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Other Sexual Disorders: Paraphilic Disorders

Lorraine Benuto, Ph.D., edited by C. E. Zupanick, Psy.D.

books forming question mark Paraphilic Disorders re-introduce the discussion of what is healthy versus disordered sexual behavior. This group of disorders refers to a variety of conditions in which the person views, has recurrent fantasies about, or has sexual contact with unusual stimuli.

With the publication of the DSM-5, this family of disorders require the presence of a paraphilia. A paraphilia involves intense and persistent sexual interest (recurrent fantasies, urges or behaviors of a sexual nature) that center around children, non-humans (animals, objects, materials), or harming others or one's self during sexual activity. Sometimes this sexual interest focuses on the person's own erotic/sexual activities while in other cases, it focuses on the target of the person's sexual interest. To be diagnosed with one of these disorders, the paraphilia also needs to be causing significant distress or impairment, or involve personal harm or risk of harm to others. You can have a paraphilia, but not have a paraphilic disorder. It is only when it causes impairment, harm or the risk of harm that it become a clinical diagnosis.

This category of disorders includes:

  • Voyeuristic Disorder - spying on others in who are engaging in private activities
  • Exhibitionistic Disorder - exposing one's genitals to a non-consenting person
  • Frotteuristic Disorder - touching or rubbing against another person who has not consented to participate in such activity
  • Sexual Masochism Disorder - receiving humiliation, bondage or suffering during sexual activities
  • Sexual Sadism Disorder - inflicting humiliation, bondage or suffering on another person during sexual activities
  • Pedophilic Disorder - focuses one's sexual interest on children
  • Fetishistic Disorder - having one's sexual energies focused on a body part or object, rather than onto another human being
  • Transvestic Disorder -cross-dressing for sexual arousing reasons

There is also a diagnostic category for Other Specified Paraphilic Disorder. This is used when symptoms of a paraphilic disorder are present and cause significant distress or impairment, but do not meet full criteria for any of the other disorders. This classification is used when the clinician is listing the specific reason that the symptoms do not meet the full disorder criteria. Examples include chronic preoccupation with making obscene telephone calls or relating sexually to only a part of another's body, dead people, feces and urine, animals, etcetera.

Unspecified Paraphilic Disorder is used when symptoms cause significant distress or impairment, but do not meet full criteria for any of the other disorders, and the clinician does not wish to specify the reason that criteria are not met. This also includes situations when there is not enough information available for the clinician to make a specific diagnosis.

Paraphilic Disorders are disorders of deviant sexuality. Because they are so often associated with abusive sexual practices that create real victims, many people tend to regard persons who display sexual deviancies as monsters. Further, many people tend to assume that all sexual deviants are equally awful and disgusting. Neither of these statements are accurate. While they are ultimately responsible for their choices (including those that harm other people), should be punished and, thereafter, closely monitored to prevent further abusive practices, even people with pedophiliac disorder or sexual sadism are legitimately suffering from mental, emotional and spiritual disturbance and should be able to participate in treatment. There are also forms of sexual deviancy such as Transvestic Disorder and Fetishistic Disorder that harm no one and that do not deserve to be thought of in the same breath as the other more extreme cases.

On a final note, we should point out one mode of sexuality which is definitively not listed here, and that is Homosexuality and Bisexuality. Although historically listed as sexual deviancies, homosexuality and bisexuality has been recognized as completely normal variants of human sexuality for many years now. However, just because being gay isn't a sexual deviancy or disorder, doesn't mean that it doesn't come with its own set of stressful issues.

Paraphilic Disorder Causes and Treatments

Most of these disorders emerge during adolescence, but there is often a connection with events or relationships in early childhood. Once established, they tend to be ongoing, although some research has indicated that the behaviors will reduce as the individual ages (Barbaree & Blanchard, 2008). Most people with paraphilia disorders are men. Although biological factors play a role in some paraphilia disorders, researchers have yet to identify a specific biological or biochemical cause. Instead, psychological factors seem to be central. In most cases, one or more events happened during childhood that led the individual to associate sexual pleasure with that event (or object) and resulted in the development of a paraphilia. Thus, in therapy it may be helpful to explore early sexual experiences and fantasies (Getzfeld, 2006).

People with these conditions do not often seek treatment on their own and do not generally recognize that they have a problem until they have ended up in court and are then required to enter treatment. Common treatments include psychotherapy and medication.

Behavior therapy is often used to help the person control their urges and use more acceptable means of coping with them than exposing their genitals to others.

Cognitive-behavioral therapy can also be used where the therapist helps the person identify triggers that cause their urges and then works with the person to teach skills to manage the sexual urges in more health ways. This typically includes cognitive restructuring (identifying and changing the thoughts that drive the behavior), relaxation training (to reduce exposure impulses), and coping skills training (different ways to behave when feeling aroused).

Various medications can be used to inhibit sexual hormones (testosterone or estrogen) in order to reduce sexual desire. Selective serotonin reuptake inhibitors (SSRIs), which are commonly used for depression and other mood disorders, can also be used as lower levels of serotonin in the brain has been found to cause an increased sex drive. Therefore, using a SSRI can reduce the sexual desire being felt.

For more information of Paraphilic Disorders, visit our Sexual Disorders topic center.