PARAPHILIAS

Paraphilias are problems with controlling impulses that are characterized

by recurrent and intense sexual fantasies, urges, and behaviors involving
unusual objects, activities, or situations not considered sexually arousing to
others.

Characterized by:

• Infliction of pain or humiliation to self, partner, children or other

nonconsenting individuals
• That has lasted for at least six months
• Has resulted in severe distress in impairment in normal functioning.

• These objects, activities or situations often are necessary for the

person's sexual functioning.
• Someone with a paraphilia may be referred to as "kinky" or
"perverted," and these behaviors may have serious social and legal
consequences.

Types of Paraphilias:
Exhibitionism ("Flashing")

• Exhibitionism is characterized by intense, sexually arousing fantasies,

urges or behaviors involving exposure of the individual's genitals to
an unsuspecting stranger.
• The individual with this problem, sometimes called a "flasher," feels a
need to surprise, shock or impress his victims.
• The condition usually is limited to the exposure, with no other harmful
advances made, (although "indecent exposure" is illegal).
• Actual sexual contact with the victim is rare. However, the person
may masturbate while exposing himself or while fantasizing about
exposing himself.

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Fetishism

• People with this problem have sexual urges associated with non-
living objects. The person becomes sexually aroused by wearing or
touching the object.
• For example, the object of a fetish could be an article of clothing,
such as underwear, rubber clothing, women's shoes, or women's
underwear or lingerie.
• The fetish may replace sexual activity with a partner or may be
integrated into sexual activity with a willing partner.
• When the fetish becomes the sole object of sexual desire, sexual
relationships often are avoided.
• A related disorder, called partialism, involves becoming sexually
aroused by a body part, such as the feet, breasts or buttocks.

Transvestism

• Transvestism, or transvestic fetishism, refers to the practice by

heterosexual males of dressing in female clothes to produce or
enhance sexual arousal.
• The sexual arousal usually does not involve a real partner, but
includes the fantasy that the individual is the female partner, as well.
• Some men wear only one special piece of female clothing, such as
underwear, while others fully dress as female, including hair style and
make-up.
• Cross-dressing itself is not a problem, unless it is necessary for the
individual to become sexually aroused or experience sexual climax.

Frotteurism

• With this problem, the focus of the person's sexual urges is related to
touching or rubbing his genitals against the body of a non-consenting,
unfamiliar person.
• In most cases of frotteurism, a male rubs his genital area against a
female, often in a crowded public location.
• This disorder also is a problem because the contact made with the
other person is illegal.

Pedophilia
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 • People with this problem have fantasies, urges or behaviors that
involve illegal sexual activity with a prepubescent child or children
(generally age 13 years or younger).
• Pedophilic behavior includes undressing the child, encouraging the
child to watch the abuser masturbate, touching or fondling the child's
genitals and forcefully performing sexual acts on the child.
• Some pedophiles are sexually attracted to children only (exclusive
pedophiles) and are not attracted to adults at all. Some pedophiles
limit their activity to their own children or close relatives (incest),
while others victimize other children.
• Predatory pedophiles may use force or threaten their victims if they
disclose the abuse. Health care providers are legally bound to report
such abuse of minors.

 This activity constitutes rape and is a felony offense punishable by

imprisonment.
 Age of pedophile is set at 16 years old or more
 Age difference between the offender and the victim set at 5 years or
more
o When the victim is postpubertal, the disorder is labeled as
child molestation or ephebophilia

Sexual Masochism

• Individuals with this disorder use sexual fantasies, urges or behaviors

involving the act (real, not simulated) of being humiliated, beaten or
otherwise made to suffer in order to achieve sexual excitement and
climax.
• These acts may be limited to verbal humiliation, or may involve being
beaten, bound or otherwise abused. Masochists may act out their
fantasies on themselves -- such as cutting or piercing their skin, or
burning themselves -- or may seek out a partner who enjoys inflicting
pain or humiliation on others (sadist).
• Activities with a partner include bondage, spanking, and simulated
rape.
• Sadomasochistic fantasies and activities are not uncommon among
consenting adults. In most of these cases, however, the humiliation
and abuse are acted out in fantasy.
• The participants are aware that the behavior is a "game," and actual
pain and injury is avoided.
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 • A potentially dangerous, sometimes fatal, masochistic activity is
autoerotic partial asphyxiation, in which a person uses ropes,
nooses or plastic bags to induce a state of asphyxia (interruption of
breathing) at the point of orgasm. This is done to enhance orgasm,
but accidental deaths sometimes occur.

Sexual Sadism

• Individuals with this disorder have persistent fantasies in which

sexual excitement results from inflicting psychological or physical
suffering (including humiliation and terror) on a sexual partner.
• This disorder is different from minor acts of aggression in normal
sexual activity; for example, rough sex.
• In some cases, sexual sadists are able to find willing partners to
participate in the sadistic activities.
• At its most extreme, sexual sadism involves illegal activities such as
rape, torture, and even murder, in which case the death of the victim
produces sexual excitement. It should be noted that while rape may
be an expression of sexual sadism, the infliction of suffering is not the
motive for most rapists, and the victim's pain generally does not
increase the rapist's sexual excitement. Rather, rape involves a
combination of sex and gaining power over the victim. These
individuals need intensive psychiatric treatment and may be jailed for
these activities.

Voyeurism ("Peeping Tom")

• This disorder involves achieving sexual arousal by observing an

unsuspecting and non-consenting person who is undressing or
unclothed, and/or engaged in sexual activity.
• This behavior may conclude with masturbation by the voyeur. The
voyeur does not seek sexual contact with the person he is observing.
Other names for this behavior are "peeping" or "peeping Tom."

• Other rarer paraphilias are grouped together under Other paraphilias

not otherwise specified (ICD-9-CM equivalent of "Sexual Disorder
NOS") and include telephone scatalogia (obscene phone calls),
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 necrophilia (corpses), partialism (exclusive focus on one part of the
body), zoophilia (animals), coprophilia (feces), klismaphilia (enemas),
urophilia(urine), emetophilia (vomit).

Hormone drug treatments

• testosterone has a crucial role not only in the development and
maintenance of male sexual characteristics but also in the control of
sexuality, aggression, cognition, emotion, and personality.
Testosterone is a major determinant of sexual desire, fantasies, and
behavior, and it increases the frequency, duration, and magnitude of
spontaneous and nocturnal erections.
• The deviant sexual fantasies, urges, and behavior of men with
paraphilias also appear to be triggered by testosterone. Therefore,
reducing testosterone secretion or inhibiting its action is believed to
control these symptoms.
• Antiandrogenic drugs such as medroxyprogesterone (also known
as the long-acting contraceptive Depo Provera) have been widely
used to reduce sex drive.
o efficacy is limited and they have many unpleasant side effects
(breast growth, headaches, weight gain, and reduction in bone
density).
o Even if compliance is good, only 60 to 80 percent of men
benefit from this type of drug.
• Long-acting gonadotropin-releasing hormones, such as
Triptorelin (Trelstar) which reduces the release of gonadotropin
hormones, are also used. This drug is a synthetic hormone which
may also lead to reduced sex drive.

Psychoactive drug treatments

• Selective serotonin reuptake inhibitor (SSRI) - reducing impulse
control problems and/or sexual obsessions
• Tricyclic antidepressants (TCA)
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 • Lithium, the mood-stabilizing drug also known as Eskalith is typically
used for the treatment of mania in bipolar disorder.
o There are some reports of reduced sexual compulsive behavior
and a reduction in obsessive sexual thoughts in patients

Etiology:
a. Biologic Factors: destruction of the parts of the limbic system,
temporal lobe disorders, abnormal levels of androgens
b. Psychoanalytic theory: failure to resolve oedipal conflict,
identification with parent of the opposite sex or selection of
inappropriate object for libidinal cathexis.

meimom
ongan

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