Paraphilic Disorder

Part of Society

The Skinny and Scarry

Unfortunately, individuals with sexual masochism or sadism disorder rarely present for treatment until someone becomes an unwilling partner or is injured. The seriousness and intensity of these behaviors often increase over time. Prognosis varies, depending on the depth of the underlying dynamics (which are especially poor when sociopath is involved) and the patient’s level of motivation.

What is Paraphillia?

Paraphilia is any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners; if a paraphilia causes distress or impairment to the individual or if its satisfaction entails personal harm (or the risk of such harm) to others, it is considered a paraphilic disorder. (APA,2014)

the following 8 specific paraphilic disorders[1] :

  • Voyeuristic disorder

  • Exhibitionistic disorder (including type I, the inhibited flaccid exposer, and type II, the sociopath exposer who may have a history of other conduct)

  • Frotteuristic disorder

  • Sexual masochism disorder

  • Sexual sadism disorder

  • Pedophilic disorder

  • Fetishistic disorder

  • Transvestic disorder


The various paraphilic disorders affect a wide variety of people. The level of severity, distress, and impairment (up to and including criminal behavior) resulting from these disorders also are highly variable. Consequently, treatment options vary and must take into account the specific needs of each individual case.

Treatment options may include psychotherapy, individual psychotherapy, group therapy, marital therapy, and family therapy, as well as pharmacotherapy or even surgical interventions, as indicated.

Inpatient treatment is indicated for patients who are suicidal, homicidal, or disabled to the point where they cannot take care of themselves. Suicide risk is high if they feel exposed or confronted. If patients are charged with a crime or have been arrested, they may be incarcerated. (WebMD., 2014)

Transvestic Disorder Symptoms

Though not necessary, this disorder can occur with fetishism (the person is sexually aroused by materials, garments, or fabrics) or with autogynephilia (the person is sexually aroused by thoughts or images of oneself as a female).

If a person has had a history of this disorder but it has not caused distress or impairment within the past 5 years, the person would be considered “in remission”(DSM-5,2013)


Paraphilic disorders must be distinguished from nonpathologic use of sexual fantasies, behaviors, or objects as stimuli for sexual excitement. Studies that may be considered in the assessment of a patient with a paraphilic disorder include the following:

  • Standard medical workup, including sequential multiple analysis, complete blood count, rapid plasma reagent, and thyroid-stimulating hormone level or thyroid function test

  • HIV screen

  • Hepatitis panel

  • Unscheduled DNA synthesis

  • Computed tomography (CT)

  • Magnetic resonance imaging (MRI)

  • Penile strain gauge

  • Abel assessment for interest in paraphilia

  • Phallometric testing

  • Electroencephalography (EEG)

Myth: People with pedophilia have sex with children.
Reality: People who are sexually attracted to children and have sex with children are pedophiles. However, there is a much larger percentage of individuals who have pedophilic fantasies, yet never disclose or execute them. These thoughts tend to create enormous distress, and society’s standard of deeming pedophiles as an exclusive, sick-minded population, only heighten the suffering. Most people fail to understand that these individualsknow their thoughts are sickening and wrong, yet they cannot stop them. Paraphilias refer to sexual fantasies or urges related to non-human objects or non-consenting persons; other ones include exhibitionism, voyeurism, sexual masochism, and sexual sadism. These are all mental disorders, not just a set of fantasies individuals choose to enjoy. In fact, paraphilias are often very tormenting and detrimental to an individual’s self-esteem and intimate relationships, and treatment is far more complicated than simply changing one’s thoughts.

Medscape. Ed. David Bienenfeld, MD. N.p., 2014. Web. 2 Nov. 2014. Path:

Paraphilic Disorder (2014). In American Psychological Association. Retrieved November 2, 2014, from

Nolen-Hoeksema, S. (2014). Abnormal psychology (6th ed.). New York: McGraw-Hill.