A paraphilic disorder is a sexual perversion that a person requires to experience arousal and orgasm. Paraphilic disorders can range from nearly normal behavior to behavior that is destructive or hurtful only to a person’s self or to a person’s self and partner, and finally to behavior that is deemed destructive or threatening to the community at large.
Paraphilic disorders include pedophilia, voyeurism, frotteurism, exhibitionism, sexual sadism, sexual masochism, fetishism, and transvestism. The diagnosis of a paraphilic disorder requires that the individual has experienced intense and recurrent arousal from their perversion for at least 6 months and has either acted on the paraphilic impulse or has experienced marked distress, interpersonal or job-related difficulties.
Paraphilias seem to be largely male conditions. More than 50 percent of all paraphilias start before age 18. Individuals with paraphilia frequently have three to five different paraphilias, either occurring concurrently or at different times in their lives. This pattern of occurrence is especially the case with exhibitionism, fetishism, sexual masochism, sexual sadism, transvestic fetishism, voyeurism, and zoophilia. The occurrence of paraphilic behavior peaks between ages 15 and 25 and gradually declines.
Different types of paraphilic disorders include:
Yes, a diagnosis of “other specified paraphilic disorder” may apply to various abnormal sexual behaviors. These include the following:
Five types of psychiatric interventions are used to treat individuals with the paraphilic disorder and paraphilic interests: external control, reduction of sexual drives, treatment of coexisting conditions (e.g., depression or anxiety), cognitive-behavioral therapy, and dynamic psychotherapy.
Cognitive-behavioral therapy may be used to disrupt learned paraphilic patterns and modify behavior. Interventions include social skills training, sex education, cognitive restructuring (confronting and destroying the rationalizations used to support victimization of others), and development of victim empathy. Imaginal desensitization, relaxation techniques, and learning what triggers the paraphilic impulse so that such stimuli can be avoided are also taught.
Insight-oriented psychotherapy is a long-term treatment that focuses on the dynamics and events that caused the paraphilia. Psychotherapy allows patients to regain self-esteem to approach a partner in a more normal sexual manner.
Drug therapy, including antipsychotic or antidepressant medication, may be used for the treatment of schizophrenia or depressive disorders if paraphilia is associated with these disorders.