Key Takeaways
- Paraphilic disorders involve intense sexual arousal to atypical ideas that cause distress or problems.
- Fetishism becomes a disorder when it causes distress or harm and lasts over six months.
- Sexual sadism disorder requires distress, harm, or non-consensual acts over six months.
Sex is a normal part of life, and having unconventional sexual thoughts and fantasies isn’t unusual. However, when these urges and thoughts become so intense as to interfere with your daily functioning, it may be a paraphilic disorder.
Paraphilic disorders are a group of mental health conditions that cause recurring and intense sexual arousal to atypical thoughts, fantasies, and behaviors. These disorders involve clinically significant distress or impairment in functioning.
People with paraphilic disorders will often engage in sexual behaviors that can cause harm to themselves and others. Some paraphilias focus explicitly on causing pain and suffering to oneself or others.
Not all paraphilic interests make up a paraphilic disorder. It’s important to distinguish between paraphilia and a paraphilic disorder. While the former includes unusual sexual urges and behaviors, the latter features paraphilic symptoms that cause distress or impairment to the individual or the risk of harm to yourself or others.
Symptoms of Paraphilic Disorders
Because paraphilic disorders involve a range of sexual thoughts and fantasies, the symptoms are wide and varying. Such symptoms may include:
- Intense and persistent sexual fantasies or urges that often center on non-human objects, non-consenting adults, or children.
- Sexual arousal that is considered atypical, unusual, or socially unacceptable.
- Difficult controlling sexual impulses despite the potential harm and consequences.
- Disruptions to daily life, including work and relationships.
- Feelings of guilt, anxiety, or shame about these interests and behaviors.
However, it’s important to note that having atypical sexual interests does not necessarily mean that a person has a paraphilic disorder. A common thread of paraphilic disorders is their potential to cause harm. They are often so intense that they cause significant distress and disrupt daily functioning.
Types of Paraphilic Disorders
According to the DSM-5-TR, there are eight specified paraphilic disorders. They are:
Fetishism Disorder
With fetishism, a person has recurrent and intense sexual arousal from inanimate objects or nongenital body parts. Fetishism can be harmless; it’s only classified as a disorder when it causes significant distress or causes some form of harm and occurs for at least six months. Some common fetishes include undergarments, feet, rubber, and leather items.
Frotteuristic Disorder
A person with frotteurism is excited by touching or rubbing their genitals against another’s in a sexual manner without the other person’s consent. It’s a rare type of paraphilia, and much research still needs to be done to understand it.
According to the DSM-5-TR, for a person to be diagnosed with frotteuristic disorder, they must have experienced an intense and recurrent urge to rub their genitals against a non-consenting party to achieve sexual gratification for at least six months. This must have caused significant distress or impairment, or the individual must have acted upon this urge.
Sexual Sadism Disorder
Sexual sadism involves inflicting physical or psychological pain on another person to achieve sexual gratification. It’s important to distinguish between sexual sadism disorder, a paraphilic disorder, and sadistic sexual behavior, which is not.
It’s normal for mild sadistic sexual behavior to occur between two adults who consent. With sexual sadism disorder, for at least six months, the sadistic sexual urges must cause significant distress, impairment, or the individual has acted on these urges with a non-consenting person.
Exhibitionistic Disorder
People with an exhibitionistic disorder experience recurrent and intense arousal from the exposure of their genital to an unsuspecting person. They may become distressed and unable to function properly due to their urges or have acted on these urges with a non-consenting person.
On the other hand, exhibitionism isn’t a paraphilic disorder, which is simply the desire to expose your genitalia to a consenting party for sexual arousal.
Pedophilic Disorder
Pedophilia is sexual attraction to children. According to the DSM-5-TR, a person with pedophilic disorder must have felt intense and recurrent sexual urges, behaviors, and fantasies toward prepubescent children for at least six months. The condition must also bring significant distress or impairment to a person with it.
Sexual Masochism Disorder
Sexual masochism may be seen as the flip side of sexual sadism. With sexual masochism, being beaten, humiliated, or abused will bring sexual excitement and gratification. Asphyxiophilia, a desire to have your breathing restricted during sexual activity, is sometimes considered a subtype of sexual masochism.
Voyeuristic Disorder
Voyeuristic disorder causes a person to have intense and recurrent urges to watch a non-consenting person engage in sexual activity. Voyeuristic disorder causes significant distress and can limit a person’s ability to function. Voyeuristc disorder is more common amongst men than women.
Transvestic Disorder
A person who is sexually aroused by cross-dressing may have transvestic disorder. For it to be regarded as a disorder, the urges or behaviors must have been recurrent, intense, and present for at least six months. While people who cross-dress do not necessarily have a disorder, a person with transvestic disorder experiences significant distress or impaired functioning.
Paraphilic disorders are not limited to the above eight types. People’s sexual interests are broad and diverse, creating possibilities for many paraphilic conditions not recognized by the DSM-5-TR to crop up.
Identifying Paraphilic Disorders
It’s important to note that there’s a distinct difference between paraphilias and paraphilic disorders. Paraphilias can be harmless if they aren’t causing harm or distress to yourself or others. If there’s a risk of harm, it could also be classified as a paraphilic disorder.
For unknown reasons, paraphilias appear to be more common in men than women. To be diagnosed with a paraphilic disorder, the DSM-5-TR requires the following criteria to be met:
- Feeling personal and not just societal distress as a result of your sexual interests, urges, and behaviors
- Experiencing sexual desire that could cause physical harm or psychological distress to another person
- A desire to engage in sexual behaviors with non-consenting parties or people who cannot give consent.
What Causes Paraphilic Disorders?
It’s a little unclear what exactly causes paraphilic disorders. Scientists and researchers suspect that a combination of neurobiological, genetic, developmental, behavioral, and interpersonal factors play a role.
In a 2019 study on paraphilic disorders, researchers observed that people with paraphilic disorders have elevated levels of serotonin and norepinephrine and decreased levels of a metabolite of dopamine called dihydroxyphenylacetic acid (DOPAC).
Treatment for Paraphilic Disorders
Treatment for paraphilic disorders is highly individualized. It depends on various factors, including which type of paraphilic disorder you have and the personal goals of the person being treated. In general, different forms of therapy and medications are used in treating paraphilic conditions.
A combination of psychotherapy and medication is often recommended for the most effective results.
Medication
Medication approaches to paraphilic disorders may help people control their sexual arousal or behavior. Antiandrogen treatment is may be a pharmacological treatment for men with severe paraphilic disorders.
Antiandrogen treatments are particularly recommended for paraphilic disorders that can cause harm to others or lead to sexual offenses. Antiandrogen treatments work by reducing testosterone, which in turn reduces sexual drive.
In mild cases, selective serotonin reuptake inhibitors may be prescribed. There’s currently no medication explicitly approved for the treatment of paraphilic disorders.
Psychotherapy
Psychotherapy may help someone manage or cope with their paraphilic symptoms and behaviors. Cognitive behavioral therapy (CBT) has been the most commonly used approach for paraphilic disorders. This approach focuses on identifying and changing the underlying thoughts that contribute to paraphilic disorders.
