“Emotional disorders that are defined as sexually arousing fantasies, urges, or behaviors that are recurrent, intense”-Paraphilias

Emobileclinic Trending Topic: Paraphilias

Paraphilias are emotional disorders that are defined as sexually arousing fantasies, urges, or behaviors that are recurrent, intense, occur over a period of at least six months, and cause significant distress or interfere with the sufferer’s work, social function, or other important areas of functioning. This is as opposed to sexual variants, which are sexual behaviors that are not typical but are not a part of any illness.

Paraphilic disorders can seriously impair the capacity for affectionate, reciprocal sexual activity. Partners of people with a paraphilic disorder may feel like an object or as if they are unimportant or unnecessary in the sexual relationship.

The number of people who suffer from a paraphilia is thought to be difficult to gauge for a number of reasons. Many people with one of these disorders suffer in secret or silence out of shame, and some are engaging in sexual offending behaviors and so are invested in not reporting their paraphilia.

Types

Voyeurism: watching an unsuspecting/non-consenting individual who is either nude, disrobing, or engaging in sexual activity

Exhibitionism: exposing one’s own genitals to an unsuspecting person

Frotteurisim: touching or rubbing against a non-consenting person

Sexual masochism: being humiliated, beaten, bound, or otherwise suffering

Sexual sadism: the physical or emotional suffering of another person

Pedophilia: sexual activity with a child that is prepubescent (usually 13 years old or younger)

Fetishism: sexual fascination with nonliving objects or highly specific body parts

Transvestism: cross-dressing that is sexually arousing and interferes with functioning

Other specified paraphilia: some paraphilias do not meet full diagnostic criteria for a paraphilic disorder but may have uncontrolled sexual impulses that cause enough distress for the sufferer that they are recognized. Examples of such specific paraphilias include necrophilia (corpses), scatologia (obscene phone calls), and zoophilia (animals).

Apart from masochism, which is 20 times more common in women than men, paraphilias are almost exclusively diagnosed in men.  Many people who suffer from one paraphilia have more than one. For example, about one-third of pedophiles also have another paraphilia. More than half engage in three or four such kinds of behaviors rather than just one. Most people who develop a paraphilia begin having fantasies about it before they are 13 years old.

Causes and Risk factors

Brain injury

Schizophrenia

Biological factors

Hormones

childhood trauma, such as abuse

frequently and repeatedly associated with a pleasurable activity

difficulty developing personal relationships with others

Signs and Symptoms of Paraphilias 

Pain

Humiliation to another person

Bitten or spanked

Diagnosis

A mental-health professional usually conduct a medical interview, physical examination, and routine laboratory tests. The professional will assess for any history of mental-health symptoms.

Treatment

Paraphilias have been found to be quite chronic, such that a minimum of two years of treatment is recommended for even the mildest paraphilia.  Treatment modalities currently used fall into three categories: surgical castration, psychotherapy, and pharmacotherapy.

Pharmacological interventions consist of antiandrogens that either completely reduce testosterone secretion and/or antagonize the action of testosterone at the level of the receptor, and psychotropic drugs, namely antidepressants.

Cyproterone and medroxyprogesterone acetates are the two antiandrogens more commonly used.

Psychotropic drugs may be effective solely in men with a definite obsessive-compulsive disorder component.

Long-acting gonadotropin-releasing hormone (GnRH) agonist analogues are the most potent antiandrogens, and selectively abolish testosterone secretion in a totally reversible fashion.

Group therapy involves breaking through the denial so commonly found in people with paraphilias by surrounding them with other patients who share their illness.

Cognitive therapies described include restructuring cognitive distortions

Use social skills training to treat patients with these types of disorders. Many social skills training groups also teach basic education, which is very helpful to this patient population.

Prevention

Given that paraphilic behavior tends to be highly stigmatized and some paraphilic behaviors are illegal, tracking how successful treatment often involves rates of criminal recidivism. Therefore, prevention of future paraphilic behavior often focuses on preventing sexual offenders from having access to potential victims. Prevention for the development of any paraphilic behavior usually involves alleviating the psychosocial risk factors for its development