Paraphilic Disorders Differential Diagnoses

Updated: Jun 17, 2020
  • Author: Claudia L Reardon, MD; Chief Editor: David Bienenfeld, MD  more...
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Diagnostic Considerations

In diagnosing paraphilic disorders, it must be kept in mind that nonparaphilic individuals may describe nonpathologic use of sexual fantasies, behaviors, or objects as stimuli for sexual excitement. In patients with mental retardation, paraphilia should be distinguished from dementia, personality change due to a general medical condition, substance intoxication, manic episode, or schizophrenia in which judgment, social skills, or impulse control are compromised. When appropriate, public urination should be distinguished from exhibitionism.

Other problems to be considered (as alternative explanations of symptoms or comorbidities) are as follows:

  • Experimentation

  • Hormone dysregulation

  • Seizures

  • Chromosome abnormality

  • Social phobia

  • Conduct disorder

  • Multiple sclerosis

  • Conversion disorder

  • Frontoparietal traumatic brain injury

  • Abnormal amygdala activation [16]

  • Sexsomnia [17]

  • Autoerotic asphyxiation [18]

  • Paraphilic coercive disorder