Behavioral Models of Etiology

Conditioning Theories of Paraphilia

Theorists of classical conditioning have proposed that some forms of fetishism can be explained by early learned associations between sexual stimulation and common objects of infancy such as diapers, bottles, and pacifiers (22). One early study using aversion techniques with sexual offenders provided modest support for conditioning theories, in that frequency of masturbation to exhibitionist fantasies, implying stronger conditioning, was associated with treatment failure (96). However, etiological explanations based on responses to treatment have limited validity.

Clinical work in the Internet era provides observational support for the role of conditioning in the paraphilias. Exposure to Internet-based sexually explicit material and accompanying high levels of sexual arousal appear to, in some individuals, profoundly influence the development of conditioned sexual fantasy and arousal responses. However, there is a wide range of responses to comparable levels of exposure. Therefore, caution must be exercised in drawing conclusions about any direct causative effects of exposure—Internet or otherwise—on the development or latensification of psychosexual pathology. Fisher and Barak have presented eloquent reviews on the effects of exposure to pornography, concluding that it is difficult to distinguish between the effects of exposure and the effects of pre-existing underlying personality factors in individuals who seek such exposure (97).

In contrast to classic conditioning is the theory of imprinting, which proposes that early childhood is a critical period in which animals instinctually grow attached to a primary object. Species such as precocial birds are thought to become "imprinted," or physiologically programed to follow whatever creature or object they see shortly after hatching (98). Binet hypothesized pathological imprinting in humans as a possible explanation for the development of fetishes (41). Owing to events in sensitive developmental periods, an association between arousal and a particular object or experience becomes imprinted. Study of nonhuman species suggests that behavior learned through imprinting is extremely difficult, if not impossible, to unlearn, whereas in classic conditioning models deconditioning and reconditioning are, theoretically, possible. Overall, empirical attempts to validate conditioning theories in the etiology of paraphilias have produced mixed results.

Junginger pointed out the possible relevance of the two-process learning theory, which has earned acceptance as an explanation of avoidance behavior in obsessive-compulsive disorder, to the development of fetishism (46). In this conceptualization, a formerly neutral object, when paired with sexual stimulation, acquires the power to elicit sexual arousal, leading to an operant response of stimulation and approach, rather than fear and avoidance as in OCD. The rewards inherent in sexual arousal and orgasm then serve as positive reinforcement.

Deviant Arousal Theory of Paraphilia

Some behaviorists have examined the role of deviant arousal—arousal in response to deviant or nonnormative stimuli—in the etiology of sexual offending behaviors. Some have found evidence of deviant arousal in pedophilia and others have found deviant arousal in exhibitionism, although with concurrent higher arousal to normative stimuli (99-101). Still other studies have failed to find deviant arousal in exhibitionism. The inconsistent findings suggest that deviant arousal is present in some men with paraphilia and less so or not at all in others (102). Why that is the case is unknown and there is no current explanation for the presence or development of the deviant arousal.

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