Introduction
Background
Paraphilia is a rare disorder, and the best criteria for diagnosis come from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)1 or the International Statistical Classification of Diseases, 10th Revision (ICD-10)2 . 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.
Paraphilia is a means for some people to release sexual energy or frustration. The act commonly is followed by arousal and orgasm, usually achieved by masturbation and fantasy. These disorders are not well recognized and often are difficult to treat for several reasons. Often, people who have these disorders conceal them, experience guilt and shame, have financial or legal problems, and can (at times) be uncooperative with medical professionals.
Some psychiatrists discuss whether paraphilias are a part of the impulse control disorders or if they fall within the spectrum of obsessive-compulsive disorders. The more common paraphilias include voyeurism and frotteurism, and the most rare paraphilia is zoophilia. In this age of computer technology, individuals can easily access information about paraphilias from any computer, thus fueling a disorder that already is difficult to control.
Pathophysiology
Many theories exist regarding the etiology of paraphilias, including psychoanalytical, biological, and sociobiological theories; however, none are conclusive. This subject requires additional research.
Psychoanalytical Theory
According to psychoanalytical theory, several possible factors may contribute to the origin of paraphilias. Freud and his colleagues suggested that some paraphilias may be attributed to possible distortion of the courtship phases. Normal courtship behavior is what brings males and females together for the purpose of mating. It usually occurs during adolescence and may or may not involve sexual intercourse at this early stage of sexual development. Courtship is composed of 4 definitive phases.- Location of a potential partner - The initial phase of courtship
- Pretactile interaction - Talking or flirting with a potential partner
- Tactile interaction - Usually consists of touching, hugging, hand holding, etc (This could also be considered foreplay.)
- Effecting genital union - More commonly known as sexual intercourse
Although most of the population are able to appropriately engage in these 4 phases of interaction, other people are unable to adhere to these socially acceptable norms. Freud and his colleagues have indicated that certain deviant or unconventional sexual practices can be viewed as exaggerations of the 4 phases of courtship. Based on Freud's research with incarcerated sex offenders, one distortion of courtship behavior may result in others.
Certain paraphilias are associated with distortions of courtship behaviors.
- Voyeurism: This is the distorted view of the initial courtship phase. Normally the initial courtship phase is known as locating a potential partner. Psychoanalysts postulate that voyeurism may be attributed to a child witnessing episodes of his or her parents engaged in sexual intercourse. Individuals with maladaptive social and sexual skills find voyeurism as an outlet for sexual pleasure void of the threat of sexual interaction. The risk or danger of discovery may likely give the voyeur a false sense of masculinity, this behavior tends to be similar for the exhibitionist as well.
- Exhibitionism: Psychoanalysts consider exhibitionism a distortion of the pretactile interaction of the courtship phase. Psychoanalytical theory is based on the theory that gender identity for little boys requires psychological separation from the mother, so that he will not identify with her as a member of the same sex as do little girls. Exhibitionists regard their mothers as rejecting them on the basis of their different genitalia. The act of exhibitionism forces women to accept them by forcing them to look at their genitals. The act of self-exposure is also a way for the exhibitionist to compensate for his introversion and lack of assertiveness. The act of exposing oneself may give the exhibitionist a false sense of power, and the danger of discovery may further reinforce this feeling. In general, psychoanalysts theorize that the act of an exhibitionist displaying his penis is a way of proving his manhood to the world, but more importantly to an adult woman. Narcissism, the extreme form of self-admiration, is also believed to contribute to exhibitionism. Many of these men are married and have regular sexual contact with their spouse. However, in the mind of the exhibitionist/narcissist, by receiving only his wife's admiration of his genitalia is not sufficient in feeding his endless secondary narcissistic supply. Therefore, this leads to his search for other unsuspecting victims to fulfill his insatiable need for admiration. The exhibitionist is sometimes compared to an actor on stage who desires an audience, but does not want to participate in the act.
- Toucherism and frotteurism: These are considered exaggerations of the tactile interaction of the courtship phase. These paraphilias provide a sexual outlet without the risk of rejection. Toucherism tends to occur in conjunction with other paraphilias.
Behavioral Theory
Behavioral theory attributes the development of certain paraphilias to the process of conditioning. Actually, paraphilias are a result of accidental conditioning. If nonsexual objects are frequently and repeatedly associated with a pleasurable sexual activity, then the object becomes sexually arousing. A small study was conducted with 7 heterosexual males, all of whom were free of any fetishes. They were repeatedly shown erotic stimuli that were paired with a slide of women's black knee-high boots. Later, when the slide of the boots was shown alone, 5 of the 7 men experienced penile erection. This indicated that a boot fetish had been conditioned. A similar study with a small group of women was conducted to determine if they could be conditioned to become sexually aroused by a stimulus. Results showed no significant differences found in physiological sexual arousal between the experimental and control groups. These results imply that sexual arousal is not readily classically conditioned in women. This might explain why fetishism and other paraphilias occur almost exclusively in males. In this article, these findings are supported in another school of theory.
Conditioning does not always involve positive reinforcement. Negative reinforcement may occur as well. If an individual experiences unpleasant consequences with normal sexual activity, an aversion to sex may occur, resulting in the development of deviant behavior. An example of this would be a young boy who is humiliated and punished by his parents for proudly displaying his erect penis. As the boy matures he may associate guilt and shame with normal sexual behavior.
Certain atypical sex acts, such as exhibitionism and voyeurism, that provide intense sexual arousal may lead to individual preference of that behavior. Pedophiliacs, exhibitionists, and voyeurs may be driven by risk-taking behaviors. Therefore, the constant threat of discovery may be as arousing to them as the act itself.
Conditioning is not the only contributing factor in the development of paraphilias. These individuals usually experience low self-esteem, which may lead to difficulty in forming person-to-person sexual relationships.
Sociobiological Theory
An article of particular interest in explaining possible etiologies of paraphilias is A Theory about the Variety of Human Sexual Behavior, written by Richard A Gardner . Gardner's article combines a couple of theories. These theories are Dawkins's theory of gene transmission and Darwin's well-known survival of the fittest theory. In a sense, this could be considered a sociobiological theory.Dawkin's theory
Dawkins's theory of gene transmission is used in developing a theory regarding the variations in human sexual behavior. These variants in sexual behavior, even atypical sexual behavior (paraphilias), are seen as survival of the species. According to this view, the different paraphilias may be responsible for enhancing society's level of sexual excitation. In turn, this would increase the likelihood of people engaging in sex acts that would ultimately lead to procreation.
First, we discuss the origin of the gender differences in mating patterns. In the courtship process, women seem to be genetically programmed to be more passive and seductive, while men are more assertive and aggressive. Before the 20th century, males served the role of hunters and fighters, while the primary role of the female was in child rearing. The men who were more adapt at hunting and fighting (protectors and warriors) were more likely to survive and attract females as mates. The weaker men were less likely to attract women as desirable mates because they were unable to adequately provide food, clothing, and shelter. This would make them less able to protect their potential family from enemies.
Men were also more likely to be attracted to women who were stronger in child rearing abilities. This would more likely ensure that their genes would be passed down to subsequent generations. Therefore, the stronger and more aggressive men, as well as women with a stronger capacity for raising children, were more likely to acquire mates. This would ensure propagation of their genes.
Today, this genetic programming is carried in both sexes. Although lower primates are more instinctually driven, humans are also affected to a certain degree. During the mating season, animals are compelled to go through the mating ritual of their species.
Humans also have procreative urges, but not in a particular mating season or in a particular mating ritual as seen in the lower primates. Unfortunately, this does not make us exempt from such mating patterns with the resultant pattern of their expression.
Darwin's theory
Darwin's theory of survival of the fittest relates more directly to reproductive capacity. Each species produces more offspring than could possibly survive; therefore, those who are more capable of adapting to their environment are more likely to survive and perpetuate the species. In general, those species that are less adaptable to their surroundings are more likely to become extinct.
Quantity and quality are 2 of the operative factors inDarwinian Theory. As already mentioned, the quantity of offspring produced in an environment is far greater than what can actually survive. Therefore, the quality of offspring that is most adaptable to the environment will survive.
Each of the sexes is designated to provide either quantity or quality. The male is the species physically able to produce the greatest amount of offspring. Since a female producing a greater quantity of offspring than the male is biologically impossible, she is the one responsible for quality control. As discussed earlier, the woman tends to be selective in the process of choosing a mate. The mate of choice is one that will be the best in providing for and protecting the family. The female will also ultimately take on the responsibility of child rearing.
This brings us to the procreative process discerning males versus females. A biology professor at LouisianaStateUniversity in Shreveport once said, "Sperm are cheap and eggs are expensive." This pretty much sums it up. If a man devoted his whole life to the procreation process, he could possibly father or produce 30,000 offspring. On the other hand, if a woman were to devote her entire fecund life to procreation, she could only possibly produce 40-45 babies.
Although this procreative potential may exist, humans partake in other necessary life activities besides fornication and propagation. Child rearing may be the most important of these life activities. If protection is not provided for the young, the babies would be unable to survive. Therefore, to devote one's life to the sole purpose of manufacturing babies without the potential for survival would be senseless. Also, women must try and select the mate that will remain around after impregnation and serve the role as protector and gatherer. In order to have the ability to assess a proper mate, women were more cautious in regards to their impulsivity regarding sexual gratification. Women with inhibited sexual arousal were more likely to select a proper mate and increase their likelihood of survival. Also, once aroused, a woman is more likely to attempt an ongoing relationship with her mate.
While women are programmed to be more cautious in the selection of a mate, men tend to desire sex indiscriminately with large amounts of women. Again, this is a means of spreading their sperm for the purpose of procreation and passing down their genes. According to literature, males are quicker to arousal than the average female. Following gratification from a sexual encounter, the man is less likely to be interested in maintaining a relationship or commitment.
The old saying, "Men are looking for girls, and girls are looking for husbands" suggests that men are on the prowl, hunting solely for sexual companionship from women. Shanor (1978) conducted a study that found men aged 12-40 years think of sex approximately 6 times an hour. However, we need to determine the distribution by age ranges. Males aged 12-19 years think of sex an average of 20 times per hour or once every 3 minutes. In males aged 30-39 years, this slows down to approximately 4 times per hour. This may be one reason in explaining that paraphilias usually occur in males aged 15-25 years.
According to this data, most men are promiscuous, either physically or psychologically. The distinguishing factor is the degree of control that is exerted toward action or inaction in regard to the sexual urges. Women must be aware of this fact and reject most of the "men in heat" or risk the possibility of impregnation without commitment. Females are much more relationship oriented. This is one of the factors that contribute to women having a greater orgasmic capacity than men. While it may be necessary for a woman to acquire more touching, caressing, and overall romance to become aroused, this will ensure that her arousal will more likely last longer. Most women have the potential for multiple orgasms, which may further enhance the procreative capacity. This capacity for multiple orgasms enables the female to captivate the sustained interest and involvement of the male who otherwise tends to be slow to ejaculation. This may prove difficult because males reach the point of orgasm, which is immediately followed by the refractory period, otherwise known as "falling asleep."
The data mentioned above may explain why men are more like likely to be sexually aroused by visual stimuli, and women are more readily to respond to tactile stimuli. The hunters (roving bands of men) spot their prey (women) at a distance and are able to achieve excitement just by the sight of a possible future conquest. Their hunting nature in itself enlarges the potential for sexual partners. Unlike females, this may explain why males gawk at females. If women are watching men, they are much less obvious and exhibitionistic than men in their plight.
Women are more susceptible to caressing, tenderness, and the reassurance of a man's commitment. This commitment ensures that he is emotionally invested in this union and will remain around to supply food and protection for her and their offspring. This may explain one of the reasons that men are more likely to be sexually aroused by visual pornography.
Frequency
United States
Paraphilias are considered rare, affecting only a small percentage of the US population. Researchers have a difficult time trying to determine a specific percentage of involved individuals because many of the acts are illegal and reporting methods (ie, self-reporting) typically are unreliable.
International
International percentages of patients with paraphilias are difficult to discern because these disorders are rare.
Mortality/Morbidity
Determining the morbidity or mortality of paraphilias depends on the act practiced, the comorbidity involved, the patient's cooperation with the therapist, and whether or not the legal system is involved. Paraphilias can be transient, as demonstrated by experimentation during the teenage years, or can remain a life-long problem involving legal, financial, interpersonal, occupational, academic, and other problems. Death may occur in some circumstances, through acts such as autoerotic asphyxiation.
Race
Patients typically are white.
Sex
Patients typically are men.
Age
Most patients are aged 15-25 years; this disorder rarely occurs in individuals older than 50 years. The information on paraphilia in older individuals is limited.
Clinical
History
DSM-IV-TR criteria include the following:
- Exhibitionism
- Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors that involve exposing their genitals to unsuspecting strangers.
- The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Exhibitionism typically involves men exposing themselves to women (not a DSM-IV-TR criterion).
- Fetishism
- Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving nonliving objects.
- The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Patients do not limit the fetish objects to articles of female clothing used in cross-dressing or to devices designated for the purpose of tactile genital stimulation.
- Patients may have a particular pathological displacement of erotic interest and satisfaction for their entire lives (not a DSM-IV-TR criterion).
- Frotteurism
- Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving rubbing against and touching a nonconsenting person.
- The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Patients typically practice this behavior in crowded places (not a DSM-IV-TR criterion).
- Pedophilia
- Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children.
- The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The patient must be aged 16 years or older and at least 5 years older than the child or children involved.
- Sexual masochism
- Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving the act of being humiliated, beaten, bound, or otherwise made to suffer.
- The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- This variant is named for the activities of Leopold von Sacher-Masoch (not part of the DSM-IV-TR criterion). Sacher-Masoch was born in Lemberg, Austria in 1836. As an author he is most known for his book Venus in Furs. This writing is reportedly based on true events from his life.
- Sacher-Masoch's novel is said to be one long masochistic fantasy in which the principle male character desires and encourages his mistress to treat him as a slave. This story appears to parallel his relationship with his wife. He used to plead with her to treat him as a slave, and his outlandish requests would progressively become more demeaning to satisfy his sexual appetite. However, she was not interested in partaking in his deviant self-deprecating fantasies. Eventually they met other partners and parted ways.
- Leopold von Sacher-Masoch was the eldest son of a couple in the town of Galacia, where his father was the Director of Police and his mother was a little Russian lady of noble birth. As an infant, Leopold was very frail and sickly, and not expected to survive. To increase the infant's chances of survival, his parents hired a robust Russian wet nurse who was able to nurse him back to health. Leopold later spoke of the strong bond between the 2 of them. The woman shared strange and melancholy legends about her people with the boy, and he formed a love of the Russians that remained constant throughout his life. He reportedly said that not only did he gain his health from her, but also his soul.
- As a child, Leopold was fascinated by various representations of cruelty. He was especially drawn to pictures of executions, and some of his favorite reading materials pertained to legends of martyrs. At the onset of puberty, he had a recurring dream that he was under the power of a cruel and torturous woman. The term dream is used in this context as opposed to nightmare.
- In the town of Galacia, where Leopold was born, women were said to either rule their husbands or vice versa. At the age of 10, the boy witnessed a sadistic scene that left a permanent impression. The scene involved a female relative from his father's side of the family. This woman was referred to as Countess X. Prior to Leopold witnessing the life-altering event, he was enamored by the Countess and was impressed by her beauty and costly furs. He used to help her with various duties, services, etc. On one occasion, as he was putting on her shoes, he bent down to kiss her feet and she smiled at him and then kicked him. Instead of being hurt, he experienced a perverse sensation of pleasure.
- Sometime after this event, he witnessed the Countess and her lover caught in the act by her husband and 2 of his friends. The Count, who was obviously stunned, paused momentarily to plot his course of revenge. In the meantime, the Countess beat all 3 men to a bloody pulp. Leopold had been hiding in the room throughout the encounter, and was discovered by the Countess after gasping in astonishment. Upon discovery, she beat him as well. He made his way out of the room, but was still right outside the door watching should anything else occur. Moments later, the boy witnessed the Count, back in the same room where he had been humiliated earlier, begging for her forgiveness. The Countess looked at her husband and with that same calculating smile, all too familiar to Leopold, gave him a big swift kick.
- Sexual sadists
- Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving the acts in which psychological or physical suffering of the victim is sexually exciting to the patient.
- The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- This variant is named for the activities of the Marquis de Sade (not part of the DSM-IV-TR criterion).
- The Marquis de Sade was born in Paris, France on June 2, 1740 and died on December 2, 1814 in Charenton, France. His full name was Donatein Alphonse Francois comte de Sade. The term sadism is a derivative of his name. The Marquis was an aristocrat and an author of violent pornography. The French author's erotic books, mainly written while imprisoned, include Justine, Juliette, and 120 Days of Sodom. The Marquis de Sade regarded criminal/sexually deviant acts as being natural, which was apparent in both his writings and actions. Consequently, his novels were banned into the 20th century.
- The Marquis de Sade's life consisted of numerous acts of cruelty, which were indicative of his total disregard for human life and the law. His acts of extremely violent physical and sexual abuse resulted in numerous imprisonments and consequent escapes. He was also declared insane and admitted to an insane asylum on 2 different occasions. The Marquis was imprisoned or committed to insane asylums for at least 32 years of his life. Most victims of Marquis were young female prostitutes, as well as both male and female employees of his chateau.
- Donatein's mother was a distant cousin to the Prince de Conde, a junior branch of the royal Bourbon family. She served as a lady in waiting to the Princess de Conde and was a governess to her son, the young Prince de Conde. An early account of Donatein's violent nature involved an altercation between he and his young cousin over a toy. When the young Prince tried to retrieve one of his favorite toys from the grasp of his 4-year-old cousin, Donatein pummeled his cousin with increasing blows of violence. Soon after this incident, the young Marquis was sent to live with his paternal grandmother in Avignon.
- The troubled young boy spent his formative years in Avignon surrounded by female relatives who indulged his every need and enveloped him with sensual affection. Donatein's grandmother and aunts continually doted on the child and indulged every one of his selfish demands. There was no mention of discipline in the boy's upbringing. These actions were only detrimental to the child's development; consequently, his behavior became increasingly unruly. When the Comte de Sade (Donatein's father) received report of his son's unconventional upbringing, the young Marquis was sent to live with his father's brother. The Comte hoped that his brother, Abbe de Sade, would be able to provide a masculine presence and influence that was obviously lacking in Donatein's life.
- Abbe de Sade was a noted author, clergyman, and scholar of his time. He was also very much like his sisters in the sense that he enjoyed the sensual side of life and indulged himself with many pleasures. He was referred to as "sybarite of Saumane" meaning one inordinately attached to pleasure and luxury. Once again the young boy was in an atmosphere that encouraged sexuality and sensual indulgence as an expectation rather that an exception to the rule. During Donatein's stay at his uncle's home, the abbe housed many female companions which included a local prostitute.
- Throughout this period of time in Europe, men and women of the cloth, indulged themselves in various sexual escapades with little remorse. There was rumor of orgies taking place in abbeys and convents, where priests, nuns, prostitutes, and nobles all engaged in debaucherous behavior. Abbe de Sade had a library filled with a genre of literature, and some were pornographic in nature. Donatein was free to read all of the literature in the library at his leisure. After becoming abreast of the ever present debauchery in Donatein's life, his father moved him to Paris where he was enrolled in a Jesuit prep school for young men of nobility.
- Donatein was quite young to have been uprooted so many times. He was 10 years old when he was enrolled at the prep school. Although the Jesuits had a remarkable reputation as educators, they were infamous for their practices involving sodomy and corporal punishment. The Jesuits would beat, whip, or flog the young boys in front of an assembled student body to humiliate them. The humility of the beatings, oddly enough, could also be sexually arousing. This practice came to be known as sado-masochistic behavior. As an adult, the Marquis de Sade was unable to be aroused by normal sex, so it appeared that his sexuality was arrested at the infantile anal stage.
- After 4 years with the Jesuits, Donatein was transferred to a military academy upon this father's request. In 1755, shortly following his arrival, Donatein served in the King's light cavalry regiment as a sub leutenant. He was only 15 years old at the time. The young Marquis served in the war and was considered a brave and decisive leader. Unsatisfied with Donatein's success in the cavalry, his father had him placed with a cavalry company commanded by one of the members of the royal family. Donatein's bravery, good looks, and social charm made him a very successful soldier. His superiors were quite impressed by the Marquis; therefore, he was promoted to captain at the young age of 18. Donatein seemed able to impress everyone but his own father. His father never praised his son for his many accomplishments, yet had no difficulty pointing out his shortcomings.
- When the Marquis de Sade returned from the war in 1763, he had his sights set on a particular lady whom he wished to marry. However, his father was opposed to the union. Instead, he arranged for the Marquis to marry her elder sister, Renee-Pelagie de Montrieul. The couple had 3 children, 2 boys and a girl.
- The same year the couple was married, the Marquis de Sade frequently traveled away from home for "business" reasons. While away on his travels, he rented several different maisons around Paris where orgies were held. One particularly disturbing encounter took place between the Marquis and a young prostitute. After he was alone with her, he quizzed the young prostitute about her religious convictions regarding the Roman Catholic Church. When he discovered that she was a faithful Roman Catholic, he began degrading her with inconceivable vile insults.
To the young woman's horror, he proceeded to perform sexually explicit acts on her with the aid of religious objects that were extremely blasphemous and sacrilegious in nature. When the young prostitute refused his request to beat each other with a hot whip, he pleasured himself sexually with a pair of crucifixes. Then he held her at knife point, forcing her to repeat vulgarities in the most blasphemous manner. This resulted in the Marquis de Sade's first imprisonment; however, his lewd and debaucherous behavior would result in numerous other imprisonments during his lifetime. He died in 1814 and was buried in Charenton. Later his skull was removed from the grave for phrenological examination. - The Marquis de Sade's life was not an ordinary one. From early on, he was rejected by his parents and moved from one place to another. The Marquis would never gain his father's approval, no matter how hard he worked. His life lacked structure, appropriate discipline, balance, and unconditional love/approval. The young Marquis was exposed to complete self-indulgent behavior lacking any form of discipline while raised by his grandmother, aunts, and uncle. Then he was exposed to extreme corporal punishment while attending prep school with the Jesuits. He was also exposed to deviant sexual behavior in both of these very different settings.
- In theory, one might postulate that exposure to these extreme polarities of behavior, especially during the very crucial formative years, might cause the underdeveloped psyche to integrate the 2. Therefore associating pleasure with pain, hence the deviant masochistic behavior.
- Transvestic fetishism
- Over a period of 6 months, heterosexual male patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.
- The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Typically, patients derive sexual gratification from wearing clothes usually worn by the opposite sex, and patients typically are heterosexual married males (not a DSM-IV-TR criterion).
- Voyeurism
- Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity.
- The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Patients derive sexual gratification from seeing sex organs and sexual acts; scopophilia is a synonym for voyeurism (not a DSM-IV-TR criterion).
- 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 involves making obscene phone calls.
- Necrophilia involves an erotic attraction or sexual interest in corpses. This paraphilia is rare and seldom reported to the police. Patients typically work in mortuaries and funeral parlors. This also involves dangerous situations where the individual could actually acquire infections from the corpse.
- Partialism is sexual interest exclusively focused on a particular body part.
- Zoophilia involves sexual activity with animals (ie, both actual sexual contact and sexual fantasies, higher in psychiatric patients).
- Coprophilia is sexual activity involving feces.
- Klismaphilia is sexual activity involving enemas.
- Urophilia is sexual activity involving urine.
- Masturbation is sexual self-gratification.
- Other paraphilias
- Autogynephilia describes a man's propensity to be sexually aroused by thoughts or images of himself as a woman (with female attributes).
- Asphyxiophilia or hypoxyphilia is when a patient uses hypoxia to achieve sexual excitement; this can be complicated by autoerotic asphyxiation.
- Video voyeurs derive sexual gratification from videos, usually of women doing natural acts or women involved in sexual activity.
- Infantophilia is a new subcategory of pedophilia in which the victims are younger than 5 years.
Physical
Obtain a complete history and perform complete mental status, physical, and neurological examinations to assist with the evaluation and to rule out other disease processes. This particular patient population may be more difficult to interview because they may be more likely to have guilt associated with their disorder, therefore making them reluctant to openly share information with the interviewer. The interviewer must establish rapport with these patients and allow them to talk more freely about their disorder. By asking leading questions and then allowing the patient to reveal information on his or her own helps in the treatment and management of this disorder.
Causes
Rule out major medical or psychiatric illnesses. Look for both hard and soft neurological signs involving the striato-thalamo-cortical processing loop (theory). This theory states that a disruption of the striato-thalamo-cortical processing loop can cause abnormal filtering of information resulting in the brain's inability to block unimportant information, which is thought to cause a propensity to initiate or perpetuation paraphilias and other psychotic phenomena. It is important to point out that this is just a theory and much more research is needed to either confirm or disprove this concept as a cause of paraphilias.
More on Paraphilias |
 Overview: Paraphilias |
| Differential Diagnoses & Workup: Paraphilias |
| Treatment & Medication: Paraphilias |
| Follow-up: Paraphilias |
| References |
| Next Page » |
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Further Reading
Keywords
sexual urges, sexual fantasies, masturbation, voyeurism, frotteurism, zoophilia, exhibitionism, fetishism, pedophilia, sexual masochism, sexual sadism, transvestic fetishism, scopophilia, scatologia, necrophilia, partialism, coprophilia, klismaphilia, urophilia, autogynephilia, asphyxiophilia, hypoxyphilia, autoerotic asphyxiation, infantophilia, video voyeurism
