Psychoanalytic Models of Etiology

Psychoanalytic writers posit that early life experiences are fundamentally related to the development of the paraphilias. Stoller asserted that vengeful hostility, in response to the young child's ambivalent struggle to separate from his mother, is the core of all perversion (67). Many variations of this theme have been proposed.

Psychoanalytic View of Fetishism

Psychoanalytic theory suggests that fetishism is due to unconscious fears and a sense of inadequacy related to early childhood experience (68,69). Freud proposed that fetishism originates in the phallic phase of psychosexual development as a male child experiences anxiety about his mother's missing penis, for which he finds a symbolic object, thus resolving his fear and restoring an erotic attachment to his mother (70). The memory of sexual pleasure as a mechanism to cope with stress becomes fixated and eventually transmutes into repetitive behavior.

Psychoanalytic View of Transvestic Fetishism

In the orthodox psychoanalytic view, cross-dressing is a defense against castration anxiety. Some proposed that transvestism represents an unconscious wish for the father's attention by identification with the mother (71,72).

Greenacre described transvestism as an effort at reparation of a flawed body image in early life (73). Stoller described transvestism as a "hostile mastery" of early trauma and humiliation by the mother (74). In contrast, Oversey and Person suggested anxiety as the central theme in transvestism, caused by flawed maternal bonding and consequent incomplete sense of self (75).

Psychoanalytic View of Exhibitionism

To the psychoanalyst, exhibitionism is associated with childhood experiences with a dominant, seductive mother and a distant father (69,76). The assault on the male child's developing sense of masculinity and adequacy is resolved in the feelings of gratification and power when a female reacts to his genital displays.

Psychoanalytic View of Sadomasochism

Stoller described sexual masochism as the neurotic eroticization of maternal hatred, a narcissistic solution to early life trauma (74), although in later writings, after observing many higher functioning individuals and couples who engaged in recreational S&M practices, he questioned his earlier assumptions (77,78). Kernberg suggested that masochists experience narcissistic gratification in the grandiose view of the self associated with high tolerance for pain (79). Waska described the masochist as alternating between compulsion toward servitude and rage at the internalized possessive, rejecting, or neglectful maternal object (80). The masochist suffers a core incapacity to self-soothe and, therefore, deep cravings to be soothed by others. The cravings, and accompanying rage, explain the masochist's inherently ambivalent position, in which self-suffering disguises feelings of anger and yearning for maternal soothing. Ultimately, his compensatory style is one of the expecting to be hurt by those from whom he needs love, and one of the confusing pain and humiliation with longed-for love. He tolerates pain and suffering in order to remain attached to the needed but pain-causing mother, a stance that is preferable to no attachment at all. In Lebe's formulation, the masochist is sensitive to others but cannot be to himself because as a child he was unable to differentiate between self and the punishing or rejecting mother (81). A more recent formulation proposed that sexual desire itself is a driving force in masochism, and that sadomasochistic aggression is, paradoxically, an attempt to find safety under the primitive lure of sexual feelings and preoedipal yearnings (82).

Psychoanalytic interpretations assist the clinician in formulating a sense of the early life experiences of individuals seeking treatment and in understanding their developmental vicissitudes. Most clinicians who treat individuals with para-philias can provide testimony to the life stories that offer convincing anecdotal evidence for the relevance of psychoanalytic constructs to our efforts to explain unusual erotic interests.

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