Paraphilias

We can talk about the existence of paraphilia if:

• the sexual fantasy or sexual behavior is directed toward a non-consenting person or inanimate object;
• these fantasies or behaviors are persistent or represent the dominant sexual interest for the individual.

Paraphilias were previously defined as perversions. A diagnosis of paraphilia requires that the fantasies last at least six months and that they are repeatedly acted out or cause suffering.

Paraphilias include:

Exhibitionism. An exhibitionist exposes his genitals to strangers. Some exhibitionists masturbate or attempt to touch their victim during such a display.

Frotteurism. This is the desire to touch and rub against someone if that person does not agree with such behavior. These actions are usually carried out in crowded places - on a train, bus or elevator.

Fetishism. This disorder involves sexual stimulation with inanimate objects, most often with women's clothing (bras, women's tights, stockings, shoes) or with a body part (for example, a foot). Most often, this is accompanied by masturbation using a favorite object. In transvestite fetishism, clothing of the opposite sex is used as a fetish.

Masochism. People with this type of paraphilia experience sexual arousal when they are beaten, tied up or shackled, humiliated or otherwise made to suffer. Sometimes they demand these actions from their sexual partner or inflict pain on themselves by masturbating. Masochism can be extremely dangerous. In one form (hypoxyphilia), a person suffocates himself or herself during sexual intercourse, either by himself or with the help of a partner.

Sadism. This is a strong sexual desire that occurs when another person suffers mentally or physically. Sexual behavior that involves whipping, beating, or mutilating a partner can sometimes be extremely dangerous for the victims, whether they are forced into such behavior or are voluntarily involved. The severity of the behavior usually increases over time.

Pedophilia. Pedophiles have a strong sexual attraction to children and often use them as sexual objects. Some pedophiles are sexually attracted to children who have distinctive features, such as blond hair or a certain age. Others molest both boys and girls, regardless of their somatic features. Unfortunately, pedophilia is widespread in our society, although not every case of sexual abuse of children is reported. Such behavior is often found in antisocial personality disorders.

Voyeurism. The main symptom of this disorder is a strong sexual impulse that occurs when watching people who are either undressing or performing sexual intercourse. The voyeur does not seek any contact with his victim. Sexual arousal is caused by the act of peeping, which is usually accompanied or ends with masturbation.

Rare variants of paraphilia include necrophilia (the desire for sexual activity with dead people), zoophilia (animals), coprophilia (excrement), urophilia (urine), klismaphilia (enema), and phone sex (indecent conversations on the phone).

Sexual activity between adults and children (pedophilia) or between adults and "partners" who do not consent to such relationships (exhibitionism, voyeurism, frotteurism) is unacceptable to society, illegal and potentially dangerous for their victims.

The true extent of paraphilia and its dynamics in our society are unknown. It seems to be growing, but this may not be so much an increase in the number of cases as in the number of reports of such incidents.

Reasons

The majority (about 90%) of all individuals with paraphilias are men, many of whom exhibit two or more types of these disorders. In most of these men, the disorders described arise in adolescence, before the age of 18. Unfortunately, paraphilia is often first diagnosed with certainty after an arrest.

It is unclear how paraphilia occurs. Some researchers believe that a biological factor, perhaps a brain defect, is involved. Others see a metabolic disorder due to excess testosterone as the cause. It is believed that the origins of such disorders originate in early childhood castration fears, hostility towards women, or may be caused by rudeness and heartlessness of parents. There is a theory that explains paraphilia as an acquired reaction to early sexual arousal. When a young boy, for example, experiences sexual arousal when he is dressed in women's clothing, then perhaps he will associate dressing in clothes of the opposite sex with sexual feelings even when he is an adult.

Diagnosis and treatment

First, let us distinguish paraphilia from variants of normal sexual behavior. It is quite possible that a couple sometimes uses tying up, exchanging clothes, etc. to add variety to their sex life, provided there is mutual consent. A paraphilia diagnosis is only valid if this behavior is long-term or is the sole and exclusive means of sexual stimulation leading to orgasm, and if such sexual activity is carried out without mutual consent.

If paraphilia is suspected, a thorough interview is needed regarding the sexual history, including unusual behavior and the intensity of sexual fantasies. A psychotherapist (sexologist) should rule out such causes of unusual behavior as psychosis or dementia.

The diagnostic process involves exploring all false beliefs and assumptions that may be associated with the patient's behavior. Many rapists, for example, believe that women enjoy being forced into sex. Pedophiles often say that sex with children is acceptable as long as it does not involve physical harm. Exhibitionists claim that they show women their naked penis because they enjoy it. The therapist seeks to correct such self-deception in their patients by developing appropriate behavior patterns and social skills instead.

Treatment of paraphilias involves a range of interventions, from relatively mild to radical. In some countries, castration is used for repeated violations of the law. It is believed that after castration, the concentration of hormones released into the blood from the testicles will decrease and will restrain unacceptable sexual behavior. The results of such surgical interventions, however, are contradictory.

Another treatment involves altering hormone levels with medications, which suppresses sexual desire (called chemical castration). This pharmacological treatment is best done in conjunction with psychotherapy.

Behavioural therapy, which aims to replace the abnormal type of arousal with acceptable patterns of behaviour, is also successfully used to treat paraphilias. This form of therapy monitors the level of arousal by measuring erection. The patient is compared with the arousing effect of paraphilic and non-paraphilic stimuli (slides, videos, tape recordings). The degree of erection is recorded.

Because some paraphiliacs break the law and lure helpless victims into relationships, it is important that they seek treatment for their sexual deviations. They should know that paraphilias usually do not go away on their own and that they need professional help.

• Most people with paraphilia are not motivated to seek treatment. They must be motivated by those around them.
• In most cases, effective treatment can be provided. To get help, contact the psychotherapy department of a nearby hospital and contact doctors and psychotherapists who specialize in treating paraphilias. When meeting with a specialist, ask if he or she has experience working with this type of problem and find out within what framework such therapy should be carried out.

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