Paraphilic Disorders

Atypical sexual preferences

What are paraphilias?

Paraphilic disorder is characterized by atypical sexual activity that involves one of the following:

1. Nonhuman objects

2. Non-consenting adults

3. Suffering or humiliation of oneself or one's partner

4. Children

(Nolen-Hoeksema, 2014).

Signs and Symptoms:

These include but are not limited to, preoccupation to the point of obsessiveness. This may interfere with the person's attempt to think or engage in other things or even have a normal conventional sexual relationship. Those suffering from a paraphilia disorder often suffer depression and anxiety that sometimes is relieved by the paraphilic behavior. These individuals may also have guilt and fear of punishment (MedicineNet, 2015).

Types of paraphilias

The DSM-V currently documents eight specific types pf paraphilia.

  • Pedophilic Disorder: Sexual preference for prepubescent children

  • Sexual Sadism Disorder: Sexual pleasure from inflicted pain or humiliation

  • Transvestic Disorder: Sexual arousal associated with clothing and accessories associated with the opposite sex

  • Fetishistic Disorder: Inanimate objects used used to obtain sexual pleasure

  • Exhibitionistic Disorder: The urge to expose one's genitalia or performance of sexual act to an unsuspecting stranger

  • Frotteuristic Disorder: Touching or rubbing against a non-consenting person

  • Sexual Masochism Disorder: Act and desire to be humiliated, beaten, tied up or other sufferings to obtain sexual pleasure

  • Voyeuristic Disorder: Observing a person while they are naked, undressing, performing sexual acts or activities that are considered private without their knowledge

(MedicineNet, 2015)

Possible Causes

The cause of paraphilic disorders is not fully clear but there are a few theories out there. Many of the paraphilias began in adolescence and will usually decrease as the person ages. The occurrence and intensity of the disorder will alter per individual. Most individuals with paraphilia has difficulty obtaining personal and sexual relationships with others (WebMD, 2016).

Behavioral theories explain paraphilias as being due to an "initial classical pairing of intense early sexual arousal with a particular stimulus" (Nolen-Hoeksema, 2014). For example, a young child may be aroused when spying on her neighbor's lovemaking to her husband. This could potentially be followed by intensive operant conditioning in which the stimulant is present. This reinforces the association between the sexual arousal and stimulus. The person may try to control and suppress the undesired behavior. Eventually similar stimuli will trigger the sexual arousal (Nolen-Hoeksema, 2014).

Principles of social learning theory have been supplemented with classical behavioral theories. The social learning theory suggests "that the larger enviroment of a child's home and culture influences his or her tendency to develop deviant sexual behavior" (Nolen-Hoeksema, 2014). Children who have parents that frequently use corporal punishment and use aggressive contact with one another are more likely to engage in impulsive, aggressive, and sexual acts towards others as they age. Childhood sexual abuse is an extremely strong predictor of pedophilia (Nolen-Hoeksema, 2014).

There is some evidence that suggests alterations in the development of the brain and hormonal systems may contribute to pedophilia. A few some studies state men with pedophilia have dysfunctions in the frontal area of their brain that involves regulating aggressive and impulsive behavior. Men with pedophilia also are more likely to have endured a head injury before age 13 to have lower intelligence, cognitive and memory deficits, and have different brain structure volumes (Nolen-Hoeksema, 2014).


Most paraphilias are rare. These disorders are 20 times more common in men than in women. The reasoning for the gender difference is unknown (WebMD, 2016). One study also found that there is a significantly higher rate of previous hospitalizations in patients with paraphilias (Marsh et al., 2010).

Treatment options

Most people who deal with paraphilia do not seek treatment for their abnormal behavior and instead treatment is often forced on those who are arrested after engaging in illegal activity. Unfortunately, incarceration does little to help the behaviors and convicted sex offenders often become repeat offenders (Nolen-Hoeksema, 2014). It is important to seek treatment as those who seek treatment are less likely to relapse compared to those who do not (Fedoroff & Beverly, 1997).

Biological interventions are focused on reducing the sex drive in order to reduce the behavior. Although, it is rarely done today, castration has been preformed across the the world. Surgical castration has also been preformed, completely eliminating the production of androgens and lowers repeat offences of convicted sex offenders (Nolen-Hoeksema, 2014).

Cognitive-behavioral techniques is another primary intervention for paraphilias. "The individual is taught to to associate the sexually arousing stimulus with its negative consequences" (Taylor, 2014). These techniques help people "identify and challange thoughts and situations that trigger their behaviors and serve as jsutifications for the behaviors" (Nolen-Hoeksema).

Behavior modifications are also commonly used to treat paraphilic behavior and have the potential to be successful if individual is willing to change the abnormal behavior. "Aversion therapy is used to extinguish sexual responses to onjects or situations a person with a paraphilia finds arousing" (Nolen-Hoeksema, 2014). During this therapy the person may be exposed with a harmless but painful shock or loud bursts of noise while viewing photos that arouse them. These therapies are found effective in non predatory paraphilias (Nolen-Hoeksema).

Antiandrogen drugs are offered to sex offenders to suppress production of testosterone and decrease sex drive. These medications are generally used in conjunction with psychotherapy. Results on the consistency and effectiveness of these drugs are mixed. There are many side effects including sleepiness, depression, weight gain, hair loss, breast formation, and osteoporosis. Serotonin reuptake inhibitors have been used to reduce sexual drive but effects are not totally consistent across studies (Nolen-Hoeksema).

Myths and misconceptions

  1. Sex offenders cannot be cured: This is a deep belief in history but recent studies find this untrue. A recent paper found that nine out of ten studies reviewing 887 programs were effective. Those without treatment are at a higher risk of relapse compared to those that receive treatment (Fedoroff & Beverly, 1997).
  2. Paraphilias are not traditional mental illnesses, therefore they can’t be reasons for commitment: Many paraphilias can manifest by antisocial or criminal behavior; it’s the second part that makes the “myth.” "Justices unanimously agreed that sexual predator commitment procedures need not require a “traditional” mental illness in order to be constitutional" (Reid, 1998).
  3. Sex Offenders are all the Same: Defining all offenders as the same is unwise and dangerous. It would be similar to saying all viruses are the same. Although they are similar, the motivations and symptoms are different and should be treated as different disorders (Fedoroff & Beverly, 1997).
  4. Sex offenders are the result of child abuse: One man, Dr. Barendzen associated his sexual behavior on his own experience of being sexually abused as a child. There was little evidence to support this (Fedoroff & Beverly, 1997). As mentioned above there are many possible causes of these sexual behaviors.
  5. Treatments aren’t reliable enough for such dangerous people: It is often not a matter of what works but a matter of using it. Medicine and psychology have a number of treatments that are reliable (Reid, 1998).


Psychotherapists use a variety of psychological techniques to help clients. Psychiatrists may perform psychotherapy as part of their medical practice.

Psychotherapist usually have a masters degree in psychology or one of the social sciences. They will then complete a post graduate internship. The majority of the therapist are not medical doctors but some have medical degrees and a license to prescribe medication. After completion of the degree and internship, psychotherapist must obtain a license in psychotherapy or one of the therapeutic fields.

Certain skills are required for the job. It is important to have good verbal and listening skills. The therapist must be skeptical but also insightful. Patience and persistence are also great skills to have to break down the resistance of clients.

(, 2016)

Paraphilic Disorders


References (2016). List of paraphilias. Retrieved from

Fedoroff, P., & Beverly, M. (1997). Myths and misconceptions about sex offenders. The Canadian Journal of Human Sexuality, 6(4).

Gauer, G., Osório, F., Neto, A., Teixeira, N., Caum, M., Da Costa Souza, T., … Cristófoli, V. (2007). Nonimputability: a study on inmates at Instituto Psiquiátrico Forense Maurício Cardoso. Revista de Psiquiatria do Rio Grande do Sul, 29(3), 286-293.

Marsh, P., Odlaug, B., Thomarios, N., Davis, A., Buchanan, S., Meyer, C., & Grant, J. (2010). Paraphilias in adult psychiatric inpatients. Annals of Clinical Psychiatry, 22(2), 129-134.

MedicineNet. (2015, January 17). Paraphilia: Read about treatment and types. Retrieved from

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

Hill Education.

Reid, W. H. (1998). Myths about violent sexual predators and all that pesky legislation. Journal Practice of Psychiatry and Behavioral Health, 246-248. (2016). Psychotherapist Career: Job Description & Requirements. Retrieved from Requirements_for_Becoming_a_Psychotherapist.html

Taylor, G. (2014, August 18). Paraphilic Disorders: DSM-5 EPPP Lecture Video. Retrieved from

WebMD. (2016). Sexual conditions health center. Retrieved from