Paraphilias

Jornal, Mariejo A. PARAPHILIAS Paraphilia (in Greek para παρά = besides and -philia φιλία = love)—in psychology and sexology, is a term that describes a family of persistent, intense fantasies, aberrant urges, or behaviors involving sexual arousal to nonhuman objects, pain or humiliation experienced by oneself or one's partner, children or other nonconsenting individuals or unsuitable partners. Paraphilias may interfere with the capacity for reciprocal affectionate sexual activity. Paraphilia is also used to imply non-mainstream sexual practices without necessarily implying dysfunction or deviance (see Clinical warnings section). Also, it may describe sexual feelings toward otherwise non-sexual objects Paraphilias are problems with controlling impulses that are characterized by recurrent and intense sexual fantasies, urges, and behaviors involving unusual objects, activities, or situations not considered sexually arousing to others. In addition, these objects, activities or situations often are necessary for the person's sexual functioning. With a paraphilia, the individual's urges and behaviors cause significant distress and/or personal, social or occupational dysfunction. Someone with a paraphilia may be referred to as "kinky" or "perverted," and these behaviors may have serious social and legal consequences.

Clinical context Clinical literature discusses eight major paraphilias individually. According to the Diagnostic and Statistical Manual of Mental Disorders, the activity must be the sole means of sexual gratification for a period of six (6) months, and either cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning" or involve a violation of consent to be diagnosed as a paraphilia. 

Exhibitionism: the recurrent urge or behavior to expose one's genitals to an unsuspecting person.

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Fetishism: the use of inanimate objects to gain sexual excitement. Partialism refers to fetishes specifically involving nonsexual parts of the body.

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Frotteurism: the recurrent urges to slap yourself or behavior of touching or rubbing against a nonconsenting person.

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Incest: Sexual relations withi members of ones own family

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Pedophilia: the sexual attraction to prepubescent or peripubescent children. (See also: Chronophilia Ephebophilia, Hebephilia)

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Sexual Masochism: the recurrent urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made to suffer for sexual pleasure.

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Sexual Sadism: the recurrent urge or behavior involving acts in which the pain or humiliation of a person is sexually exciting.

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Transvestitism

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Transvestic fetishism: a sexual attraction towards the clothing of the opposite gender. (Compare to autogynephilia.)

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Voyeurism: the recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing or engaging in sexual activities, or may not be sexual in nature at all.

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Other rarer paraphilias are grouped together under Other paraphilias not otherwise specified (ICD-9-CM equivalent of "Sexual Disorder NOS") and include telephone scatalogia (obscene phone calls), necrophilia (corpses), partialism (exclusive focus on one part of the body), zoophilia (animals), coprophilia (feces), klismaphilia (enemas), urophilia (urine), emetophilia (vomit).

Causes: It is not know for certain what causes paraphilia. Some experts believe it is caused by a childhood trauma, such as sexual abuse. Others suggest that objects or situations can become sexually arousing if they are frequently and repeatedly associated with a pleasurable sexual activity. In most cases, the individual with a paraphilia has difficulty developing personal and sexual relationships with others. Many paraphilias begin during adolescence and continue into adulthood. The intensity and occurrence of the fantasies associated with paraphilia vary with the individual, but usually decrease as the person ages.

Clinical procedures

Observation of paraphiliac behavior has provided valuable scientific information on the mechanisms of sexual attraction and desire, such as behavioral imprinting. Investigation has also led to the tentative conclusions that biological processes may sometimes be manifested in idiosyncratic ways in at least some of the paraphilias, and that these manifestations are frequently associated with (and especially traumatic) events associated with early sexual experience. They tend to be caused by classical conditioning in that a sexual stimulus has been paired with stimuli and situations that do not typically result in sexual response and has then been perpetuated through operant conditioning because the sexual response is its own reward or positive reinforcement. According to Dr. Joseph Merlino, Senior Editor of the book Freud at 150: 21st Century Essays on a Man of Genius and psychiatry adviser to the New York Daily News, a paraphilia is by definition a disorder. "It's the blurring of what I might do that is a turn-on for me, and what might get me into problems with others," said Merlino in an interview. "Once you cross that line, it exists as a problem....the term itself is a diagnosis and if you look at the current listing of diagnoses, the one thing you will find as a qualifier on every one of them for it to be considered a disorder is that it must interfere with functioning, personal interrelationships, career, etc. Absent that, we can't give it a diagnosis." Drug treatments The treatment of men with paraphilias and related disorders has been challenging for patients and clinicians. In the past, surgical castration was advocated as a therapy for men with paraphilias, but it was abandoned because it is considered a cruel punishment and is now illegal in most countries. Psychotherapy, self-help groups, and pharmacotherapy (including the controversial hormone therapy sometimes referred to as "chemical castration") have all been used but are often unsuccessful. Here are some current drug treatments for these disorders. Hormone drug treatments In humans, testosterone has a crucial role not only in the development and maintenance of male sexual characteristics but also in the control of sexuality, aggression, cognition, emotion, and personality. Testosterone is a major determinant of sexual desire, fantasies, and behavior, and it increases the frequency, duration, and magnitude of spontaneous and nocturnal erections. The deviant sexual fantasies, urges, and behavior of men with paraphilias also appear to be triggered by testosterone. Therefore, reducing testosterone secretion or inhibiting its action is believed to control these symptoms.

Antiandrogenic drugs such as medroxyprogesterone (also known as the longacting contraceptive Depo Provera) have been widely used as therapy in these men to reduce sex drive. However, their efficacy is limited and they have many unpleasant side effects, including breast growth, headaches, weight gain, and reduction in bone density. Even if compliance is good, only 60 to 80 percent of men benefit from this type of drug. Long-acting gonadotropin-releasing hormones, such as Triptorelin (Trelstar) which reduces the release of gonadotropin hormones, are also used. This drug is a synthetic hormone which may also lead to reduced sex drive. Psychoactive drug treatments Selective serotonin reuptake inhibitor (SSRI) class of antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), and paroxitine (Paxil), have all been used to treat paraphilias and related disorders by reducing impulse control problems and/or sexual obsessions with some success. Tricyclic antidepressants (TCA), such as imipramine (Tofranil) and desipramine (Norpramin), are also used. Lithium, the mood-stabilizing drug also known as Eskalith is typically used for the treatment of mania in bipolar disorder. There are some reports of reduced sexual compulsive behavior and a reduction in obsessive sexual thoughts in patients, which they attribute to the drug's enhancement of serotonergic functioning. Anxiolytics are not considered a typical treatment for these type of disorders, however the efficacy of buspirone (BuSpar) has been clinically demonstrated. Psychostimulants have been used recently to augment the effects of serotonergic drugs in paraphiliacs. In theory, the prescription of a psychostimulant without pretreatment with an SSRI might further disinhibit sexual behavior, but when taken together, the psychostimulant may actually reduce impulsive tendencies. Methylphenidate (Ritalin) is an amphetamine like stimulant used primarily to manage the symptoms of attention deficit hyperactivity disorder (ADHD). Recent studies imply that methylphenidate may also act on serotonergic systems; this may be important in explaining the paradoxical calming effect of stimulants on ADHD patients. Amphetamine is also used medically as an adjunct to antidepressants in refractory cases of depression.