Paraphilias are intense, recurrent sexual desires bordering on obsession-compulsion and directed toward unusual targets such as inanimate objects (women’s underwear, urine, feces), animals, children, inflicting pain, or receiving pain.1
Paraphilias overwhelmingly afflict men. The only paraphilia for which women receive a diagnosis to any significant degree is sexual masochism (~ 1 woman for 20 men diagnosed).2
Non-paraphilic sexual compulsion disorders are intense, recurrent sexual desires bordering on obsession-compulsion and involve conventional sexual activities directed toward adults.
Table 1 provides a listing of the more common paraphilias (paraphilias tend to at most characterize a few percent of the population).
|Table 1: Some Common Paraphilias|
|Sexual pleasure lies in||Label|
|Exposing one's sexual organs to unsuspecting individuals||Exhibitionism|
|Non living objects||Fetishism|
|Touching and rubbing against a non-consenting person||Frotteurism|
|Receiving humiliation or suffering||Sexual Masochism|
|Inflicting humiliation or suffering||Sexual Sadism|
|Secretively observing people undress or having sex||Voyeurism|
|Notes: Paraphilias are rare but some are more common than others. High intensity sexual desire, recurrence, and obsessive-compulsive desire are required for a paraphilia diagnosis.|
Non-paraphilic sexual compulsion disorders typically accompany paraphilias (e.g., Table 2). Note the relative overrepresentation of nonheterosexual men in Table 2.
|Table 2: Some aspects of men with paraphilias (PARs) and non-paraphilic sexual compulsion disorders (NPSCDs). See last row for sample sizes.|
|A||Type of Promiscuity||Total||10||11|
|B||Type of Promiscuity*||Total||21||21|
|Incestuous - heterosexual||2|
|Incestuous - homosexual||1|
|Type of Promiscuity||Total||SO||NSO||13|
|D||Type of Promiscuity**||Total||28||28|
|Type of Promiscuity****||Total||53|
|SO = sex-offenders, NSO = Non-sex-offenders. |
Multiple paraphilias tend to co-occur, i.e., there exists a tendency toward disparate erotic targets among paraphiles:
- In a sample of autogynephilic men (aroused by imagining oneself as a woman or having a woman’s body parts), 90% acknowledged some history of transvestism (cross-dressing ), 38% acknowledged transvestism alone, and 55% acknowledged both fetishism and transvestism.9
- Two or more of the following are often found in the same individual: voyeurism, exhibitionism and obscene telephoning, toucheurism and frotteurism, and the preferential rape pattern.10, 11
- Bondage and transvestism commonly accompany hypoxiphilia (deriving sexual pleasure by depriving oneself of oxygen). Among hypoxyphiles, anal self-stimulation with foreign objects and self-observation with mirrors or cameras correlate with transvestism; the highest levels of transvestism occur with low levels of bondage, i.e., transvestism and bondage compete with each other.12
- Among heterosexual men, the presence of sexual masochism increases the likelihood of transvestism and vice versa.13
- Among 164 Finnish men in two Bondage & Discipline/Sadism & Masochism clubs, approximately 50% indulged in urine play, 18% played with feces, and 42% were into enemas.14 In the entire sample, 7.4% were exclusively sexually sadistic, 18.4% were predominantly sexually sadistic, 23.9% were sexually sadomasochistic, 35.6% were predominantly sexually masochistic, and 14.7% were exclusively sexually masochistic. Their participation in various activities was as follows: rimming (77.5%), fisting (32.9%), enema (42.7%), playing with feces (18.2%), sex with animals (7.3%), hypoxyphilia (16.5%), cross-dressing (26.8%), flagellation (81.8%), electric shocks (16.4%), mummifying (13.4%), and gagging (53%). 25% indulged in the role playing of execution scenes, and 11% enacted rape scenes.
- There exists an association between pedophilia and exhibitionism.15, 16, 17
- Some case reports:18
- Freund and Blanchard described a homosexual child molester that wanted a prepuce as long as that of a little boy.
- Consider the case of a bisexual pedophile that also had nappy fetishism. He put on nappies and urinated into them before masturbation. Sometimes he wore nappies all day, changing into them before masturbating. He sometimes deliberately left his nappies hanging out from his shorts or from his fly, so that people could see them (exhibitionism).
- Consider the case of a 26-year-old man charged with 10 counts of smearing feces on the skirts of girls. From age 4 years onward, he began putting on nappies for the purposes of urinating and defecating into them, initially “feeling good” while doing this. From age 11 years onward, this activity was accompanied by sexual arousal.
- A large proportion of individuals having sex with animals also have sex with humans (see zoophilia).
- McNally and Lukach described the case of a mildly mentally retarded exhibitionistic zoophilic man who also enjoyed sex with women. He sexually enjoyed exposing himself to large dogs of either sex and then masturbated in front of them; he did not have sexual contact with dogs.19
- Two reports:20
- In a sample of child molesters, over 80% of non-familial child molesters and at least 70% of incest offenders had multiple paraphilias. 17.6% of homosexual child molesters, 17.8% of heterosexual child molesters, and 15.1% of incest offenders had 6 or more paraphilias.
- In a sample of 561 non-incarcerated paraphiles who were guaranteed confidentiality, most paraphiles had participated in at least 10 different types of unusual sexual behaviors.
In a random sample of 2,450 Swedish adults, hypersexuality was strongly associated with paraphilic interests (OR = 4.6-25.6).21 In this study, transvestic fetishism was associated with sexual sadomasochism, voyeurism, exhibitionism and male homosexuality/bisexuality.22
Homosexuals use euphemisms to address paraphiles (Table 3). The euphemisms, apart from being non-offensive, also appear as terms of affection or endearment, thereby suggesting that the practices may not be uncommon in the homosexual community. See Table 2 above for data that male homosexuals/bisexuals are overrepresented among paraphiles; for the overrepresentation of homosexuals among specific paraphiles, see the pages on sadomasochism, pedophilia and zoophilia.
|Table 3: Some Paraphiles|
|Erotic target||Label||Homosexual term (see more)|
|Dead bodies||Necrophile||Coffin queen|
|Notes: High intensity sexual desire, recurrence, and obsessive-compulsive desire are required for a paraphilia diagnosis.|
- ^ Money J. Paraphilias: phenomenology and classification. Am J Psychother 1984;38(2):164-79.
- ^ DSM-IV-TR (American Psychiatric Association, 2000)
- ^ Kafka MP, Prentky R. A comparative study of nonparaphilic sexual addictions and paraphilias in men. J Clin Psychiatry 1992;53(10):345-50.
- ^ Kafka MP, Prentky RA. Preliminary observations of DSM-III-R axis I comorbidity in men with paraphilias and paraphilia-related disorders. J Clin Psychiatry 1994;55(11):481-7.
- ^ Kafka MP, Prentky RA. Attention-deficit/hyperactivity disorder in males with paraphilias and paraphilia-related disorders: a comorbidity study. J Clin Psychiatry 1998;59(7):388-96; quiz 397.
- ^ Kafka MP. Hypersexual desire in males: an operational definition and clinical implications for males with paraphilias and paraphilia-related disorders. Arch Sex Behav 1997;26(5):505-26.
- ^ Kafka MP, Hennen J. A DSM-IV Axis I comorbidity study of males (n = 120) with paraphilias and paraphilia-related disorders. Sex Abuse 2002;14(4):349-66.
- ^ Kafka MP, Hennen J. Hypersexual desire in males: are males with paraphilias different from males with paraphilia-related disorders? Sex Abuse 2003;15(4):307-21.
- ^ Blanchard R. Clinical observations and systematic studies of autogynephilia. J Sex Marital Ther 1991;17(4):235-51.
- ^ Freund K, Blanchard R. The concept of courtship disorder. J Sex Marital Ther 1986;12(2):79-92.
- ^ Freund K, Seto MC. Preferential rape in the theory of courtship disorder. Arch Sex Behav 1998;27(5):433-43.
- ^ Blanchard R, Hucker SJ. Age, transvestism, bondage, and concurrent paraphilic activities in 117 fatal cases of autoerotic asphyxia. Br J Psychiatry 1991;159:371-7.
- ^ Chivers M, Blanchard R. Prostitution advertisements suggest association of transvestism and masochism. J Sex Marital Ther 1996;22(2):97-102.
- ^ Sandnabba NK, Santtila P, Nordling N. Sexual behavior and social adaptation among sadomasochistically oriented males. J Sex Res 1999;36:273-82.
- ^ Rooth G. Exhibitionism, sexual violence and paedophilia. Br J Psychiatry 1973;122(571):705-10.
- ^ Paitich D, Langevin R, Freeman R, et al. The Clarke SHQ: a clinical sex history questionnaire for males. Arch Sex Behav 1977;6(5):421-36.
- ^ Raymond NC, Coleman E, Ohlerking F, et al. Psychiatric comorbidity in pedophilic sex offenders. Am J Psychiatry 1999;156(5):786-8.
- ^ Freund K, Blanchard R. Erotic target location errors in male gender dysphorics, paedophiles, and fetishists. Br J Psychiatry 1993;162:558-63.
- ^ McNally RJ, Lukach BM. Behavioral treatment of zoophilic exhibitionism. J Behav Ther Exp Psychiatry 1991;22(4):281-4.
- ^ Abel GG, Becker JV, Cunningham-Rathner J, et al. Multiple paraphilic diagnoses among sex offenders. Bull Am Acad Psychiatry Law 1988;16(2):153-68.
- ^ Långström N, Hanson RK. High rates of sexual behavior in the general population: correlates and predictors. Arch Sex Behav 2006;35(1):37-52.
- ^ Långström N, Zucker KJ. Transvestic fetishism in the general population: prevalence and correlates. J Sex Marital Ther 2005;31(2):87-95.