Stephen J. Hucker, MB, BS, FRCP(C), FRCPsych
  Consultant Psychiatrist,
  Professor, Division of Forensic Psychiatry, University of Toronto

       Forensic Psychiatry. ca

Paraphilias

What is a Paraphilia?
Paraphilia is a medical or behavioral science term for what is also referred to as: sexual deviation, sexual anomaly, sexual perversion or a disorder of sexual preference. It is the repeated, intense sexual arousal to unconventional (socially deviant) stimuli.

Richard Von Krafft-Ebing, a German psychiatrist credited with formally introducing the study of Sexology as a psychiatric phenomenon, identified paraphilias first in his 1886 Psychopathia Sexualis (Sexual Psychopathy). This highly influential psychiatric text laid the groundwork for the development of research and treatment in this area that has taken place over the last century.

Paraphilias are currently recognized as one of the categories of Sexual and Gender Identity Disorders in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders - text revision, 2000)

General Characteristics of Paraphilias
Paraphilias are found almost exclusively in males. Onset tends to begin during early puberty, reaching full development by the age of 20. They are reported in many cultures and have long been reported or described in history.

There is often an overlap of paraphilias, the most common being 2-3 concurrently present although cases of up to 10 have been reported in about 5% of paraphiliacs.

Official Criteria
Paraphilias are defined in the DSM-IV-TR as:

  • intense, recurring sexual fantasies, sexual urges or behaviors
                                      that involve
  • non-human objects, children or non-consenting adults, suffering or humiliation (to self or to others)

Two additional criteria from the DSM-IV are used in the diagnosis of a paraphilia:

Some Examples of Paraphilias
Some of the more common paraphilias are:

Rare Paraphilias

  • Acrotomophilia (amputee partner)
  • Apotemnophilia (self-amputee)
  • Asphyxiophilia (self-strangulation)
  • Autoassassinophilia (staging one's own murder)
  • Autonephioplia (diapers)
  • Ephebophilia (youth)
  • Erotophonophilia (lust murder)
  • Gerontophilia (older persons)
  • Hypephilia (fabrics)
  • Kleptophilia (stealing)
  • Mysophilia (filth)
  • Narratophilia (talking dirty)
  • Pictophilia (pictures)
  • Somnophilia (sleeper)
  • Stigmatophilia (tattoo, piercing)
  • Troilism (couples)

Assessment
Assessment usually includes the following:

  • Clinical interview: assess the frequency and chronology of the behavior, consider possibility of multiple paraphilias
  • Behavioral measurements (eg assessment during role playing)
  • Paper and pencil tests
  • Psycho-physiological assessment (phallometry, viewing time tests)

Other issues that are considered important in the assessment are:

  • Substance abuse history
  • Psychiatric diagnosis (including personality assessment, particularly the presence of psychopathy)
  • History of aggression
  • Neuropsychological factors
  • Physical examination, blood work

Treatment
Unfortunately many paraphilic individuals are poorly motivated to undergo treatment. Also, at least with the present state of knowledge, there is no "cure" for these abnormalities. Motivated patients can, however, be helped to control their urges thereby reducing their own distress and reducing the likelihood of harming themselves and/or other people.

Treatments can be broadly grouped into psychological and pharmacological (medications) approaches. As with other psychiatric disorders, a combination of the two is usually more effective than either alone.

A number of psychological techniques have been used but currently cognitive behavioral methods, including relapse prevention strategies, appear the most effective. Pharmacological treatments have included sex-drive reducing hormones such as Provera, Androcur and Lupron, though SSRI's (Serotonin Reuptake Inhibitors), such as Prozac and Paxil, have shown some promise.

Paraphilias and Sex Offending
Not all paraphilias result in illegal behaviours but some, by their very natures, do. . Fetishistic transvestism, for example, is simply the wearing of clothes of the opposite sex for sexual arousal. On the other hand, sexual sadism that involves violence to a victim in a non-consensual relationship or pedophilia that manifests itself in child molestation, are criminal behaviours.

For a more in-depth see the text sections on Sex Offending



References & Further Reading


Sexual Deviance: Theory, Assessment and Treatment. D.Richard Laws & William O'Donohue, eds. Guilford Press. New York. 1997.

Sexual Deviance: Issues and Controversies. T. Ward, D.R. Laws & SM Hudson (eds). Sage Publications: Thousand Oaks. 2003.

Other Resources:
Therapy for Sexual Impulsivity: The Paraphilias and Paraphilia-Related Disorders. Martin Kafka, MD, Psychiatric Times (on-line)


© Stephen Hucker, MB,BS, FRCP(C), FRCPsych 2003,2004,2005
This material is provided for personal use only. Any other use is strictly forbidden without the express written permission of the author

 

     
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