity as in incest, or is exposed to
adult patterns of sexuoerotic expression. Being the younger partner in a pedophilic relationship
with a wide age discrepancy between the two partners is a setup for a Catch-22 dilemma. So
also is being the younger partner in an incest relationship. The child may then, when older,
reiterate what had happened by repeating it in interaction with a younger friend or relative. For
instance, a ten-year-old boy, reversing roles, engages sexually with his five-year-old cousin.
This behavior does not qualify as authentic paraphilic rapism, although erection, penetration, and
climax without ejaculation, may have occurred.
One criterion of lovemap matching in JSRP is male/female image reciprocity. In the
earliest years, however, male and female positioning is sex shared, and not sex discriminant.
That is to say, males and females may substitute for one another in cavorting around and playing
at presenting and mounting. Homosexual and heterosexual practice serves the same function at
the outset. In subhuman as well as human primates, heterosexual pairing progressively
predominates.
Prospective Clinical Studies
The logistics and costs of studying the development of paraphilia prospectively from
infancy onward in a randomly selected sample of children have, as of the present time,
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effectively ensured a dearth of early developmental incidence data from the population at large.
Through lack of identifying markers, it is not possible to assemble an at-risk infantile or juvenile
sample for a long-term, outcome study. The alternative is to record data on the sexuoerotical
development of children who have a variety of pediatric diagnoses which necessitate longitudinal
follow-up. Applying this strategy, Money, Annecillo and Lobato (1990) documented a
relationship between the Kaspar Hauser syndrome of abuse dwarfism in infancy and childhood,
and a syndrome of paraphilia in adolescence and later (see above). The same strategy applied to
a large clinical sample of children with an endocrine and/or congenital sex-organ defect yielded
seven biographies in which the postpubertal emergence of a paraphilia could be related to
prepubertal vandalization of the lovemap. In each case the child became trapped in a Catch-22
pertaining to the secret of his or her diagnosis and treatment. Each experienced some degree of
stigmatization in childhood. The paraphilias that appeared in the seven cases were, apart from
one case of pedophilia, variants of masochism.
Treatment
Antisexual taboos commit a society to obliterate in childhood the very sexuoeroticism
that it prescribes in adulthood as normal and necessary. A new and frightening antisexual
initiative is seen in the attempt to criminalize JSRP, and to punish and incarcerate juvenile
offenders. In the professional victimology literature, a new category of criminal deviant has
emerged, the very young juvenile sexual offender or child perpetrator. Child perpetrator
literature fails, however, to adhere to established tenets of scientific inquiry. It also attempts to
pathologize species-typical childhood sexual rehearsal play (Okami, 1992). In actuality it
surreptitiously reflects a backlash response to sexual emancipation of the 1960s and early 1970s,
the era of the so-called sexual revolution. This new trend toward treating all JSRP as criminal
behavior, if successful, will achieve a pathological outcome opposite from that intended.
Developing lovemaps will be vandalized by the trauma of the well-meaning but ill-informed
guardians of children's welfare. Thus, rather than diminishing the incidence of paraphilia, such
treatment will expand it exponentially from one generation to the next.
Depo-Provera (medroxyprogesterone acetate) has been extensively utilized in the clinic
for the effective treatment of paraphilias (Money, 1987; Lehne, 1988). The rationale for using an
antiandrogen is that it is able to lower the circulating androgen titers to the level of prepuberty.
There is a corresponding reduction in the frequency and intensity of paraphilic fantasies and
urges. For the male paraphile, treatment with Depo-Provera gives him the opportunity to gain
more effective governance over the expression of his paraphilia. In some patients, the effect of
Depo-Provera is augmented if used in conjunction with lithium carbonate, which in other
patients, has proved beneficial when used alone. Whereas Depo-Provera has provided relief for
adolescents whose paraphilic ideation, imagery and behavior are problematic, the use of Depo-
Provera has not been tried in juveniles. An alternative antiandrogenic hormone is Androcur
(cyproterone acetate), used in Europe and Canada, but not yet cleared by the FDA (Food and
Drug Administration) for use in the U.S.A. Pharmacologic therapy, to be maximally effective,
should always be accompanied by talking therapies, or counseling.
Development of Paraphilia in Childhood and Adolescence 12
Money/Pranzarone, Para. in Child, 8/07/92.
In addition to pharmacologic therapy with antiandrogenic hormone, some psychoactive
drugs have been anecdotally reported to be therapeutically successful in the treatment of
paraphilias in adulthood. These drugs include lithium carbonate (Cesnik & Coleman, 1989),
BuSpar (buspirone; Federoff, 1992), Prozac (fluoxetine hydrochloride; Bianchi, 1990; Perlstein
et al., 1991), and by verbal report Tegretol (carbamazepine), Clozaril (clozapine), and Zoladex
(goserelin). Recent reports on the relationship of oxytocin to sexuoerotic phenomena and its
relatedness to the pairbondance of lovers and the mother-infant bond (Pedersen et al., 1992)
suggest the experimental use of oxytocin and, possibly, oxytocin antagonists, for the treatment of
paraphilia. For the pharmacologic treatment of sexual disorders overall see Sitsen (1989).
Training therapies are those with an ancient history that derives from the reward and
punishment training of animal trainers, and a recent history that derives from conditional
reflexology and operant conditioning. Training therapies are subsumed under the generic name
of behavior modification and biofeedback. Their aim is to eliminate or modify symptoms. Their
use for the treatment of paraphilias is predominantly in correctional institutions. Their efficacy
over the very long term has not been tested.
Apart from institutional detention or foster home placement, the most common
intervention for the treatment of juvenile and adolescent protoparaphilia or paraphilia is some
form of talking therapy -- either individual, family, or group therapy. Free associative
(psychoanalytic) or nondirective psychotherapy is not compatible with the psychopathology of
the paraphilia, and is ineffectual. In conversational dialogue, however, protoparaphilic or
paraphilic juveniles and adolescents are able to be talkative, even voluble, provided they do not
encounter a finger-wagging response of blame and judgmentalism. They do not know why they
do what they do and are often quite interested in trying to figure it out. Since no one has a
complete answer to the why, only talking about it does not necessarily have a higher prevalence
of success than does waiting for a spontaneous remission and then offering rehabilitative support.
Talking is of help in the rearrangement of a life, especially after the disruption of a period of
detention. Ultimately, however, one looks forward to advances in molecular neuroscience and
neuropsychopharmacology to provide changes in the sexuoerotic malfunction of paraphilia, so
that talking treatments can be successfully superimposed.
The treatment of the individual alone is many times not as efficacious as treating the
individual within the family in family therapy or within a consortium of his peer relationships.
The group in group therapy is a consortium of people with the same or similar diagnosis.
Self-help groups which provide supportive rehabilitative environments, or opportunities
for troopbonding of individuals with shared dilemmas and interests do not exist for juveniles or
adolescents who are developing or have developed a paraphilia. Support groups that do exist are
informal and semi-underground networks of adults who have identified one another as sharing a
common paraphilia. The oldest of such organizations are for transvestophiles, but similar
organizations are known to exist for apotemnophiles (those who have a sexuoerotic fixation on
stumps of amputees), klismaphiles (whose fixation is on enemas), sadomasochists (some of
whom are fixated on genital mutilation), and pedophiles. One threat to these self-help support
Development of Paraphilia in Childhood and Adolescence 13
Money/Pranzarone, Para. in Child, 8/07/92.
groups is that their mail, phone, and computer bulletin board services are scanned by the criminal
justice system. Thus it is virtually impossible for older paraphilies to underwrite help or offer
support to adolescents and juveniles undergoing the same sufferings as they themselves once did.
The extent to which sexology professionals can get involved in advancing research on
paraphilias and providing preventive and protective services for juveniles and adolescents is,
today, severely limited by lack of funding. In addition, public opinion favors criminalization
rather than medicalization of paraphilia.
Prevention
The ultimate culprit responsible for paraphilia in the lovemap is the powerful
antisexualism of the sexual taboo to which our society is heir. The sexual taboo can also be held
responsible for the failure of medical institutions to establish specialty clinics in pediatric and
ephebiatric (adolescent) sexology. In consequence, there is no agreed upon body of scientific
and medical knowledge by which to gauge whether a child's lovemap is developing
normophilically or paraphilically. Correspondingly, there is no agreed-upon method of effective
corrective intervention in the developmental years of childhood. There is also no public health
policy for the ultimate eradication of paraphilias in society. Both the prevention and the
correction of lovemap errors during childhood are still at the trial-and-error stage.
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