Paraphilias: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Paraphilias are recurrent, intense, sexually arousing fantasies, motivations or behavior that cause distress or maladaptation, which refer to inanimate objects, children or those who are not conscious of what is happening to an adult, or cause suffering or humiliation of the person or his partner.
Sexual preferences that seem unusual to another person or health worker are not paraphilias only because they are unusual. The features of arousal are considered pathological only if they become mandatory for sexual functioning (that is, an erection or orgasm is not achieved without the stimulus) include an inadequate partner (for example, children who are not aware of the actions of adults) and cause severe distress or disturbances in social, professional functioning or other important areas. Patients with paraphilia may have a violation or lack of ability to participate in warm mutual emotionally saturated and intimate relationships with a partner. Other aspects of personal and emotional adjustment may also be violated.
The features of erotic excitation usually quite clearly develop to pubertal. At least 3 processes are involved. Anxiety or early emotional trauma disrupts normal psychosexual development; the standard patterns of excitation are replaced by others, often associated with the early experience of extreme sexual experience, which enhances the experience of sexual pleasure in humans; patterns of sexual arousal are usually overgrown with symbolic or conditional elements (for example, a fetish symbolizes the object of excitement, but the choice of a fetish can be accidental and associated with sexual curiosity, desire and excitement). Whether all paraphilic development is the result of such psychodynamic processes remains controversial, there is evidence of brain damage in some paraphilia (for example, pedophilia).
In most cultures paraphilia is much more common among men. The biological basis for this uneven distribution probably exists, but so far it has not been sufficiently studied.
Many paraphilia are rare. Among the most frequent are pedophilia, voyeurism and exhibitionism. Only a few people with paraphilia violate the law and become sex offenders. Some of these criminals have severe personality disorders (eg, antisocial or narcissistic), which makes treatment difficult.
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