Paraphilic Disorders

Paraphilic Disorders

• “Improper affection”

• “Normal/proper”: sexual activity focusing on genital simulation while alone or with consenting adult

• Themes:

  • Inanimate objects or animals

  • Humiliation or suffering of client or partner(s)

  • Nonconsenting persons

• Differentiate thoughts/desires and action

• One of the few diagnostic categories that, by definition, often coincide with criminal behavior

• Lasts at least 6 months

Exhibitionistic Disorder

• Arousal by genital self-exposure to an unwary stranger

• Repeatedly acted on the urge

• Or distress about fantasy or urge

• May or may not involve masturbation 

• 6+ months

• 15% will involve an offense involving contact

• Sexually aroused by exposing self to:

  • Prepubertal children

  • Physically mature individuals 

  • Both

Fetishictic Disorder

• Intense arousal by inanimate objects 

  • Shoes

  • Underwear (of others, in various conditions)

• Or arousal by body parts other than those that commonly evoke sexual pleasure 

• Distress/disability at the bx,urge (due to shame)

• Specify type:

  • Body parts

  • Nonliving objects 

  • Other (combination)

Frotteuristic Disorder

• “To rub”

• Patients select victim who is accessible & rubs genitals on various parts of the body 

• Involves someone who has not consented

• Often takes place on crowded sidewalks or public transportation 

• Most common in larger cities

Pedophilic Disorder

• “Love of children’

• Most common paraphilic disorder 

• Most perpetrators aren’t strangers 

• Intense sexually arousing fantasies, urges, or behaviors involving sexual activities with prepubescent children (under 13 years)

• Specify acts preferred:

  • Watching 

  • Touching

• Most acts involve oral sex or touching (or being touched)

• Exclusive: limiting preferences to children 

• Non-exclusive: also attracted to adults

• May come with cognitive distortions/delusions of child’s enjoyment/consent

• 15-25% convicted reoffend within a few years of release 

• Men who prefer boys are 2x likely to reoffend

Pedophilic Disorder: Criteria

• Person is aroused by the notion of sex with prepubescent children and has acted on the urge OR

• Experiences severe distress or interpersonal difficulties because of urges or fantasies 

• 6+ months 

• Individual must be at least 16 and 5 years older than the child

  • Can not include an individual in late adolescence involved in an ongoing sexual relationship with a 12 or 13 year-old

  • Specify: Exclusive or Non-Exclusive

  • Specify Attraction: Males, Females, or both

  • Specify: Limited to incest

Sexual Masochism Disorder

• Sexual pleasure and arousal from suffering (self)

• Repeatedly sexually aroused by being struck, restrained, cut, or humiliated 

• Pain, humiliation, absence of control

• Distress about these behaviors or urges

• Specify: with asphyxiophilia (restricted breathing)

  • Roughly 15% of general population derives sexual pleasure from some degree of suffering (though likely underreported)

  • Affects women more than men

Sexual Sadism Disorder

• Another person’s suffering provokes sexual arousal

• Like Sexual Masochism Disorder, but sadists are the perpetrators

• Absence of control

• Either: without consent or with consent and significant distress

Voyeuristic Disorder

• Recurrent and intense arousal from watching an unwary person who is undressing or having sex 

• Has repeatedly acted on the urge with a nonconsenting person or experiences distress 

Treatments

Prognosis poor if without distress or motivation for change

• CBT for restructuring thoughts/desires

• Motivational Interviewing if ambivalent about change 

• ACT for diffusion from thoughts, clarify values, and act in accordance 

• Psychoeducation

• Trauma Psychotherapy

• Pharmalogical Interventions:

  • SSRIs

  • Anti-adrogens lowers testosterone and sexual drive