- Paraphilias Center
- Sexually Transmitted Diseases (STDs) Slideshow Pictures
- Take the Quiz on STDs
- Impotence Slideshow Pictures
- Find a local Psychiatrist in your town
- Paraphilia facts
- What is a paraphilia? What are the different types of paraphilias?
- What are causes and risk factors for paraphilia?
- What are paraphilia symptoms and signs?
- How do health professionals diagnose paraphilias?
- What is the treatment for paraphilia?
- What is the prognosis of paraphilia?
- Is it possible to prevent paraphilias?
- Paraphilias are emotional disorders 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 important areas of functioning.
- Except for masochism, paraphilias are almost exclusively diagnosed in men.
- There are a number of different types of paraphilias, each of which has a different focus of the sufferer’s sexual arousal.
- There are thought to be biological, psychological, and social risk factors for developing paraphilias.
- While the desired sexual stimulant for the paraphilia sufferer depends on the specific paraphilia, the characteristics of the illness are often very similar.
- In order to establish the diagnosis of a paraphilia, mental-health professionals usually conduct or refer the person for a medical interview, physical examination, and routine laboratory tests. The professional will assess for any history of mental-health symptoms.
- Treatment of paraphilias usually involves the combination of psychotherapy and medication.
- Paraphilias have been found to be quite chronic, such that a minimum of two years of treatment is recommended for even the mildest paraphilia.
- Prevention for the development of any paraphilic behavior usually involves alleviating the psychosocial risk factors for its development.
What is a paraphilia? What are the different types of paraphilias?
The word paraphilia is derived from Greek; para means around or beside, and philia means love. 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.
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. Therefore, many of the estimates on the prevalence of paraphilia are gained from the number of people involved with the criminal-justice system due to pedophilia. Most pedophiles are men, with just 1%-6% being women.
Except for 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.
There are a number of different types of paraphilias, each of which has a different focus of the sufferer’s sexual arousal:
- Voyeurism: watching an unsuspecting/nonconsenting 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 nonconsenting 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).
Quick GuideConception: The Amazing Journey from Egg to Embryo
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.
What is the treatment for paraphilia?
The focus of research on the treatment for paraphilias is primarily focused on pedophilia, due to the terrible impact of this behavior on victims and due to the involvement of pedophilic offenders with the justice system. Those studies have shown that treatment only tends to work if the person with pedophilia is motivated and committed to controlling his or her behavior and when treatment combines psychotherapy and medication.
Psychotherapy for pedophilia and other paraphilias tends to use cognitive behavioral therapy. The focus of psychotherapy tends to be helping the person with pedophilia recognize and combat rationalizations about his or her behavior, as well as training the pedophilia sufferer in developing empathy for the victim and in techniques to control their sexual impulses. This therapy tends to take an approach to treating sexual offenders using a relapse prevention model that is similar to treating people with a drug addiction. This approach tries to help the paraphilic person anticipate situations that increase their risk of sexually acting out and finding ways to avoid or more productively respond to those triggers. People with paraphilia may also benefit from social skills training to help them develop age-appropriate, reciprocal relationships.
Medications that suppress production of the male hormone testosterone can be used to reduce the frequency or intensity of sexual desire in pedophiles. It may take three to 10 months for testosterone suppression to reduce sexual desire. Studies of the effectiveness of selective serotonin reuptake inhibitors (SSRIs) in treating pedophilia and other paraphilias vary in their findings on their effectiveness. However, SSRIs may be a helpful addition to other treatments, because they tend to decrease sexual obsessiveness and urges associated with paraphilias and may also help with increasing the paraphile’s ability to control his or her impulses. Examples of SSRI medications include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro).
There is some preliminary research that stimulant medications like methylphenidate (Ritalin) can increase the effectiveness of SSRIs, and naltrexone can decrease some of the sexual obsessiveness associated with paraphilias.
What is the prognosis of paraphilia?
Paraphilias have been found to be quite chronic such that a minimum of two years of treatment is recommended for even the mildest paraphilia. While most people with a paraphilia do not sexually offend, and sexual offending is not considered a mental illness, people who commit sexual offenses sometimes also have a paraphilia.
Is it possible to prevent paraphilias?
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.
Daily Health News
Subscribe to MedicineNet's General Health Newsletter
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, D.C.: American Psychiatric Association, 2013.
Cantor, J.M., Kuban, M.E., Blak, T., Klassen, P.E., et al. "Grade failure and special education placement in sexual offenders’ educational histories." Archives of Sexual Behavior 35 (2006): 743–751.
Gordon, H., and Grubin, D. "Psychiatric aspects of the assessment and treatment of sex offenders." Advances in Psychiatric Treatment 10 (2004): 73-80.
"Pessimissm about pedophilia." Harvard Mental Health Letter. July 2010.
Kafka, M.P., and J. Hennen. "Psychostimulant augmentation during treatment with selective serotonin reuptake inhibitors in men with paraphilias and paraphilia-related disorders: a case series." Journal of Clinical Psychiatry 61.9 Sept. 2000: 664-670.
Lawson, L. "Isolation, gratification, justification: offenders' explanations of child molesting." Issues in Mental Health Nursing 24 Sept.-Nov. 2003: 695–705.
Polisois-Keating, A., and Joyal, C.C. "Functional neuroimaging of sexual arousal: a preliminary meta-analysis comparing pedophilic to non-pedophilic men." Archives of Sexual Behavior Oct. 2013.
Raymond, N.C., Grant, J.E., and Coleman, E. "Augmentation with naltrexone to treat compulsive sexual behavior: A case series." Annals of Clinical Psychiatry 22.1 (2010):56–62.
Schwartz, M.F. "Developmental psychopathological perspectives on sexually compulsive behavior." Castlewood Treatment Center Mar. 2008.
Siegel, R.M. "Paraphilics and sexual variants: Assessing and treating sexual concerns in couples." Winter Institutes for Advanced Clinical Training Mar. 2013.
Thibaut, F., De La Barra, F., Gordon, H., et al. "Guidelines for the biological treatment of paraphilias." The World Journal of Biological Psychiatry 11 (2010): 604–655
Top Paraphilia Related Articles
AnxietyAnxiety is a feeling of apprehension and fear characterized by symptoms such as trouble concentrating, headaches, sleep problems, and irritability. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. Treatment for anxiety may incorporate medications and psychotherapy.
Female Sexual ProblemsSexual dysfunction in women is common, from female sexual arousal disorder to other sexual problems. Causes of female sexual disorders include stress, anxiety, and medications.
fluoxetineFluoxetine (Prozac, Sarafem, Prozac Weekly) is a drug prescribed for the treatemnt of depression, bulimia, obsessive-compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder (PMDD). It is also prescribed in combination with olanzapine (Zyprexa) to treat resistant depression and depression associated with bipolar disorder. Side effects, multiple drug interactions, dosage, and pregnancy safety should be reviewed prior to taking this medication.
MasturbationJust about everybody masturbates. Masturbation itself is the self-stimulation of the male or female genitals to achieve sexual pleasure or arousal to the point of orgasm. Masturbation involves stimulating the penis or clitoris. Masturbation is very common among people who have, or do not have sexual relations with a partner. Masturbation can relieve sexual tension that can build up over a period of time. Masturbation generally is considered normal unless it becomes a problem by inhibiting sexual activity with a partner, done in public, or causes distress to the person masturbating. Some experts suggest that masturbation can improve a person's sexual health and personal relationships.
Mental Health (Psychology)Mental health is an optimal way of thinking, relating to others, and feeling. All of the diagnosable mental disorders fall under the umbrella of mental illness. Depression, anxiety, and substance-abuse disorders are common types of mental illness. Symptoms and signs of mental illness include irritability, moodiness, insomnia, headaches, and sadness. Treatment may involve psychotherapy and medication.
Mental IllnessMental illness is any disease or condition affecting the brain that influence the way a person thinks, feels, behaves, and/or relates to others. Mental illness is caused by heredity, biology, psychological trauma and environmental stressors.
methylphenidateMethylphenidate (Ritalin, Ritalin SR, Ritalin LA, Concerta, Methylin, Methylin ER, Daytrana, Quillivant XR, Metadate CD, Metadate ER) is a drug prescribed for the treatment of narcolepsy and children with ADHD. Side effects, drug interactions, warnings and precautions, patient safety information, and pregnancy efficacy should be reviewed prior to taking any medication.
Obsessive Compulsive Disorder (OCD)Obsessive compulsive disorder (OCD) is an anxiety disorder that causes a person to suffer repeated obsessions and compulsions. Symptoms include irresistible impulses despite a person's realization that the thoughts are irrational, excessive hand washing, skin picking, lock checking, or repeatedly rearranging items. People with OCD are more likely to develop trichotillomania, muscle or vocal tics, or an eating disorder. Treatment for OCD includes psychotherapy, behavioral therapy, and medication.
paroxetineParoxetine Paxil, Paxil CR, Paxeva is a drug used to treat depression, OCD, PTSD, premenstrual dysphoric disorder, and social anxiety disorder. Paroxetine is an SSRI and should not be taken with MAOIs, and some blood thinners. Common side effects include nausea, headache, anxiety, constipation, and more. Side effects, drug interactions, warnings and precautions, and pregnancy safety information should be reviewed prior to taking any medication.
PsychotherapyPsychoteraphy is often the first form of treatment recommended for depression. Psychotherapy helps depression by helping people understand the behaviors, emotions and ideas that contribute to their depression, regain a sense of control and pleasure in life, and learn coping techniques as well as problem solving skills.
Rape (Sexual Assault)There are many forms of sexual assault, including rape, attempted rape, child molestation, sexual intercourse that you say no to, inappropriate touching, and vaginal, anal, or oral penetration. Sexual assault can also be anything that forces someone to join in unwanted sexual contact or attention, such as voyeurism, exhibitionism, incest, and sexual harassment.
Zoloft (sertraline) is a medication prescribed for the treatment of depression, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder and premenstrual dysphoric disorder (PMDD). Side effects include:
- Skin rash
- Upset stomach
- Loss of appetite
- Abnormal ejaculation
- Decreased interest in sexual activity
- Dry mouth
Drug interactions, dosage, and pregnancy and breastfeeding safety information should be reviewed prior to taking this medication.
Sexual (Sex) Problems in MenMale sexual dysfunction can be caused by physical or psychological problems. Common sexual problems in men include erectile dysfunction (impotence or ED), premature ejaculation, and loss of libido. Treatment for sexual dysfunction in men may involve medication, hormone therapy, psychological therapy, and the use of mechanical aids.
Sexual (Sex) Problems in WomenSexual dysfunction refers to a problem that arises during any phase of the sexual response cycle, preventing an individual or couple from experiencing sexual satisfaction. Physical, medical, and psychological conditions may affect sexual functioning, resulting in inhibited sexual desire, inability to become aroused, lack of orgasm, and painful intercourse. Treating the underlying physical and psychological problems usually resolves most female sexual problems.
Sexual AddictionThe term sex addiction describes the behavior of someone who has an unusually strong sex drive or sexual obsession. Sex and thoughts of sex dominate a sex addict's thinking, making it difficult to work or engage in healthy personal relationships. Sex addicts may engage in exhibitionism, voyeurism, prostitution, compulsive masturbation, or cybersex. Treatment for sex addiction includes individual counseling, marital and/or family therapy, support groups, 12-step recovery programs, and in some cases, medications.
Sexual Health OverviewSexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.