Let’s explore a subject that’s still considered taboo in most cultures – paraphilia. A paraphilia is an intense sexual attraction to objects or people that are outside of consenting adult relationships.
The causes of paraphilic disorders can be vast and varied. They can stem from traumatic experiences or frequent exposure to objects or situations that were associated with sexual arousal, causing distress or impairment to the individual; or a paraphilia whereby satisfaction entailed personal harm, or risk of harm, to others.
Diagnosis of paraphilic disorders
According to the American Psychiatric Association, a person with a paraphilic disorder must have been experiencing their symptoms of attraction for at least 6 months AND this must cause distress or impairment to the individual with paraphilia, or potential personal harm or harm to others.
There is a difference between paraphilia and a simple fascination or having a sexual preference that is within healthy, consenting sexual boundaries.
Types of Paraphilias
Voyeuristic sexual disorder
This is an intense arousal arising from the observation of unsuspecting naked persons. This behavior often leads to problems with the law as voyeurism violates the right to intimacy and privacy. However, not every voyeur violates another person’s rights, and there are instances of consensual observation. Voyeurism becomes a problem when it is done compulsively with unaware and non-consenting victims. When voyeurism is pathologic (i.e. caused by physical or mental disease), voyeurs spend considerable time seeking out viewing opportunities, often to the exclusion of fulfilling important responsibilities in their life. Orgasm is usually achieved by masturbating during or after the voyeuristic activity.
Exhibitionistic sexual disorder
Exhibitionism is intense sexual arousal from exposing yourself or exposing your genitals to other unsuspecting people.
Exhibitionistic disorder involves acting on these urges with a non-consenting person or experiencing significant distress or functional impairment because of such urges and impulses.
Pedophilic disorder involves intense and recurrent sexual urges or fantasies towards pre-pubescent children and which cause the person with the attraction distress or cause harm to the subject of the pedophilia.
The World Health Organization includes this as a mental disorder. In addition, many countries do consider it a criminal act as it relates to sexual abuse and child maltreatment, which leads to long-term sentences if convicted.
It is less commonly known about, but this is a disorder where someone recurrently is aroused by, or they get sexual satisfaction from, rubbing themselves on other people or touching other people who again are unsuspecting or without their consent. This is commonly done in public settings like public transportation, subways, elevators, malls, or other crowded places.
Sexual masochism disorder
Sexual masochism is quite commonly known about and it involves recurrent and intense fantasies or sexual arousal from being sexually humiliated, beaten, bound, or otherwise abused to experience sexual excitement. Similar to other paraphilias, sexual masochism becomes a disorder when it causes distress or impairment to the person, or harm to others. Some persons with sexual masochism disorder increase the severity of their activity with time, potentially leading to serious injury or death.
Sexual sadism disorder
This is similar to sexual masochism however sexual sadism is when a person inflicts physical or psychological suffering like humiliation or terror on another person to stimulate sexual excitement and orgasm. Sexual sadism becomes a disorder when the it causes distress or impairment to the person, or harm to others, potentially to non-consenting individuals.
This occurs when people are attracted or it have sexual fetishes regarding objects or nonliving items, like underwear, and sometimes they cannot get aroused unless those objects are present in any kind of sexual or stimulating attraction.
Transvestic sexual disorder
This is when a person has sexual arousal and stimulation from clothing from members of the opposite sex. It is very important to note that this is NOT always a disorder; it can be based on gender identity. The difference is if there’s extreme sexual arousal from this behavior and the person’s urge to do so causes significant distress or impairment to their daily life.
The affected person may often have extreme emotions like anxiety, depression, guilt or shame because they have the urge to dress as a member of the opposite sex.
Treatment of paraphilic disorders
Treatment of paraphilic disorders can involve several types of therapies including: cognitive-behavioral therapy, traditional psychoanalysis, and hypnosis.
In addition to therapy, medication can be considered, and in particular selective serotonergic reuptake inhibitors (SSRIs) may be helpful. In extreme cases, anti-androgenic drugs that lower testosterone levels may be used to decrease sexual drive.
Conclusion about paraphilic sexual disorders
If someone is suffering from a certain type of paraphilic sexual disorder, seeking professional help is the way to go. These practices can cause pain and trauma to the individual with the disorder, and importantly they can cause pain and trauma to others as well as violate others’ rights. It is the responsibility of the person with a paraphilic disorder to seek help and treatment, to keep themselves and others safe.
We should not demonize those who suffer from these disorders but help them to realize that they are sick and need professional intervention.
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About the author: Martin Mūthare is a licensed clinical officer and a public health practitioner.
Special thanks to our Medical Advisor, Kimberly T. Remski, M.D. for reviewing this article.