Article 21: Cognitive Understanding and Behavioral Therapy of Fetishism and Transvestism
3. Fetishism
Fetishism is a sexual psychological disorder characterized by the repeated collection of items used by members of the opposite sex, which provides sexual gratification. Patients are mostly male, and the items they are attracted to are often women's underwear, socks, handkerchiefs, etc.
Treating fetishism is quite difficult. Traditional persuasion and education, as well as simple punishment, are not very effective, and relapse is common due to a lack of supervision. Therefore, it is hoped that patients will follow their doctor's advice and seek treatment diligently.
Currently, specific treatment methods tend to include cognitive insight therapy and behavioral therapy.
Cognitive Insight Therapy
The goal is to awaken the fetishist's normal sexual desires, eliminate their aversion and anxiety towards normal sexual activity, and cultivate a normal interest in the opposite sex. This is a method of psychological counseling and education. If the patient is young, they can be advised on how to establish a more normal sexual and emotional relationship, and then gradually overcome their fetishistic behavior. If they can find a sympathetic and supportive partner, that person can play a very positive role in the treatment.
Behavioral therapy
Electroshock aversion therapy. The specific steps of this therapy are: an electric shock device is attached to the genitals, simultaneously inducing the patient's sexual arousal. For example, a fetishist is given their cherished object; once their sexual desire is aroused, the genitals are shocked with the electric shock device to produce pain. This is repeated multiple times to establish a conditioned reflex, thereby eliminating the abnormal sexual urges.
Drug aversion therapy. The specific steps of this therapy are as follows: First, the fetishist is given an emetic (emetrine) or an injection of an emetic (dehydromorphine). Then, the patient is given the object they love. After repeated exposure, the patient develops a conditioned reflex to the object. As a result, the patient will vomit as soon as they come into contact with the object, thus inhibiting and eliminating abnormal sexual urges.
4. Cross-dressing fetish
Transvestism is characterized by recurrent, intense sexual urges and fantasies involving cross-dressing, which are then acted upon and persist for at least six months. The vast majority are heterosexual. However, women who dress as men are invariably lesbians, using cross-dressing to attract homosexuals. Transvestites derive sexual satisfaction from this behavioral pattern. It typically begins between the ages of 5 and 14, often involving cross-dressing and masturbation to enhance sexual arousal. Most patients do not experience difficulties in their heterosexual lives; some only exhibit low libido.
Treatment of cross-dressing fetish
Psychological adjustment:
The patient can put themselves in an observer's position and reflect on their behavior. If a little boy dressing up as a little girl might be somewhat amusing and barely acceptable, then a grown man dressing up as a woman and acting affectedly is simply repulsive. They should realize they are grown up, a man, and should pursue their own careers, pursue the opposite sex they like, and enjoy sweet love and a happy life.
Aversion therapy:
If the above methods are ineffective, aversion therapy can be used. Emetics can be used; please consult a doctor for dosage and administration. When the medication is about to take effect, wear clothing of the opposite sex that you like. Just as you are admiring yourself, vomiting begins, and the blissful self-admiration turns into unpleasant vomiting, resulting in a complete loss of interest. After doing this several times, the urge to wear clothing of the opposite sex will decrease or even disappear.
5. Sexual fricative
Sexual fricative disorder involves rubbing or touching a part of the opposite sex's body (often the penis) in crowded places or when the other person is not paying attention, in order to achieve sexual arousal. It is only seen in men and lasts for at least six months.
Drug treatment for friction disorder is not very effective, so psychotherapy is often used instead.
Zhong's Insight Therapy:
Zhong's Insight Therapy is a psychotherapy method that uses psychoanalysis. The main points are summarized below:
What memorable events occurred during your childhood?
What are some easily forgotten events from your childhood or early years?
What causes friction disorder in adulthood?
Which childhood event (or psychological trauma) do you repeatedly reflect upon and is it related to your current psychosexual disorder?
By repeatedly exploring the potential meaning of deviant behaviors, one can transform them into a conscious understanding, recognizing the causal relationship between past forgotten and unforgotten psychological traumas and current psychological disorders, thereby achieving enlightenment.
Gradually establish adult psychological response patterns to replace children's response and behavioral patterns.
Comprehensive psychotherapy:
Comprehensive psychotherapy uses the rubber band method (rubber band wrist tapping) to help control pathological impulses, gradually implements cognitive-insight therapy, and ultimately enables patients to give up pathological behaviors and beliefs, thereby moving towards a more mature healthy behavior pattern.
Family therapy and guidance on normal sexual life are important aspects of ensuring the success of comprehensive psychotherapy.
Traditional cultural influences can make patients feel unfamiliar with psychotherapy, and they may even disbelieve that stubborn illnesses can be treated solely through a doctor's words without medication. This misconception often leads patients to discontinue treatment. Therefore, low-dose antipsychotic medication should be used in conjunction with psychotherapy. This can improve the patient's mood while simultaneously alleviating their concerns about how the illness can be cured without medication.
6. Sexual sadism and sexual masochism
Sadism involves using whipping or tearing apart the body to cause significant pain as the sole means of increasing sexual pleasure and satisfying sexual desire. The vast majority of sufferers are male, often with a history of animal cruelty and bestiality from childhood. In adulthood, they repeatedly abuse their partners during sexual intercourse, sometimes escalating the abuse to the point of causing damage to sexual organs or limbs, fractures, or even death. Victims can be prostitutes, unfamiliar young girls, or their own spouses. Some perpetrators rape and then torture and murder their victims, mutilating the bodies, such as removing breasts, inserting branches into the vagina, stuffing a penile sheath into the mouth, or dismembering the body. Others do not engage in sexual intercourse; the killing and dismemberment of the opposite sex becomes a means of satisfying their sexual desire.
Masochism is a preference for experiencing sexual pleasure through being whipped, trampled, bound, strangled, or portraying a state of humiliation, and therefore actively seeking out the other person to inflict abusive pain during intercourse. It may also involve masturbating alone in a room, covering oneself with a plastic bag or strangling oneself with a rope, experiencing partial oxygen deprivation. The vast majority of sexual masochists are women, but it is occasionally seen in men and homosexuals.
Currently, there is no satisfactory treatment for this condition. However, based on the patient's urgent need to improve their physical condition, targeted psychotherapy can be administered multiple times. Providing relevant educational materials can help improve their understanding of the disease, analyze its harmful effects, and cultivate self-control. Displaying the abusive and masochistic areas can be used to employ aversion therapy. Psychotherapy should be supplemented with medication, such as antipsychotic drugs, with satisfactory results in some cases.
7. Transsexualism
The main characteristic of transgenderism is that the psychological identification of one's own sex is exactly the opposite of one's anatomical and physiological sex characteristics. There is a persistent and strong desire to change one's anatomical features to achieve gender reassignment. The vast majority are male. It usually begins in adolescence, with children often associating with girls, wearing clothing of the opposite sex, but without experiencing sexual arousal (unlike transvestism), exhibiting feminine speech, body language, and behavior. They believe that "a woman's heart has been mistakenly placed in a man's body, so they feel awkward in every way and try every means to change back." They dislike their own genitals and request castration surgery to change their sex. This desire usually persists, and some attempt suicide. Some patients, unable to obtain surgery, self-castrate, resulting in serious consequences. About one-third of patients are married, and about half eventually divorce.
Psychological adjustment of transgenderism
Those suffering from transsexualism should face reality, use reason to criticize their abnormal psychology, and use willpower to control their impulses. First, they should constantly remind themselves that this psychology is abnormal and perverse, and that they are men-this is undeniable. Living like a man is their only way out; becoming a woman would be unacceptable to their family and society, so they must quickly abandon this absurd idea. Secondly, they should reinforce the benefits of fulfilling their current gender role. For example, male patients can write down the advantages men have in society, such as easier access to education and employment, and greater advantages in business and adventure, secretly rejoicing in being a man. They should engage in activities that they are personally interested in and that are only suitable for their current gender role; by experiencing enjoyment in these activities, they can strengthen their identification with their gender role.
Correcting psychopathic disorders is difficult, requiring patients to endure immense mental and physical suffering, as well as strong willpower and tenacious self-control. The correction process should be viewed as an opportunity to hone one's perseverance and elevate one's personality.
8. Homosexuality
Classification of homosexuality
(1) True homosexuality is also called congenital homosexuality. It involves varying degrees of personality disorders or sexual psychological abnormalities. They exhibit strong and persistent sexual desires towards the same sex, while showing strong aversion to the opposite sex, making it difficult to correct. According to estimates from American surveys, 6% to 10% of adult men and 2% to 4% of adult women may be true homosexuals.
(2) Most homosexuals are bisexuals, meaning they are both homosexuals and can also have sexual relationships with the opposite sex.
(3) Pseudo-homosexuality is mostly situational or accidental. The attraction to the same sex is only related to certain environmental factors, such as environments lacking the opposite sex, like mines or prisons, or lacking opportunities to contact the opposite sex. These homosexuals are changeable and easier to correct.