Paraphilic Disorders

What is a Paraphilic Disorder?

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.

Epidemiology

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.

What are different types of Paraphilic Disorders?

Different types of paraphilic disorders include:

  • Exhibitionism – The recurrent urge to expose one’s genitals to a stranger or an unsuspecting person. Sexual excitement occurs in anticipation of the exposure, and orgasm is brought about by masturbation during or after the event. In almost 100 percent of cases, exhibitionism occurs in men exposing themselves to women.
  • Fetishism – A sexual focus on non-genital body parts or on objects (e.g., shoes, gloves, pantyhose, stockings) that are intimately associated with the human body. The particular fetish used is linked to someone closely involves with a person during childhood. Sexual activity may be directed toward the fetish itself, or the fetish may be incorporated into intercourse (e.g. the demand that high-heeled shoes be worn).
  • Frotteurism – An act characterized by a man’s rubbing his penis against the buttocks or other body parts of a fully clothed woman to achieve orgasm. At other times, he may use his hands to rub an unsuspecting victim. The acts usually occur in crowded places, particularly in subways and buses. Those with frotteurism are extremely passive and isolated.
  • Pedophilia – Recurrent intense sexual urges toward, or arousal by, children 13 years of age or younger, over a period of at least 6 months. Most child molestations involve genital fondling or oral sex. A significant number of perpetrators are also or have been, involved in exhibitionism, voyeurism, or rape.
  • Sexual Masochism – A recurrent preoccupation with sexual urges and fantasies involving the act of being humiliated, beaten, bound, or otherwise made to suffer. The diagnosis requires that the disorder occurs over a period of at least 6 months and causes significant distress or impairment in social, occupational, or other important areas of functioning.
  • Sexual Sadism – The recurrent and intense sexual arousal from the physical and psychological suffering of another person. The diagnosis requires that a person has experienced sadistic feelings for at least 6 months and has acted on sadistic fantasies.
  • Voyeurism – The recurrent preoccupation with fantasies and acts that involve observing unsuspecting persons who are naked or engaged in grooming or sexual activity. Masturbation to orgasm usually accompanies or follows the event.
  • Transvestism– Fantasies and sexual urges to dress in opposite gender clothing as a means of arousal. The diagnosis is given when the transvestic fantasies have been acted upon for at least 6 months.
Are there other paraphilic conditions that may not meet the criteria for the main paraphilic diagnoses?

Yes, a diagnosis of “other specified paraphilic disorder” may apply to various abnormal sexual behaviors. These include the following:

  • Telephone and Computer Scatologia– Using obscene, sexual language over the phone or computer (e.g., chat rooms, email) to achieve sexual arousal.
  • Necrophilia – Obtaining sexual gratification from cadavers.
  • Partialism – Concentrating sexual activity on one part of the body.
  • Zoophilia – Incorporating animals into sexual activities.
  • Coprophilia and Klismaphilia – Obtaining sexual pleasure from defecating on a partner.
  • Urophilia–Involving urination with a partner in sexual activity.
  • Hypoxyphilia – Achieving an altered state of consciousness through hypoxia (shortness of oxygen to lungs) during orgasm through drugs or asphyxiation.
  • Masturbation – Considered abnormal when its frequency indicates a compulsion or sexual dysfunction, or when it is consistently preferred over sex with a partner. 
What are treatments for paraphilic disorders?

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.

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Mental Health Library Sources:
Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.
Disclaimer:
Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.
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