• Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What are causes and risk factors for paraphilia?

Biological issues that are thought to be risk factors for paraphilias include some differences in brain activity during sexual arousal, as well as general brain structure. Male pedophiles have been found to have lower IQ scores on psychological testing compared to men who are not pedophiles. Research has also determined that they tend to have a history of earning lower grades in school than their nonpedophilic counterparts regardless of intellectual abilities and learning styles.

There are a number of psychological theories about how paraphilias develop. Some view these disorders as a manifestation of arrested psychosexual development, with the paraphilic behaviors defending the person's psyche against anxiety (defense mechanisms). Others believe paraphilias are the result of the sufferer associating something with sexual arousal or by having unusual early life sexual experiences reinforced by having an orgasm. Some view these disorders as another form of obsessive compulsive disorder.

Psychologically, pedophiles who act on their urges by sexually offending tend to engage in grossly distorted thinking, in that they use their position of power and view offending as an appropriate way to meet their needs, think about children as equal sexual beings to adults, and consider their sexual needs as uncontrollable.

Another theory about paraphilia risk factors is that they are linked to stages of childhood psychological development like temperament, early relationship formation, trauma repetition, and disrupted development of sexuality, as follows:

  • Temperament: a tendency to be overly inhibited or uncontrolled with emotions and behaviors
  • Early relationship formation: a lack of stable self-awareness, trouble managing emotions, and in seeking help and comfort from others
  • Trauma repetition: People who are abused, especially if it occurs during childhood, may identify with the abuser such that they act out what was inflicted on them by victimizing others in some way. They may also act out the trauma by somehow harming themselves.
  • Disrupted development of sexuality: The patterns of what one finds sexually arousing tend to become formed by adolescence. It is thought that people who are raised in a household that is either excessively sexually permissive or inhibited are at higher risk for developing a paraphilia.

Family risk factors for paraphilia development include high conflict between parents or low supervision by parents, a lack of affection from the mother, and generally not feeling treated well by their parents. People with paraphilia tend to have trouble making and keeping friends and other relationships.

What are paraphilia symptoms and signs?

While the desired sexual stimulant for the paraphilia sufferer depends on the specific paraphilia, the characteristics of the illness are often very similar. Specifically, people with a paraphilia tend to become aroused by the stimulant to the exclusion or near exclusion of more common sources of sexual arousal, like an attractive person of similar age. The intensity of the attraction can be overwhelming enough to cause distress. The unusual or forbidden nature of a paraphilia often causes symptoms of guilt and fear of punishment.

Symptoms of paraphilia can include preoccupation to the point of obsessiveness that may intrude on the person's attempts to think about other things or engage in more conventional sexual activity with an age-appropriate partner. Paraphilia sufferers may experience depression or anxiety that is temporarily relieved by engaging in paraphilic behavior, thus leading to an addictive cycle.

How do health professionals diagnose paraphilias?

Usually providers of mental-health care help make the diagnosis of paraphilias, including licensed mental-health therapists, psychiatrists, psychologists, psychiatric nurses, and social workers. One of these professionals will likely conduct or refer the person with paraphilia for an extensive medical interview and physical examination as part of establishing the diagnosis. To ensure that the paraphilic individual does not suffer from a medical condition that could complicate the assessment or treatment of their mental-health condition, routine laboratory tests are often performed during the initial evaluation.

As part of this examination, the sufferer may be asked a series of questions from a standardized questionnaire or self-test to help assess the presence of paraphilic symptoms.  Thorough exploration for any history or presence of all mental-health symptoms will be conducted such that paraphilia can be distinguished from other types of mental disorders. People with pedophilia may also suffer from a personality disorder or mood disorder, and about 60% have an additional paraphilia, like exhibitionism, voyeurism, or sadism.

In order to qualify for the diagnosis of a paraphilia, the individual has to experience recurrent, significant sexual arousal by the object of their attraction; act on that attraction in urges, fantasies, or actions; and experience the symptoms for at least six months to the point that the individual suffers significant levels of distress or interference with his or her work, social function, or other important aspects of life.

Medically Reviewed by a Doctor on 3/16/2016

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