Aspects of the psychopathology of parafilias-analysis of exhibitionism
GKOLIA I., KARPOUZA B.

Paraphilias are deviant sexual behaviors characterized by recurrent intense sexually arousing fantasies, sexual urges, or behaviors, involving nonhuman objects, the suffering or humiliation of oneself or one's partner, or children or other non consenting partners.

According to J.A. Hadfield⁴ in investigating the origin of the sex perversion we find tηem to be not essentially different ,either in their general causation or in their mechanism, from the other. Psychoneuroses are due to the feeling of deprivation of love, the repressed craving for love. When a child is deprived of love, protective or sensuous, it may reject the original normal love object and activity and resort to a morbid reaction as a substitute like thumbsucking, masturbation or other auto-erotic activities, which later constitutes the perversions.

So with exhibitionism it is not the normal pleasure of exposure experienced by the child; but the activity of a child, who being deprived of love, tries to win it back by such exhibitionism. His sex organs are a source of pleasure to himself and he naturally assumes that they will be an object of pleasure to others, arousing in them the feelings they arouse to him. These morbid reactions become fixated and persist in this arrested form, because of two factors: the exaggeration of these tendencies, and the repression. The exaggeration happens when a child is deprived of the mother's love and adopts these reactions as a substitute. It becomes his joy in life, the only thing he lives for, so that it is not only exaggerated but a fixated activity. But he is then threatened by the parent with disapproval and the further deprivation of love and so these reactions are repressed.

The exaggeration determines the persistence of the morbid tendency; the repression produces the arrest and fixation; if the morbid tendency were not exaggerated it would not hope to persist; if it were not repressed some of the libido would be transformed into more normal sexuality. When it is completely repressed and all sensual feelings with it, it is arrested, fixated, and produces a perversion.

All sexual perverts, what they really seek is not sexuality, but a lost love: perversion is a symbol of some deeper need.

According to R.H. Tuch⁵ and K. Stoller6 the central issue in perversions is all about power. In exhibitionism for example, the exhibitionist wants to show power, the triumph that comes from being in control while the other (the victim) loses control.

The bizarre and incongruous nature of the exhibitionist's behavior tends to stimulate confusion and regression in the onlooker, placing the victim at a psychic disadvantage (Siegman, 1964)⁷. She is caught unprepared, unclear about what will happen next, and unsure about how best to respond. Ego functioning is temporarily compromised. In this regard, it is worth noting that the first incident of exhibitionism described in the literature (Lasegue, 1877)⁸ was that of a man who exposed himself to a woman who knelt praying in a church - no doubt in a state of mind that left her unprepared for what was about to be revealed.

The exhibitionist shouldn't take the woman's reaction as a sign he is, in fact, impressively endowed - but often the exhibitionist comes away from the encounter with just such an impression. In fact, more often than not, the exhibitionist has sexual problems but in this way, he denies reality. The dual mechanisms of disavowal (denial of reality) and splitting of the ego account for perversion (Freud, 1927)⁹ Sanchez-Medina (2002)¹⁰ writes of how the perverse has two simultaneous 'lives' that exist side by side but try to ignore each other.

According to R. Stoller (1991)¹¹ the exhibitionists brilliantly transform childhood trauma into adult triumph, following the formula: "I am humiliated; I discover revenge; I humiliate; I have mastered the past".

Recently, there has been an increased interest in the obsessive and compulsive nature of paraphilias and whether they lie within the obsessive-compulsive disorder spectrum. The clinical response observed in patients with sexual paraphilias to SSRIs has added the hypothesis that they could be a component of the OCD spectrum, and a manifestation of serotonergic dysfunction, possibly at a hypothalamic level. Encephalos 2008, 45(4):233-236.

Key words: Toxicity, different kind of dementia, lead, mercury, arsenic, zinc, argyle, cupper.