Paraphilia - Symptom, Cause and Treatment

Paraphilias and Sexual Disorders

Paraphilia (in Greek 'para' = over and 'philia' = friendship) is a rare mental health disorder term recently used to indicate sexual arousal in response to sexual objects or situations that are not part of societally normative arousal/activity patterns, or which may interfere with the capacity for reciprocal affectionate sexual activity.

the best criteria for diagnosis come from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ) or the International Statistical Classification of Diseases, 10th Revision.

Paraphilias all have in common distressing and repetitive sexual fantasies, urges, or behaviors.  These fantasies, urges, or behaviors must occur for a significant period of time and must interfere with either satisfactory sexual relations or everyday functioning if the diagnosis is to be made. The disorder is characterized by a 6-month period of recurrent, intense, sexually arousing fantasies or sexual urges involving a specific act, depending on the paraphilia.

Some of the common paraphilias include:

• Exhibitionism
• Fetishism
• Frotteurism
• Pedophilia
• Masochism
• Sadism
• Transvestitism
• Voyeurism

Paraphilia not otherwise specified

This category is included so physicians can code paraphilias that do not meet the criteria for any of the other specific categories.

• Scatologia
• Necrophilia
• Partialism
• Zoophilia
• Coprophilia and Coprolalia
• Klismaphilia
• Urophilia
• Masturbation

Other Paraphilia

• Autogynephilia
• Asphyxiophilia or hypoxyphilia
• Video voyeurs
• Infantophilia
• Acrotomophilia
• Apotemnophilia
• Autoassassinophilia
• Autonephioplia
• Ephebophilia
• Erotophonophilia
• Gerontophilia
• Hypephilia
• Kleptophilia
• Mysophilia
• Narratophilia
• Pictophilia
• Somnophilia
• Scoptophilia
• Stigmatophilia
• Troilism

Symptoms of Paraphilia

Although many of the paraphilias seem foreign or extreme, they are easier to understand if one thinks of those behaviors that, in less extreme versions, are quite common. For instance, having a partner "talk dirty" may be a "turn-on" for some people, but when talking dirty is the only way that sexual arousal or satisfaction can occur, it would be considered a paraphilia. Others want to be bitten, or spanked, or become aroused by watching their partner. Viewing a nude person or watching sexually explicit videos can be arousing for most people. Paraphilias are magnified to the point of psychological dependence.

Treatment of Paraphilia

A number of psychological techniques have been used but currently cognitive behavioral methods, including relapse prevention strategies, appear the most effective.

• Psychotherapy - Long-term individual or group psychotherapy is usually necessary and may be especially helpful when it is part of multimodal treatment that includes social skills training, treatment of comorbid physical and psychiatric disorders (eg, seizure disorders, attention deficit disorder, depression), and hormonal treatment.
• Antiandrogen Drugs - In the USA, IM medroxyprogesterone acetate is the treatment of choice; cyproterone acetate is used in Europe. Typically, a male with a moderate to severe paraphilia is given medroxyprogesterone. Treatment is usually long-term, because deviant sexual arousal patterns usually reoccur shortly after testosterone levels return to normal.
• SSRIs ( selective serotonin reuptake inhibitors) - eg, fluoxetine or fluvoxamine may be useful.

The course of paraphilias is usually chronic in nature. The prognosis for complete recovery is generally considered to be guarded.

If you, a friend, or a family member would like more information and you have a therapist or a physician, please discuss your concerns with that person.

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Site last updated: March 4, 2008

Paraphilias and Psychosexual Disorders