Paraphilias

Characterized by a dependence on unusual behaviors or fantasies to achieve sexual excitement, paraphilias are complex psychosexual disorders. The imagery or acts may involve the use of inanimate objects (especially clothing), repetitive sexual activity that includes suffering or humiliation, or sexual behavior with nonconsenting partners. The DSM-IV recognizes eight types of paraphilias: exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, transvestic fetishism, and voyeurism.

Some paraphilias that violate social mores or norms are considered sex offenses or sex crimes. However, everyone has sexual fantasies, and sexual behavior between two consenting adults that isn't physically or psychologically harmful isn't considered a paraphilia.

Little data exist on the prevalence of paraphilias in our society. Most people with paraphilias come to the mental health care system not because of their own distress but at the behest of their partners or legal authorities.

Causes

The specific cause of paraphilias isn't known, although several contributing factors have been identified. Many patients with these disorders come from dysfunctional families, characterized by isolation and sexual, emotional, or physical abuse. Others suffer from other mental disorders. such as psychoactive substance use disorders or a personality disorder.

Do paraphilias affect males, females, or both?

Paraphilias are primarily male disorders.

Treatment

Paraphilias require mandatory treatment when the patient's sexual preferences result in socially unacceptable or harmful behavior. Depending on the paraphilia, treatment may include a combination of psychotherapy, behavior therapy, pharmacotherapy, and surgery. The effectiveness of treatment varies.

What can people do if they need help?

If you, a friend, or a family member would like more information and you have a therapist or a physician, please discuss your concerns with that person.