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Paraphilias: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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Paraphilias are defined as recurrent, intense, sexually arousing fantasies, urges, or behaviors that cause distress or maladaptation, that involve inanimate objects, children, or unaware adults, or that cause distress or humiliation to the person or a partner.
Sexual preferences that seem unusual to another person or to a health care professional are not paraphilias simply because they are unusual. Arousal patterns are considered pathological only if they become essential to sexual functioning (i.e., erection or orgasm is not achieved without stimulation), involve an inappropriate partner (e.g., children who are unaware of adult actions), and cause significant distress or impairment in social, occupational, or other important areas of functioning. Patients with paraphilia may have an impairment or lack of ability to engage in warm, mutually fulfilling, and intimate relationships with a partner. Other aspects of personal and emotional adjustment may also be impaired.
The characteristics of erotic arousal usually develop quite clearly before puberty. At least three processes are involved. Anxiety or early emotional trauma disrupts normal psychosexual development; standard patterns of arousal are replaced by others, often associated with early experiences of extreme sexual intensity, which enhances the experience of sexual pleasure in the individual; patterns of sexual arousal are usually overgrown with symbolic or conventional elements (e.g., a fetish symbolizes the object of arousal, but the choice of fetish may be accidental and associated with sexual curiosity, desire, and arousal). Whether all paraphilic development is the result of such psychodynamic processes remains controversial; there is evidence of impaired brain functioning in some paraphilias (e.g., pedophilia).
In most cultures, paraphilias are significantly more common among men. There is likely a biological basis for this uneven distribution, but it is not well understood.
Many paraphilias are rare. The most common are pedophilia, voyeurism, and exhibitionism. Only a few people with paraphilias break the law and become sex offenders. Some of these offenders have severe personality disorders (such as antisocial or narcissistic), making treatment difficult.
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