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Sexuality: Paraphilias: Bizarre Sexuality

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
Cross-dressing Transvestic Fetishism
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.
Study PARs NPSCDs
A Type of Promiscuity Total 10 11
Heterosexual 7 3
Homosexual 1 6
Bisexual 2 2
B Type of Promiscuity* Total 21 21
Heterosexual 19 13
Homosexual 4 9
C Pedophilic Total 11 Not-applicable
Heterosexual 4
Homosexual 3
Bisexual 1
Incestuous - heterosexual 2
Incestuous - homosexual 1
Type of Promiscuity Total SO NSO 13
5 4
Heterosexual 3 3 8
Homosexual 1 0 2
Bisexual 1 1 3
D Type of Promiscuity** Total 28 28
Heterosexual 22 19
Homosexual 9 10
Sexual orientation*** Total 65 35
Heterosexual 52 26
Homosexual 4 6
Bisexual 9 3
E Pedophilic**** Total 20
Heterosexual 9
Homosexual 7
Bisexual 1
Incestuous 3
Type of Promiscuity**** Total 53
Heterosexual 25
Homosexual 18
Bisexual 10
F Sexual orientation*** Total 88 32
Heterosexual 69 14
Homosexual 2 12
Bisexual 17 6
Notes
SO = sex-offenders, NSO = Non-sex-offenders. * 2 men with PARs and 1 man with NPSCDs reported both heterosexual and homosexual promiscuity; ** 3 men with PARs and 1 man with NPSCDs reported both heterosexual and homosexual promiscuity; *** based on Kinsey 0-6 scale, 0-1 classified as heterosexual, 2-4 classified as bisexual, 5-6 classified as homosexual; **** data for PARs and NPSCDs combined. The study samples were as follows: 30 consecutive respondents to a newspaper advertisement soliciting individuals with PARs and NPSCDs in study A;3 63 consecutively evaluated outpatient men in study B;4 60 consecutive male outpatients in study C;5 100 consecutive male outpatients in study D;6 and 120 consecutively evaluated male outpatients in studies E7 and F.8 The number of individuals with PARs and NPSCDs were: 15 and 15, respectively in study A; 34 and 26, respectively in study B; 42 and 18, respectively in study C (among the 42 individuals with PARs, 30 were sex-offenders and 12 were not sex-offenders); 65 and 35, respectively in study D; 88 and 32, respectively in studies E and F. The participants in these studies appear to have been drawn from the Belmont-Cambridge-Boston area; it is unlikely that the prevalence of nonheterosexuals in this region approaches that seen in the participants.

Multiple paraphilias tend to co-occur, i.e., there exists a tendency toward disparate erotic targets among paraphiles:

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)
Children Pedophile Chicken hawk
Dead bodies Necrophile Coffin queen
Feces Coprophile Mud-man
Urine Urophile Golden queen
Animals Zoophile Interspecies lover
Notes: High intensity sexual desire, recurrence, and obsessive-compulsive desire are required for a paraphilia diagnosis.

References

  1. ^ Money J. Paraphilias: phenomenology and classification. Am J Psychother 1984;38(2):164-79.
  2. ^ DSM-IV-TR (American Psychiatric Association, 2000)
  3. ^ Kafka MP, Prentky R. A comparative study of nonparaphilic sexual addictions and paraphilias in men. J Clin Psychiatry 1992;53(10):345-50.
  4. ^ 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.
  5. ^ 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.
  6. ^ 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.
  7. ^ 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.
  8. ^ 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.
  9. ^ Blanchard R. Clinical observations and systematic studies of autogynephilia. J Sex Marital Ther 1991;17(4):235-51.
  10. ^ Freund K, Blanchard R. The concept of courtship disorder. J Sex Marital Ther 1986;12(2):79-92.
  11. ^ Freund K, Seto MC. Preferential rape in the theory of courtship disorder. Arch Sex Behav 1998;27(5):433-43.
  12. ^ 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.
  13. ^ Chivers M, Blanchard R. Prostitution advertisements suggest association of transvestism and masochism. J Sex Marital Ther 1996;22(2):97-102.
  14. ^ Sandnabba NK, Santtila P, Nordling N. Sexual behavior and social adaptation among sadomasochistically oriented males. J Sex Res 1999;36:273-82.
  15. ^ Rooth G. Exhibitionism, sexual violence and paedophilia. Br J Psychiatry 1973;122(571):705-10.
  16. ^ 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.
  17. ^ Raymond NC, Coleman E, Ohlerking F, et al. Psychiatric comorbidity in pedophilic sex offenders. Am J Psychiatry 1999;156(5):786-8.
  18. ^ Freund K, Blanchard R. Erotic target location errors in male gender dysphorics, paedophiles, and fetishists. Br J Psychiatry 1993;162:558-63.
  19. ^ McNally RJ, Lukach BM. Behavioral treatment of zoophilic exhibitionism. J Behav Ther Exp Psychiatry 1991;22(4):281-4.
  20. ^ 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.
  21. ^ Långström N, Hanson RK. High rates of sexual behavior in the general population: correlates and predictors. Arch Sex Behav 2006;35(1):37-52.
  22. ^ Långström N, Zucker KJ. Transvestic fetishism in the general population: prevalence and correlates. J Sex Marital Ther 2005;31(2):87-95.
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