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This is part 1 of a two-part series. Part 2, which will appear in the May issue, will discuss older classifications of telephone scatologia and a new approach to evaluating obscene telephone calls based on their content and comorbidity. Treatment options will also be reviewed.
Paraphilias are characterized by socially deviant, repetitive, highly arousing sexual fantasies, urges, and activities that last at least 6 months.1 Telephone scatologia is a paraphilia characterized by a pattern of sexual arousal associated with exposing an unsuspecting victim to sexual and obscene material over the phone. The caller frequently will masturbate either while speaking to the victim or later while recalling the encounter.2 The occasional obscene caller must be differentiated from the telephone scatologist, who, according to the DSM-IV criteria, must engage in the behavior (or have intense sexual urges or fantasies involving the behavior) for at least 6 months and must experience significant distress or impaired functioning as a result of the behavior.
Although much has been written about the paraphilias and their treatment during the past 10 years, there has been comparatively little empirical interest in obscene telephone calling. Thus, telephone scatologia remains classified as a paraphilia not otherwise specified (NOS) in the DSM-P/,1 a category reserved for sexual disorders that either are uncommon or have been so inadequately described in the literature that a separate category is not warranted. The term scatologia is derived from the Greek words skato, for dung, and logos, for speech.3 The disorder is also referred to as telephone scatophilia, and telephomcophilia.4
Telephone scatologia has been traditionally described as a kind of verbal exhibitionism, a "nonvisual analogue of exposing."5,6 Early clinical reports equated the production of obscenities over the phone with exhibitionism.7,8 Both involve sudden attempts to provoke fear, shock, or aversion in strangers, and physical contact with the victim is not required for the sexual gratification of the perpetrator.9 This view has been questioned by reports of obscene telephone callers who do not complain of any other form oí sexual deviancy. Dalby described four obscene telephone callers who denied concomitant traditional exhibitionism.8 Although more recent epidemiologic studies have confirmed an association with exhibitionism, they have also suggested comorbidity with other paraphilic disorders such as voyeurism.10,11
These demographic studies have strongly suggested an...