What is Paraphilia?

Paraphilia is a disorder where sexual gratification depends upon sex fetishes like fantasizing about persons or things not normally considered sexually stimulating.  They could be anything from children, animals, underwear, wishing to inflict pain during sexual activity, exhibitionism, etc.  These are uncontrollable impulses which are recurrent and intense.   Also, these objects, activities or situations often are necessary for the person’s sexual functioning.

Many paraphilias (sex fetishes) begin in adolescence and continue into adulthood.  The intensity and frequency of the sexual fantasies vary from individual to individual but usually decrease with age.  A person with this disorder can feel and cause significant distress as well as personal, social or occupational dysfunction.  In lay terms such persons are referred to as “kinky” or “perverted”.  Their actions can have serious social and legal consequences.

Symptoms of Paraphilia

A paraphilia or sex fetish could manifest in many ways, depending on the individual and his (her) family background, friends, environmental conditions, etc.  Some of the symptoms are:

1) Sexual fantasies of non-sexual objects or situations

2) Agitation and irritability when the person is unable to indulge in the fantasies

3) Arousal after indulging in the fantasy (like inflicting pain, sex with children, etc)

4) Sexual gratification only after indulging in the fantasy.

Diagnosis of Paraphilia

Most of the paraphilias (sex fetishes) are more common in men than in women.  There is no evidence to show why this happens to be true.  The following signs would tell a psychoanalyst whether it is a case of paraphilia requiring treatment:

Unchanging fetish: The fetish will remain specific and unchanging in the patient.  For example, if a person derives sexual gratification by beating his partner, then exposing his genitals in public or watching others engaging in sexual activity will not give him the same sexual gratification.

Psychological dependency: Also, preoccupation with the fetish to the point of being dependent on it for sexual gratification makes the person miserable when denied.  He has to be allowed to or must have the opportunity to indulge in his fantasy whenever he needs sex.

Causes of Paraphilia

Causes of Paraphilia are a matter of conjecture and debate among experts even today.  But various theories have been put forth by experts.

Trauma: Some psychoanalysts believe that paraphilia is caused by childhood trauma like witnessing or experiencing sexual abuse.

Inferiority: In most cases, the individual with a paraphilia has difficulty developing personal and sexual relationships.  Hence, anything providing sexual arousal and gratification can later become a paraphilia.

Peer pressure to perform: Sometimes there is the need to perform as well as ones friends.  The inability to do so could cause the person to find other non-conventional methods to experience sexual arousal and gratification.  Any object or situation that manages to do so would then become a paraphilia.

Types of Paraphilia

There are innumerable types of paraphilia. They are:

Exhibitionism: What is called “Flashing” or “indecent exposure” in layman’s terms; exhibitionism involves exposure of the genitals to an unsuspecting stranger. The “flasher” finds it sexually gratifying to surprise, shock or impress his victims with his behavior.  The person usually does not approach or touch the strangers, although he may masturbate while exposing himself.

Fetishism: This paraphilia pertains to sexual arousal and gratification only when the person handles non-living objects like partner’s clothing, women’s shoes or women’s lingerie. The fetish may be indulged in simultaneously with sexual activity or may replace sexual activity.

Partialism: Instead of a non-living object, if the fetish involves becoming sexually aroused by a body part of the partner like the feet, breasts or buttocks, then it is called partialism.

Frotteurism: This type of paraphilia involves the person’s urge to touch or rub his genitals against the body of a non-consenting stranger in a crowded public location.

Pedophilia: This paraphilia pertains to a person’s urge to indulge in illegal sexual activity with a child (pre-puberty) younger than 13 years of age.  The urge would involve undressing the child; encouraging the child to watch the pedophile masturbate; touching or fondling the child’s genitals; and finally, forcefully indulging in sexual activity with the child.  Some are exclusively pedophiles and are not attracted to adults at all.  Some pedophiles limit their activity to their younger siblings (incest) or their own children; while others are predatory pedophiles.

Masochism: This type of paraphilia involves the person’s wish to be humiliated or beaten in order to get sexual gratification.  Activities include bondage, spanking and simulated rape.  Sometimes, masochists may act out their fantasies on themselves and accidentally cause bodily harm to themselves by cutting, piercing the skin, or burning themselves.  A potentially fatal form of masochism is self-asphyxiation with a rope, noose or plastic bag to reach climax.  In this case accidental death can occur.

Sadism: This is the opposite of masochism.  In sadism, the person wishes to inflict psychological or physical suffering (including humiliation and terror) on the sexual partner in order to achieve sexual arousal and gratification.  This is not a simple case of rough sex, but involves illegal activities such as rape, torture or even murder where the death of the partner would give sexual gratification.

Sadomasochistic pair – In some cases a masochist may seek out a sadist in order to indulge in the fantasies and activities.  This is not uncommon among consenting adults.  The humiliation and abuse are fantasies and the partners are aware that their behavior is just a game for both of them to achieve sexual gratification.  A sadomasochistic pair would be complementary to each other and not cause harm as long as the fantasies are not overdone.

Transvestitism: Transvestitism is a paraphilia that involves the heterosexual male dressing in female clothes, lingerie, hairstyle, makeup, etc in order to achieve sexual arousal and gratification.  The sexual arousal usually does not involve a real partner, but includes the fantasy that the individual is the female partner as well.  This is not the same as male homosexuals who occasionally dress in women’s clothing.  Cross-dressing would constitute a problem when the person cannot experience sexual arousal without indulging in it.

Voyeurism (peeping Tom): The term voyeur has come from the French verb meaning “to see”.  This paraphilia involves achieving sexual arousal and gratification only by watching non-consenting and unsuspecting persons undress and indulge in sexual activity.   The arousal comes from the high risk of being discovered.  The voyeur would then masturbate but not approach or assault the ones he is watching.

Bestiality: Also called zoophilia, this involves the person’s repeated preference in sexual activity with animals to obtain sexual gratification.  Bestiality usually emerges as a result of curiosity; as a novelty; or a desire for sexual release when the person’s partner is unavailable.  But sometimes, zoophilia may reach sadistic proportions and may harm the animal.

Obscene Telephone Calls: Making repeated obscene telephone calls for the purpose of sexual excitement is also considered a paraphilia.  This is a masturbatory fantasy and there is no face-to-face contact between the caller and the victim.  The calls are of three basic types: boasting in detail about one’s masturbation; direct threats to the victim; and asking the victim intimate details of her sexual life.  The caller may use the same victim or switch to others depending on the victim’s willingness to play his game.

Rare Sexual Attractions: Then there are some rare types of paraphilias like
apotemnophilia (sexual attraction to amputations), coprophilia and urophilia (sexual attraction to feces and urine), klismaphilia (sexual attraction to enemas) and necrophilia (sexual attraction to a corpse).

Treatment of Paraphilia

Counseling and behavioral therapy:  Most cases of paraphilia are treated with counseling, psychoanalysis and hypnosis.  This treatment is aimed at modifying the behavior of the person.  This would involve individual counseling sessions with a psychiatrist as well as group therapy which would help the person to talk about the problem and get the problem out of his system.

Hormonal therapy: Paraphilia which is potentially dangerous to the person himself or to his partner can be treated to some extent with hormonal therapy.   Here the hormones are prescribed with the intention of generally reducing the sex drive of the person rather than as treatment for a specific paraphilia.

Combination therapy: Recently, anti-androgens that drastically lower testosterone levels temporarily have been used along with other traditional methods of treatment.  This drug not only reduces the sex drive in males but also the frequency of sexually arousing fantasies; after which behavioral therapy can be continued.  Combination therapy has proved more successful in the recent times.

Living with Paraphilia

For the treatment to be effective, it has to be on a long-term basis.  Sometimes, unwillingness of the patient to undergo/continue treatment can hinder success.  Secondly, illegal and potentially dangerous paraphilias like pedophilia, exhibitionism, voyeurism, sadism and frotteurism are criminal offenses and should be reported to the authorities when detected.

Prevention of Paraphilia

Since various mental disorders and a high sex drive can lead to paraphilia, prevention of paraphilia would actually entail prevention of other causative problems.

Antidepressants: Preventing disorders like depression, anxiety, personality disorders, insomnia, premature ejaculation (which causes low self-esteem), etc is very important.  This can be done with the use of selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, for example fluoxetine, sertraline, fluvoxamine, and paroxitine.

Hormones: Testosterone is a major determinant of sexual desire, fantasies and resultant behavior.  Therefore, testosterone plays a major role in maintaining behavior like sexual aggression, emotion and personality, hence would also have a bearing on the deviant behavior.  It is believed by experts that reducing testosterone secretion or inhibiting its action can prevent recurrence.

Anti-androgenic drugs: Drugs like medroxyprogesterone (also known as the long-acting contraceptives) have been used to reduce sex drive in men.  However, their efficacy is limited and they have many unpleasant side effects like breast growth, headaches, weight gain, and reduction in bone density.

Psychostimulants: Lithium is considered a mood-stabilizing drug.  It reduces compulsive behavior and obsessions of sexual thoughts by increasing the serotonergic functioning.  This can prevent recurrence of the ailment.