What are paraphilias?

Background

A paraphilia can be centered on a particular object (animals, clothing, etc.) or on a particular act (inflicting pain, exhibitionism, etc.). A paraphilia is characterized by a preoccupation with the object or behavior to the point of dependence on that object or behavior for sexual gratification. Most paraphilias are much more common in men than in women.

Paraphilias are divided into three categories: sexual arousal and preference for nonhuman objects (as in fetishes and transvestism); sexual arousal and a preference for situations that involve suffering and humiliation (such as in sadism and masochism); and sexual arousal and preference for non-consenting partners, behaviors that include exhibitionism and voyeurism.

Specific Types of Paraphilia

Fetishism
. Fetishism involves sexual urges associated with nonliving, or inanimate, objects, including clothing items.

Frotteurism . Frotteurism is characterized by a man rubbing his genitals against a non-consenting, unfamiliar person.

Pedophilia
. Pedophilia is characterized by fantasies or behaviors that involve sexual activity with a child.

Sadomasochism
. Sexual masochism is a paraphilia in which one incorporates his or her sexual urges into suffering to achieve sexual excitement and climax. Sexual sadism involves persistent fantasies in which sexual excitement results from inflicting suffering on a sexual partner. Extreme sadism may involve illegal activities such as rape, torture, and murder.

Transvestism . Transvestism refers to the practice of dressing in clothes associated with the opposite sex to produce or enhance sexual arousal. Note that transvestic disorder only occurs when an individual's cross-dressing causes distress.

Voyeurism . Voyeurism involves achieving sexual arousal by observing an unsuspecting and non-consenting person who is undressing or unclothed or engaged in sexual activity. The voyeur does not seek contact with the person that he or she is observing.

Other paraphilias. Some paraphilias are relatively rare, and include apotemnophilia (sexual attraction to amputations), coprophilia and urophilia (sexual excitement derived from contact with human waste), zoophilia (sexual attraction to nonhuman animals), and necrophilia (sexual attraction to corpses).

Symptoms

A person with paraphilias is distinguished by the insistence and relative exclusivity with which his or her sexual gratification focuses on the acts or objects in question. For many, orgasm is not possible without the paraphilic act or object. Such individuals often have difficulty developing personal and sexual relationships with others and frequently exhibit compulsive behavior. Although it is not known for certain what causes paraphilia, some experts have theorized that paraphilias may develop in response to childhood trauma, such as sexual abuse.

Screening and Diagnosis

The American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders
lists two basic criteria for diagnosing paraphilia: one, the unusual sexual behavior should occur over a period of six months and, two, the sexual behavior causes a clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The second criterion differs for some disorders. For pedophilia, voyeurism, exhibitionism, and frotteurism, the diagnosis is formulated if acting out on these urges or if the urge itself causes a significant distress or interpersonal difficulty. For sadism, a diagnosis is made if these urges involve a non-consenting person. For the other paraphilias, a diagnosis is made when the sexual behavior, urges, or fantasies cause substantial distress or disability in important areas of life.

Treatment and Therapy

Most cases of paraphilia are treated with counseling and therapy in an effort to help patients modify their behavior. Research suggests that cognitive-behavioral models are especially effective in treating persons with paraphilias. Group therapy involves breaking through the denial associated with paraphilias by surrounding the affected person with other people who share their disorder. Once they begin to admit that they have a sexual deviation, a therapist can address individual issues, such as past sexual abuse, that may have led to the disorder. Many physicians and therapists refer persons with paraphilias to twelve-step programs designed for sexual addicts. The programs incorporate cognitive restructuring with social support to increase awareness of the problem.

Also used in treatment are drugs called antiandrogens, which drastically lower testosterone levels in men temporarily. These medications help to decrease compulsiveness and reduce deviant sexual fantasies. In some cases, hormones such as medroxyprogesterone acetate (Depo-Provera) and cyproterone acetate (Androcur) are prescribed for persons who exhibit dangerous sexual behavior. These medications work by reducing one’s sex drive. Antidepressants such as fluoxetine (Prozac) work in a similar manner but have not been shown to effectively target sexual fantasies.

Bibliography

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington: APA, 2013. Print.

Bhugra, D. “Paraphilias across Cultures: Contexts and Controversies.” Journal of Sex Research 47.2–3 (2010): 242–315. Print.

Bradford, John M. W., and A. G. Ahmed, eds. Sexual Deviation: Assessment and Treatment. Philadelphia: Elsevier, June 2014. Digital file.

Laws, R. D., and W. T. O’Donohue, eds. Sexual Deviance: Theory, Assessment, and Treatment. 2nd ed. New York: Guilford, 2008. Print.

Lehmiller, Justin J. The Psychology of Human Sexuality. Malden: Wiley, 2014. Print.

Wilson, Glenn, ed. Variant Sexuality. New York: Routledge, 2014. Digital file.