Stephen J. Hucker

The courtship disorders

This study tested parts of the hypothesis that voyeurism, exhibitionism, toucheurism and frotteurism, obscene telephone calling, and at least some cases of the preferential rape pattern are all based on the same disturbance. In Part One, a frequency count of patients referred for one of these activities who subsequently reported having engaged in others of this same class was in accord with the clinical impression that there is a high degree of concomitance among at least some of these activities. In Parts Two and Three, relative preference for anomalous vs. normal erotic interactions was assessed by monitoring penile volume changes during verbally presented descriptions of corresponding situations. Part Two demonstrated that patients who suffered from one of the disorders in question other than voyeurism and who denied voyeuristic activity or tendencies, nonetheless responded more to narratives describing voyeuristic situations than did controls. Part Three showed that exhibitionists who denied toucheuristic activity or tendencies responded more to toucheuristic stimuli than did controls.

A comparison of typical death scene features in cases of fatal male and female autoerotic asphyxia with a review of the literature

Autoerotic asphyxia is an increasingly recognised syndrome in which accidental death occurs during solitary sexual activity due to failure of an apparatus that was designed to produce hypoxic augmentation of the victims sexual response. Evidence of repetitive, secretive behaviour utilizing ropes and ligatures characterizes cases involving either males or females. Here the similarity in reported cases ends with males tending to utilize a far greater range of elaborate devices and props, often designed to cause real or simulated pain with pornographic material and evidence of cross-dressing and fetishism. Females, on the other hand, have usually been found naked with only a single ligature and no unusual or bizarre equipment. To further clarify the similarities and differences between typical cases involving males and females and to assist in the diagnosis of less obvious cases, the literature is reviewed and characteristic findings in both sexes compared and contrasted.

Psychopathy and Sexual Sadism

Psychopathic personality disorder and sexual sadism share several common characteristics, such as emotional detachment from the suffering of others or the preparedness to inflict pain or injuries. Based on a sample of 100 male forensic patients (all of them sex offenders, half of them sadistic), the concept of psychopathy and sexual sadism as a unified construct was tested empirically. Pooling indicator variables for psychopathic and sexually sadistic disorders showed that a two-factorial solution yielded a better fit than a single-factor model. The two factors identified psychopathy and sexual sadism as separate latent variables. More specifically, the data were compatible with a path model in which affective deficits and behavioral disinhibition of the psychopathy domain are precursors to sexually sadistic conduct.

Fatal and near-fatal autoerotic asphyxial episodes in women. Characteristic features based on a review of nine cases

As asphyxial episodes during autoerotic activity are rarely reported in women, a review of eight fatal cases and one near-fatal case was conducted to delineate more clearly the characteristics of this syndrome in women. Six cases involved characteristic fatal autoerotic asphyxial activity. The remaining two fatal cases were atypical in that the apparatus that was used for sexual purposes was not intended to cause asphyxia in one case and did not directly cause asphyxial death in the second case. The final case was not fatal. Significantly, the majority of women did not use unusual clothing, props, or devices to augment their activity, for example, five were completely naked and only one was found with elaborate clothing and extra ligatures. Six of the fatal cases had objective evidence of sexual activity, three had used neck padding to prevent chafing, and eight had failed self-rescue mechanisms. Of note, the initial impression in four cases (44%) was homicide (two), attempted suicide (one), and accidental death during sexual activity with a partner (one). These results support the assertion that the manifestations of female autoerotic asphyxial activity reported to date may be initially misleading to investigators. Our purpose in presenting these findings, therefore, is to increase awareness of the more subtle features of this syndrome in women in an attempt to reduce the potential for underdiagnosis or confusion with nonaccidental death in future cases.

The courtship disorders: A further investigation

The senior author had put forward the hypothesis that voyeurism, exhibitionism, obscene telephone calling, toucheurism-frotteurism, and at least some cases of the preferential rape pattern all distort normal courtship behavior in basically the same manner. An earlier study (Freund et al.,1983) tested part of this hypothesis, namely that voyeurism, exhibitionism, and frotteurism-toucheurism, are closely related. However, the outcome of one of the experiments by which this test was performed could be interpreted as indicating that the relationship between these anomalous erotic inclinations consists simply in that they may be expressions of a disinclination toward intercourse. The present study was conducted to test this interpretation. It compared 16 exhibitionists with 16 sexually normal controls on penile responses to auditorily presented descriptions of the four phases of normal sexual interaction (location of a suitable partner; pretactile erotic interaction; tactile interaction short of intercourse; the situation of intercourse) and sexually neutral situations. These descriptions were narratives about the examined subjects involvement in such interaction. No differences in responding between exhibitionists and normal controls were observed. Both groups responded most to descriptions of intercourse. The second largest response was to tactile interaction (short of intercourse). The third was to situations of partner location and pretactile interaction, which were not differentiated from each other. Responses to sexually neutral situations were smaller than those to descriptions of any category of sexual interaction. This result refutes the hypothesis that exhibitionism develops on the basis of a disinclination toward intercourse. The close relationship between exhibitionism, and voyeurism and toucheurism (or frotteurism), had been demonstrated earlier. Therefore, it is also unlikely that these latter anomalies develop from a disinclination toward intercourse.