Paraphilias

Key Features

• Atypical objects or orientations are associated with sexual excitement

• Stimuli can vary from common objects such as a woman's shoe, a child, animals, instruments of torture, or aggressive acts

• The pattern of sexual stimulation is usually one that has early psychological roots

• Disorders are differentiated by the object or activity used to achieve arousal

• When paraphilias are associated with distress, impairment, or risk of harm, they become paraphilic disorders

• Some paraphilias or paraphilic disorders include

  • Exhibitionism

  • Transvestism

  • Voyeurism

  • Pedophilia

  • Incest

  • Sexual sadism

  • Sexual masochism

Clinical Findings

• Exhibitionism is the achievement of arousal by exposing genitalia to strangers

• Transvestism consists of recurrent cross-dressing in a heterosexual man often in masturbation foreplay

• Voyeurism involves attaining arousal watching sexual activities or disrobing of an unknowing person

• Pedophilia is the use of a child to achieve sexual arousal and often gratification

• Incest involves a sexual relationship with a person—usually a child—in the immediate family

• Sexual sadism involves inflicting pain upon the sexual object as a means of arousal

• Sexual masochism is erotic pleasure being achieved by being humiliated, enslaved, or physically bound or restrained

Diagnosis

• Clinical history, often including court-ordered evaluations

Treatment

• Psychological therapy

  • Focus is on barriers to normal arousal response

• Behavioral therapy

  • Modeling, role-playing, and conditioning procedures

• Medroxyprogesterone acetate, a suppressor of libidinal drive

• SSRIs (eg, fluoxetine)

• Luteinizing hormone-releasing hormone agonists