Paraphilic Disorders: What They Are, Symptoms, Causes And Treatment

A paraphilic disorder is, according to the DSM-V⁽¹⁾a paraphilia that is truly causing discomfort or deterioration in the person, or a paraphilia whose satisfaction has entailed personal harm or an external risk. It is important that we keep in mind that a paraphilia is a necessary condition, but not sufficient to have a paraphilic disorder. That is, a paraphilia alone does not automatically justify clinical intervention.

Therefore, according to the diagnostic criteria proposed by the American Psychologist Association, paraphilia is the presence of repeated and intense sexual fantasies of an excitatory type, sexual impulses or behaviors that generate discomfort or deterioration, for at least 6 months, generally included in 3 categories:

• Non-human objects.
• Suffering or humiliation of oneself or one’s partner.
• Children or other non-consenting persons.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), They are classified as follows:

• Exhibitionism disorder.
• Fetishism disorder.
• Frotteurism disorder.
• Pedophilia disorder.
• Sexual masochism disorder.
• Sexual sadism disorder.
• Cross-dressing disorder.
• Voyeurism disorder.
• Unspecified paraphilia.

Other types of paraphilic disorders

Although many more types are known, the DSM-V also takes into account other paraphilias in addition to those that give rise to a paraphilic disorder:

• Zoophilia.
• Coprophilia.
• Necrophilia.
• Hypoxophilia.
• Telephone eschatology.

The variety of symptoms of the person with paraphilic disorder will depend largely on the type of paraphilia they have. Even so, we find some general symptoms in all of them:

• Contract for sexual services and abuse: People who do not have a partner or who have one but are not willing to fulfill their sexual fantasies, can request prostitution services or can even force their victims to perform them against their will.
• Choice of work depending on the excitatory stimulus For example, a pedophile may choose jobs that involve children, or a person who suffers from fetishism may choose to work in a store selling women’s lingerie.
• Leisure related to the stimulus preferred by the individual: books, movies, photographs, etc.
• Social conflict: It is a consequence of your behavior.
• Intense feelings of guilt, shame and depression: This happens due to the fact of carrying out unusual sexual activities that are not socially accepted or that they themselves consider immoral.
• sexual dysfunction: difficulties in developing reciprocal and emotional sexual activity.
• Personality alteration: This dysfunction is severe enough that a comorbid diagnosis can be made.
• Depression symptoms.
• Injuries: These occur due to sadistic or masochistic behaviors.
• STD Acquisition (Sexually Transmitted Diseases): this happens due to not using protection during sexual practices.

The causes are not clear However, we can affirm that some paraphilias can begin in childhood or in the early stages of adolescence; although its development is better defined and elaborated in adolescence and the first years of adult life, and can continue throughout the individual’s life cycle.

The alterations tend to become chronic and last for many years. And, although in general behaviors and fantasies decrease over time, we can find cases in which these increase in response to stressful psychosocial stimuli in relation to other mental disorders or with the opportunity to practice paraphilia.

Treatment of paraphilic disorders must be multidisciplinary and psychopharmacological treatment must be applied hand in hand with psychological treatment. The psychological treatment per se will vary in some aspects depending on the stimulus that gives rise to the fantasy, in any case, in the treatment we could base it on:

• Classical conditioning techniques: mainly with the application of aversive extinction stimuli.
• Operant and social learning techniques: specifically operant reinforcement with biofeedback, through a phallometer, empathy training and masturbation techniques; and social skills training.
• Cognitive techniques: in order to identify perpetuating/conceptual distortions.

Now, how to treat paraphilic disorders with drug administration? Two options are offered:

• Hormonal treatment:especially for those that present a real danger to society.
• Treatment with psychoactive medications: An example is fluoxetine, used with the aim of reducing libido.

Since the cause is not entirely clear, we understand that the expression of the symptoms associated with this type of disorder arises from the interaction between genetics and environment. Thus, It is difficult to determine how to prevent paraphilic disorders without being clear about which genetic and environmental factors are involved and which factors to attack.

Now that you know what paraphilic disorders are, you may be interested in knowing more details about sexual disorders according to the DSM-V.

This article is merely informative, at PsychologyFor we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

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