Paraphilic Disorders

Understanding Distress Causing Sexual Desires and Impulses

What is a Paraphilic Disorder?

A paraphilic disorder is a diagnose-able mental health condition where an individual's paraphilia (atypical sexual desires/fantasies) causes distress or harm to themselves or others. This disorder is diagnosed in indiviudals, at least 18 years of age, who have sexual desires that involve another person's distress, pain, or death, or an unwilling person's involvement (McManus, et al., 2013). The symptoms must be present for at least 6 consecutive months. There are currently eight types of paraphilic disorder in the DSM-5: pedophilic, sexual sadism, sexual masochism, voyeuristic, frotteuristic, exhibitionistic, fetishistic, and transvestic. Men are thought to be more likely than women to have a paraphilic disorder, but for both, distress or impairment of self or others is required to be diagnosed with a paraphilic disorder (Nolen-Hoeksema, 2014).


There are a number of theories about what causes a paraphilic disorder. The most common are behavioral conditioning, childhood trauma, and accompanying personality disorders. Paraphilic disorders are a mental health condition, they are not caused by being evil or a monster. Behaviorally an individual can be conditioned to feel sexual arousal from certain objects or behaviors. Childhood sexual abuse may also cause certain behaviors linked to paraphilic disorders(Dryden-Edwards, 2016). Studies show that many individuals with a paraphilic disorder have an accompanying personality disorder that can result in voyeurism, frotteurism, or exhibitionism (ISSM, 2016).

Myths of Paraphilic Disorders

It is important to remember that this is an illness, it can be treated, and there is hope. Here are some common myths vs. the reality:
Myth: All paraphilia is illegal.
Fact: Only pedophilia, voyeurism, frotteurism, and exhibitionism are illegal, as long as all others involve consenting adults (US Legal, Inc., 2016).
Myth: Only men can have a paraphilic disorder.
Fact: Men may be more commonly diagnosed, but women can develop a paraphilic disorder. Women are much more likely than men to have a sexual masochistic disorder (Brannon, 2015).
Myth: If a paraphilic disorder doesn't cause legal problems, no treatment is needed.
Fact: Paraphilic disorders cause distress or impairment, and treatment helps relieve symptoms and teaches coping skills (Nolen-Hoeksema, 2016).

Treatment Options

With all mental disorders, there are specific therapies that are best for treatment. With paraphilic disorders, the most commonly used therapies are:
Medication- certain medications that lower sex drive can be helpful
Aversions therapy- the sexual fantasy (paraphilia) is paired with either unpleasant smell, sounds, or shock to cause aversion
Cognitive-Behavior Therapy- restructuring cognitive functions and changing behavior to overcome paraphilic tendencies and symptoms of disorder
Victim Identification Therapy- identifying the individual(s) involved in a predatory paraphilic disorder can help overcome impulsive behavior (Benuto, 2009).

Finding a Psychologist to Fit Your Needs

When looking for a therapist it is important to know what you want, need, expect, and deserve. Here is a list of questions to ask a therapist in your first session:
  • What is your area of expertise? How much experience do you have?
  • Do you have a Doctorate? What about other certifications and licenses?
  • Can you bill my insurance? Tell me about cost and payment options.
  • What can I expect in terms of therapy choice and medication?
  • What are your hours, location, and overall availability?
(ADAA, 2016)
Tips for Finding a Therapist


ADAA. (2016). Questions to ask: Choosing a treatment provider. Retrieved from Anxiety and Depression Association of America:

Benuto, L. (2009). Paraphilias causes and treatment. Retrieved from MentalHelp:

Brannon, G. (2015). Paraphilic Disorders. Retrieved from Medscape:

Dryden-Edwards, R. (2016). Paraphilias. Retrieved from MedicineNet:

First, M. &. (2008). Use of DSM paraphilia diagnoses in sexually violent predator commitment cases. American Academy of Psychiatry and the Law, 36, 443-454. Retrieved from

International Society for Sexual Medicine. (2016). What causes paraphilias? Retrieved from Education for All:

McManus, M. A., Hargreaves, P., Rainbow, L., & Alison, L. J. (2013). Paraphilias: definition, diagnosis and treatment. F1000Prime Reports, 5, 36.

Miilru. (2015). Comp_1. Malou's Figments. Retrieved from

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

Hill Education.

US Legal, Inc. (2016). Paraphilia Law & Legal Definition. Retrieved from US Legal: