Deck 14: Sexual Dysfunctions, Gender Dysphoria, and Paraphilic Disorders

Question 1

Graham has been sexually active since he turned 16. After turning 20, he begins to experience a problem with lack of arousal. Which category best fits Graham's disorder?

A) gender dysphoria
B) paraphilia
C) sexual deviance disorder
D) sexual dysfunction

Answer 1

D

Question 2

Although sex is an important part of people's lives, for many years, discussion of sexual topics was taboo. In the recent history of psychology, who first made sex an appropriate sexual topic for discussion?

A) Alfred Kinsey, when he published his research findings about human sexual practices
B) William Masters and Virginia Johnson, when they published their findings on the human sexual response
C) Sigmund Freud, when he made the libido an important part of his psychoanalytic theory
D) Helen Singer Kaplan, when she wrote about desire and sexual readiness

Answer 2

C

Question 3

Diane is a typical 68-year-old woman who is in a committed relationship. She indicates that sex is important in her life. It is likely that Diane will also state that ____.

A) sex is more important than relationships
B) relationships and closeness to her partner are more important than sex
C) she is having more sex now that she is post-menopausal because she no longer worries about getting pregnant
D) she is not satisfied with the quality of her sex life

Answer 3

B

Question 4

The highly publicized allegations against such well known people as former president Bill Clinton, boxer Mike Tyson, and golfer Tiger Woods underscore the magnitude and seriousness of problems related to ____.

A) sexual dysfunction
B) sexual addiction
C) paraphilias
D) gender dysphoria

Question 5

Joanne had orgasms infrequently even though she had been married happily for 12 years. She enjoys her sex life and her husband has no complaints. However, after learning that her friends are more sexually active, she asked her doctor for advice. Her doctor likely recommended ____.

A) no treatment at all
B) psychoanalysis
C) sensate focus therapy
D) hormone treatment

Question 6

Which statement about homosexuality is accurate ?

A) Homosexuals tend to regret being homosexual and can usually change their sexual orientation through psychotherapy.
B) The human sexual response cycle does not apply to homosexual sex.
C) Homosexuals show greater psychological disturbance and gender identity confusion than heterosexuals.
D) Homosexuality was not completely removed from the DSM until 1986.

Question 7

Which statement best describes the central problem in determining whether or not a sexual practice is abnormal?

A) The abnormal behavior usually does not threaten society, impair social or occupational functioning, or cause distress to the individual.
B) While the laws are usually clear about what is illegal, people are often unaware of the laws.
C) Acceptable sexual practices differ between cultures and historical times.
D) The DSM-5 only lists sexual disorders that are illegal, not ones that are merely unusual or abnormal.

Question 8

Scott has sexual fantasies and engages in sexual behavior that is focused on objects and situations that are not part of the usual pattern of affectionate sexual activity. His behavior often puts him at risk for being arrested. If Scott has a sexual problem, it is likely to be in the general category of ____.

A) sexual dysfunctions
B) gender dysphoria
C) paraphilic disorders
D) sexual personality disorders

Question 9

Lindau et al. (2007) suggests that among older adults ages 57-85, ____.

A) sexual activity continues with over half reporting having sex at least twice a month
B) sexual activity and enjoyment is quite low
C) sexual dysfunctions actually decrease in frequency
D) sexual activity and masturbation are seen as evil

Question 10

Nancy has a sexual problem that is diagnosed as occurring during the appetitive phase of sexual response. We can guess that Nancy's problem involves ____.

A) an inability to experience relaxation after orgasm
B) difficulties during the last two stages of the response cycle
C) difficulties concerning thoughts or fantasies about sex
D) an inability to experience orgasm

Question 11

Elizabeth, married for six years, has no interest in either fantasizing or engaging in sexual activity. In fact, she does whatever she can to avoid situations where intercourse is a possibility. According to the DSM-5, Elizabeth has ____.

A) the rarest form of sexual dysfunction
B) a normal variant of the human sexual response cycle
C) a sexual arousal disorder
D) a sexual desire disorder

Question 12

The definition of sexual disorders is ____.

A) unique because it does not include subjective distress
B) among the clearest of all forms of psychological disorders to identify
C) based primarily on the statistical rarity criterion
D) difficult because it is influenced by cultural norms and values

Question 13

Shalisa has little desire for sexual activity; Karina experiences no breast swelling despite direct sexual stimulation. Which person is paired with the correct stage of the sexual response cycle (during which the problem is experienced)?

A) Shalisa-resolution; Karina-arousal
B) Shalisa-appetitive; Karina-arousal
C) Shalisa-arousal; Karina-appetitive
D) Shalisa-appetitive; Karina-orgasm

Question 14

According to the transgender community, homosexuality is considered ____.

A) a normal variation in sexual behavior
B) a problem that needs to be fixed
C) the result of poor parenting
D) nature's way of controlling overpopulation

Question 15

Hypersexuality, or sexual addiction, ____.

A) has been classified as a sexual disorder since DSM-III-R
B) has recently been included as a sexual disorder in DSM-IV-TR
C) has been broadened in DSM-IV-TR from its original name, nymphomania, to include men as well as women
D) is not recognized as a classification of sexual disorder in the DSM-5

Question 16

Which type of disorder involves a conflict between one's anatomical sex and one's psychological feeling of being male or female?

A) gender dysphoria
B) dissociative identity disorder
C) sexual desire disorder
D) paraphilia

Question 17

Fetishism, low sexual drive, and gender identity conflict are considered deviant because they ____.

A) threaten societal mores
B) do not fall within normal arousal and activity patterns
C) result in distress for the people who experience them
D) result in impaired social functioning

Question 18

Which of the following is a stage in the human sexual response cycle?

A) appetitive
B) dyspaurenia
C) erectile
D) satyriasis

Question 19

When Luz began studying the variation of sexual activities around the world, she was surprised to find that ____.

A) unmarried people living together have more sex than married people living together or single people living alone
B) twenty-five percent of adults worldwide have never had sex
C) ten percent of people in the United States claim to have sex every day
D) homosexuality was banned in ancient Greece

Question 20

Mr. and Mrs. Bell are concerned about their sex lives. Mr. Bell is usually unresponsive to sexual stimulation after he has an orgasm. Mrs. Bell is capable of multiple orgasms. Prior to orgasm, Mrs. Bell experiences neither vaginal lubrication nor expansion of the clitoris. What should a therapist tell the Bells?

A) "Mrs. Bell's lack of lubrication may reflect an arousal phase problem."
B) "Everything the Bells experience is part of the normal sexual response cycle."
C) "Mrs. Bell's having multiple orgasms is a sign of an orgasm disorder."
D) "Mr. Bell's unresponsiveness is a sign of an orgasm disorder."

Question 21

Cynthia enters therapy because she is concerned about her inability to become sexually aroused. Which aspect of her circumstance will likely be explored by her therapist to help determine why she experiences this disorder?

A) She has an expectation that she should be sexually satisfied when she has sex.
B) She was given information that was too realistic about sex when she was a child.
C) She has never been sexually assaulted or molested.
D) She has conflicts with her sexual partner.

Question 22

Giovanni has been treated with vascular surgery to increase blood flow to his genitals. When that did not cure his sexual dysfunction, he was given extra hormones. Now he is a candidate for implant surgery. What disorder is he most likely to suffer from?

A) premature ejaculation
B) hypoactive desire disorder
C) male orgasmic disorder
D) erectile dysfunction

Question 23

Artise suffers from a rare disorder in which the uncontrolled spasms of her vaginal muscles prevents her husband from having intercourse with her. What is this disorder?

A) dyspareunia
B) paraphilia
C) a form of sexual aversion disorder
D) vaginismus

Question 24

Which statement about the cause of sexual dysfunctions is accurate ?

A) Recent studies indicate that biological factors interact with psychological, social, and sociocultural factors to explain sexual disorders.
B) Masters and Johnson tended to deemphasize the importance of psychological factors.
C) All primary forms of these disorders stem from a sociocultural basis.
D) Recent studies show that biological factors only explain secondary forms of the disorders.

Question 25

Research on female orgasmic disorders suggests that the problem is ____.

A) due to neurotransmitter deficits
B) related to inhibited sexual desire
C) around 10 percent of all woman have never achieved an orgasm
D) much more widespread than previously believed

Question 26

What is a psychological factor that may cause sexual dysfunction?

A) guilt, anger, or resentment toward one's sexual partner
B) being raised in a strict religious environment
C) desiring a closer relationship with one's sexual partner
D) pain when engaging in sexual intercourse

Question 27

Which description best illustrates gender dysphoria (transsexualism)?

A) Pedro is sexually attracted to other men.
B) Carlos experiences sexual arousal only if he dresses in women's clothes.
C) Miguel is constantly preoccupied with thoughts of castration.
D) Luis has had poor social relationships because he has always been distressed about being a man.

Question 28

Unlike ____, which can occur in both men and women, ____ is a problem for women only.

A) vaginismus; dyspareunia
B) sexual interest/arousal; vaginismus
C) erectile dysfunction; inhibited arousal
D) premature ejaculation; vaginismus

Question 29

The reported estimates of erectile dysfunction have greatly increased over the past several years. Which statement is one of the contributing factors for the increase in reporting ED?

A) The increase in social and occupational stressors is creating more stress and dysfunction in relationships.
B) The availability of drugs like Viagra presents men with a non-intrusive treatment.
C) There is an increasing assumption that the dysfunction may be caused by a psychological inadequacy rather than physical condition.
D) There is significantly decreased acceptance of a woman's right to expect satisfaction in sexual relationships.

Question 30

A sex therapist counsels his clients to masturbate and use both tactile exploration and sexual imagery both individually and with a partner. The clients who hear this advice are most likely to have which sexual dysfunction?

A) sexual pain disorder
B) premature ejaculation
C) female orgasmic dysfunction
D) paraphilia

Question 31

Jennifer is a classic "tomboy" and insists she has a penis. She says she wants to be a man when she grows up. Most children with gender identity conflicts such as Jennifer's ____.

A) become transvestites
B) develop gender dysphoria as adults
C) do not develop gender dysphoria as adults
D) engage in paraphilias as adults

Question 32

Which factor is psychological, and most associated with female orgasmic dysfunction?

A) being raised in a sexually permissive home
B) having a partner who is sexually healthy and functional
C) having issues with body image
D) being over-informed about sexuality or sexual technique

Question 33

Dr. Ward says, "Premature ejaculation is a relatively uncommon sexual dysfunction in which the inability to achieve an erection leads to ejaculating reflexively during instances of excessive sexual stimulation. It is a source of great distress for many males." What part of the statement is accurate ?

A) Premature ejaculation involves an inability to achieve an erection.
B) Premature ejaculation is uncommon.
C) Premature ejaculation involves excessive sexual stimulation.
D) Premature ejaculation is a source of great distress for many males.

Question 34

what disorder is being treated when a woman is taught to relax and then insert increasingly large dilators until the comfortable insertion of a penis is possible?

A) dyspareunia
B) female orgasmic dysfunction
C) vaginismus
D) sexual aversion disorder

Question 35

Which male has erectile dysfunction based on a primarily psychological cause?

A) Bill, whose inability is caused by a physiological problem with which he was born
B) Charlie, who does not have spontaneous erections
C) Emmett, who has never had an erection sufficient for intercourse
D) Del, who has nocturnal penile tumescence

Question 36

Oral medications like Viagra, Levitra, and Cialis ____.

A) can cure erectile dysfunction
B) may aid sexual arousal and performance by stimulating men's expectations
C) improve sexual performance among men without sexual dysfunction by causing even stiffer erections
D) have redefined erectile dysfunction as a medical problem rather than a quality-of-life issue

Question 37

A therapist instructs Mrs. Weaver: "Stimulate your husband's penis until he feels ejaculation is about to happen, then stop all stimulation for a while. Continue with stimulation and then stop, repeating until he can tolerate longer periods of stimulation without ejaculating." What sexual dysfunction is being treated?

A) early ejaculation
B) secondary erectile dysfunction
C) sexual aversion disorder
D) vaginismus

Question 38

Although the relationship between hormones and sexual functioning is complex and unclear, we would expect that low levels of testosterone are associated with ____.

A) paraphilias
B) erectile difficulties
C) premature ejaculation
D) vaginismus

Question 39

Professor Newell tells her students, "Vaginismus is a relatively common sexual dysfunction involving recurrent or persistent pain in the genitals before, during, or after sexual intercourse. Spasms of the outer third of the vaginal wall prevent sexual intercourse. Surprisingly, a lack of history of incestuous molestation is often found in women with this disorder." Which part of Professor Newell's statement is accurate?

A) Vaginismus is a relatively common sexual dysfunction.
B) A lack of history of incestuous molestation is often found in women with this disorder.
C) Vaginismus involves recurrent or persistent pain in the genitals before, during, or after sexual intercourse.
D) Spasms of the outer third of the vaginal wall prevent sexual intercourse.

Question 40

George and Laura are seeing a sex therapist because of problems in their sex life. The therapist tells them that they are suffering from the most common complaint of couples seeking sex therapy. We could conclude from this statement that George and Laura are having problems with ____.

A) sexual arousal
B) sexual interest
C) orgasm
D) refraction

Question 41

The controversy about gender reassignment surgery will likely continue because ____.

A) insurance companies are becoming more open to paying for the procedures
B) the issue of personal freedoms continues to be a political "football"
C) therapists have not done a very good job of screening which patients are good candidates for the surgery
D) some patients benefit from the procedures and others seem to be emotionally worsened by it

Question 42

Brenda was a transsexual who had gender reassignment surgery. She now calls herself Brad. Research on the outcome of these operations suggests that she will ____.

A) get more negative reactions from others than if she were a man who changed to a woman
B) quickly relapse to gender identity disorder
C) be more satisfied with surgery than men who change to women
D) never feel depressed again

Question 43

Norman is diagnosed with gender dysphoria. We can confidently expect that as a child, he ____.

A) was considered a very aggressive boy
B) avoided rough-and-tumble activities
C) was sexually attracted to other boys
D) cross-dressed as a way of attracting attention from others

Question 44

Which individual exhibits a paraphilia?

A) Jules, who becomes sexually aroused when he sees his wife in a sexy negligee
B) Jake, who can only become sexually aroused when he is tied up and spanked by his partner
C) John, who consentually rubs against his wife to become sexually aroused
D) Joe, who becomes sexually aroused in the presence of an attractive woman

Question 45

When an object such as shoes or women's underwear is used during masturbation as the sole means of achieving sexual gratification and this practice is distressing, the diagnosis is ____.

A) frotteuristic disorder
B) fetishistic disorder
C) transvestic fetishism
D) transsexualism

Question 46

Which psychological or social factor is thought to contribute to development of gender dysphoria in boys?

A) parental encouragement of the development of autonomy
B) excessive attention and overprotection by the father
C) a relatively powerful or overly involved father figure
D) parental encouragement of feminine behavior

Question 47

What paraphilia is relatively common, and involves urges or fantasies about exposing one's genitals to strangers in order to cause shock in the observer.

A) exhibitionistic disorder
B) voyeuristic disorder
C) fetishistic disorder
D) frotteuristic disorder

Question 48

Both transsexuals and transvestites cross-dress. What factor helps differentiate the two disorders?

A) Transsexuals develop their interest in cross-dressing at a much later age than transvestites.
B) Only transvestites are dissatisfied with their gender.
C) Only transsexuals identify with the opposite gender.
D) Transvestites tend to be homosexuals.

Question 49

Connie's therapist attempts to replace the misconceptions and sexual myths that Connie has learned since childhood with accurate information about sexual anatomy and feelings. Which component of psychological treatment is the therapist using?

A) anxiety reduction
B) education
C) communication training
D) graded tasks

Question 50

Wayne has neither homosexual fantasies nor an attraction to other men. He knows he is male, but he can only achieve sexual arousal by shopping for women's clothes, dressing in them, and masturbating in front of a mirror. An appropriate diagnosis for Wayne is ____.

A) gender dysphoria
B) ranssexualism
C) transvestic disorder
D) exhibitionism

Question 51

Research suggests that vaginismus among women ____.

A) has a genetic predisposition
B) is the result of rigid religious beliefs about sex
C) is a very rare occurrence
D) is due to having a husband or partner who was impotent

Question 52

Keith is diagnosed with transsexualism (gender dysphoria). How is the therapist likely to explain his disorder?

A) "You cross-dress because it allows you to experience sexual arousal."
B) "As a child, you over-identified with your strong and independent father."
C) "We will probably find that your mother encouraged you to dress up like a girl and may have punished him for being aggressive."
D) "Your parents must have discouraged your development of autonomy."

Question 53

The sexual disorders that involve intense sexual urges regarding situations, objects, or people that are not part of the usual arousal pattern leading to reciprocal and affectionate sexual activity are called ____.

A) gender dysphoria
B) paraphilias
C) dyspareunia
D) psychosexual disorders

Question 54

A man has persistent fantasies about having sex with non-consenting people. Although he has not acted on them, these fantasies have lasted for almost a year and cause the man severe distress. What diagnosis is appropriate and why?

A) paraphilia, because the man has distressing fantasies with nonconsenting others even though he has not acted on them
B) no mental disorder, because unless the man acts on his fantasies, there is no form of sexual deviance
C) sexual dysfunction, because the man is not able to achieve sexual arousal normally
D) gender dysphoria, because the man has fantasies about having sex with non-consenting people

Question 55

Which statement about treatment of transsexualism is accurate ?

A) Gender reassignment surgery is much less complicated for women who wish to be men than for men who wish to be women.
B) Men who change to females are generally more satisfied with gender reassignment surgery than women who change to males.
C) The only valuable therapy is gender reassignment surgery.
D) Although hormone therapy has been helpful for some transsexuals, gender reassignment operations may be more appropriate for others.

Question 56

Mary has a fetish for men's clothes and has two other forms of paraphilia as well. She is distressed with her fantasies and actions. These paraphilias have lasted several years. What aspect of Mary's case is unusual ?

A) It is unusual for a paraphilia to last several years.
B) It is unusual for a woman to have paraphilias.
C) It is unusual for a person to have more than one paraphilia.
D) It is unusual for a person with a paraphilia to be distressed.

Question 57

An individual who presents with a paraphilia is likely to ____.

A) have a homosexual orientation
B) have experienced a stressful life event
C) have more than one paraphilia
D) be a female

Question 58

Which of the following is considered to be a biological influence of gender dysphoria?

A) abnormal levels of testosterone
B) excessive amounts of certain neurotransmitters
C) lack of development in certain brain structures
D) stress-related organ dysfunction

Question 59

How successful is gender reassignment surgery for males transitioning to females?

A) It is completely successful.
B) Many report satisfaction, but some side effects.
C) Most report that the process was painful and unsuccessful.
D) Surgery decreases the risk of mental health issues.

Question 60

Brent has been diagnosed with transvestic disorder. Although he is married, he has long wanted a sex-change operation. He must dress as a woman to be able to have intercourse with his wife. If the diagnosis is accurate, what is unusual about Brent's case?

A) It is unusual for cross-dressing to be used for heterosexual sex.
B) It is unusual for a man to have transvestic disorder.
C) It is unusual for a person with transvestic disorder to be married.
D) It is unusual for a person with transvestic disorder to want a sex-change operation.

Question 61

All of these men were diagnosed with exhibitionistic disorder. What is typical of men with this disorder?

A) Wayne, who maintains complete self-control throughout his episodes of exposing himself
B) Lars, who is 49 and is sexually aroused only by pictures of women in the nude
C) Jim, who is 24 years old and likes pornography
D) Arnold, who is 53 years old and unmarried

Question 62

Norm is suspected of being a child molester. If he is a pedophile, which of the following could we expect?

A) sexual arousal to slides of neutral, clothed women
B) being acquainted with his victims
C) high intelligence and right-hemisphere dysfunction
D) lack of interest in hard-core pornography

Question 63

Ali is being treated for a shoe fetish. The therapist pairs electric shock with the sight and touch of shoes. The therapist also is teaching Ali to engage in appropriate social skills and how to feel sexual pleasure without resorting to shoes. The therapist probably supports which approach to treatment?

A) behavior
B) psychodynamic
C) biogenic
D) cognitive

Question 64

Shame and humiliation are most likely to be used by behavior therapists to treat ____.

A) people with sexual dysfunction
B) masochists
C) people with gender identity disorders
D) exhibitionists

Question 65

Research with sadomasochists found that a large minority ____.

A) reported that "straight" sex is more satisfying than sadomasochistic activities
B) played either a dominant or a submissive role but not both.
C) engaged in behaviors that caused only minor pain
D) reported that they seek to injure others or be injured themselves

Question 66

What sexual practice would include sexual relations between a brother and sister?

A) incest
B) oral sex
C) homosexuality
D) sadomasochism

Question 67

Professor Diebold tells his class, "Pedophilic disorder is a disorder in which an adult obtains sexual gratification through urges, acts, or fantasies of sexual contact with prepubescent children. The pedophile must be at least 14 years of age and at least five years older than the victim. Most pedophiles prefer boys, but some choose girls. Regrettably, sexual abuse of children is common." Which part of Professor Diebold's statement is accurate ?

A) Pedophilic disorder is a disorder in which an adult obtains sexual gratification through urges, acts, or fantasies of sexual contact with prepubescent children.
B) The person with pedophilic disorder must be at least 14 years of age and at least five years older than the victim.
C) Most pedophiles prefer boys, but some choose girls.
D) Sexual abuse of children is common.

Question 68

A key concept in the psychodynamic explanation of transvestic disorder, exhibitionistic disorder, sexual sadism disorder, and sexual masochism disorder is ____.

A) excessive superego
B) castration anxiety
C) inadequate id impulses
D) the defense mechanism of projection

Question 69

Jordan is an exhibitionist. He would be more likely than other men to ____.

A) want no contact with the person to whom he exposes himself
B) masturbate
C) have sex with prostitutes
D) molest young girls

Question 70

Dr. Monte says about a patient, "As a child, he was often spanked on the bare buttocks by his very attractive governess. He cannot remember these incidents clearly, but as an adult, he always associates pain with sexual arousal." Dr. Monte's patient likely has which disorder?

A) voyeuristic disorder
B) exhibitionistic disorder
C) pedophilic disorder
D) sexual sadomasochism disorder

Question 71

Stefanie has intense sexually arousing fantasies of being utterly helpless while being tied up and humiliated and she finds sex partners who fulfill these urges. A reasonable assumption is ____.

A) a diagnosis of sexual masochism disorder
B) that she was a victim of child sexual abuse
C) a diagnosis of pedophilia
D) a diagnosis of sadism

Question 72

Dr. Estes treats patients who have sexually deviant behavior. He uses extinction and aversive conditioning to eliminate inappropriate behaviors and helps them acquire or strengthen appropriate behaviors. He also helps them develop social skills. Dr. Estes uses which approach for treating his patients?

A) psychodynamic
B) behavior
C) humanistic
D) cognitive

Question 73

What is a paraphilia involving non-consenting others?

A) fetishistic disorder
B) frotteuristic disorder
C) sexual masochism disorder
D) transvestic disorder

Question 74

Recent research suggests what biological predisposition to pedophilic disorder?

A) low levels of testosterone and high levels of estrogen
B) anomalies in the limbic system
C) deficits in brain activation and less white matter in the brain
D) deficits in brain activation and less white matter in the brain

Question 75

A therapist working with child victims of sexual abuse is likely to see symptoms that most closely parallel ____ in some cases.

A) bipolar (manic-depressive) disorder
B) dissociative identity (multiple personality) disorder
C) paraphilias
D) posttraumatic stress disorder

Question 76

Dr. Julius says to his exhibitionist patient, "Your dreams tell us that, for you, fear of castration requires that you prove to others that you still have a penis by exposing yourself. Once you acknowledge and overcome that fear, your need to exhibit will disappear." Dr. Julius holds which viewpoint on the disorder?

A) psychodynamic
B) cognitive-behavioral
C) operant conditioning
D) humanistic-existential

Question 77

Serena has been sexually molested. Who is least likely to be the molester?

A) her father
B) her grandfather
C) a stranger
D) a family friend

Question 78

Which statement about pedophilic disorder is accurate ?

A) Most pedophiles are under 16 years of age and molest children nearly their same age.
B) In most cases, one relative or friend of the family molests one child.
C) Most pedophiles remain unaroused when they see hard-core pornographic films.
D) Most pedophiles are highly intelligent and socially skilled.

Question 79

For the past three years, Larry has repeatedly fondled his preteen stepdaughter and has sworn her to secrecy. Larry's behavior illustrates ____.

A) pedophilic disorder
B) voyeuristic disorder
C) transvestic disorder
D) sexual masochism disorder

Question 80

Suppose that, in a research study, slides of nude women were shown to men at the same time they held or stroked white feathers. If these stimuli were paired enough times for the feathers alone to produce an erection, this would ____.

A) suggest that paraphilias are actually under the voluntary control of the individual
B) suggest that paraphilias are unrelated to "preparedness"
C) provide support for the biological perspective on paraphilias
D) provide support for a learning perspective of paraphilias