Paraphilias

PARAPHILIAS 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. Characterized by: • Infliction of pain or humiliation to self, partner, children or other nonconsenting individuals • That has lasted for at least six months • Has resulted in severe distress in impairment in normal functioning.

• These objects, activities or situations often are necessary for the person's sexual functioning. • Someone with a paraphilia may be referred to as "kinky" or "perverted," and these behaviors may have serious social and legal consequences.

Types of Paraphilias: Exhibitionism ("Flashing") •

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Exhibitionism is characterized by intense, sexually arousing fantasies, urges or behaviors involving exposure of the individual's genitals to an unsuspecting stranger. The individual with this problem, sometimes called a "flasher," feels a need to surprise, shock or impress his victims. The condition usually is limited to the exposure, with no other harmful advances made, (although "indecent exposure" is illegal). Actual sexual contact with the victim is rare. However, the person may masturbate while exposing himself or while fantasizing about exposing himself.

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Fetishism People with this problem have sexual urges associated with nonliving objects. The person becomes sexually aroused by wearing or touching the object. • For example, the object of a fetish could be an article of clothing, such as underwear, rubber clothing, women's shoes, or women's underwear or lingerie. • The fetish may replace sexual activity with a partner or may be integrated into sexual activity with a willing partner. • When the fetish becomes the sole object of sexual desire, sexual relationships often are avoided. • A related disorder, called partialism, involves becoming sexually aroused by a body part, such as the feet, breasts or buttocks. •

Transvestism Transvestism, or transvestic fetishism, refers to the practice by heterosexual males of dressing in female clothes to produce or enhance sexual arousal. • The sexual arousal usually does not involve a real partner, but includes the fantasy that the individual is the female partner, as well. • Some men wear only one special piece of female clothing, such as underwear, while others fully dress as female, including hair style and make-up. • Cross-dressing itself is not a problem, unless it is necessary for the individual to become sexually aroused or experience sexual climax. •

Frotteurism With this problem, the focus of the person's sexual urges is related to touching or rubbing his genitals against the body of a non-consenting, unfamiliar person. • In most cases of frotteurism, a male rubs his genital area against a female, often in a crowded public location. • This disorder also is a problem because the contact made with the other person is illegal. •

Pedophilia Paraphilias2

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People with this problem have fantasies, urges or behaviors that involve illegal sexual activity with a prepubescent child or children (generally age 13 years or younger). Pedophilic behavior includes undressing the child, encouraging the child to watch the abuser masturbate, touching or fondling the child's genitals and forcefully performing sexual acts on the child. Some pedophiles are sexually attracted to children only (exclusive pedophiles) and are not attracted to adults at all. Some pedophiles limit their activity to their own children or close relatives (incest), while others victimize other children. Predatory pedophiles may use force or threaten their victims if they disclose the abuse. Health care providers are legally bound to report such abuse of minors.

 This activity constitutes rape and is a felony offense punishable by imprisonment.  Age of pedophile is set at 16 years old or more  Age difference between the offender and the victim set at 5 years or more o When the victim is postpubertal, the disorder is labeled as child molestation or ephebophilia Sexual Masochism Individuals with this disorder use sexual fantasies, urges or behaviors involving the act (real, not simulated) of being humiliated, beaten or otherwise made to suffer in order to achieve sexual excitement and climax. • These acts may be limited to verbal humiliation, or may involve being beaten, bound or otherwise abused. Masochists may act out their fantasies on themselves -- such as cutting or piercing their skin, or burning themselves -- or may seek out a partner who enjoys inflicting pain or humiliation on others (sadist). • Activities with a partner include bondage, spanking, and simulated rape. • Sadomasochistic fantasies and activities are not uncommon among consenting adults. In most of these cases, however, the humiliation and abuse are acted out in fantasy. • The participants are aware that the behavior is a "game," and actual pain and injury is avoided. •

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A potentially dangerous, sometimes fatal, masochistic activity is autoerotic partial asphyxiation, in which a person uses ropes, nooses or plastic bags to induce a state of asphyxia (interruption of breathing) at the point of orgasm. This is done to enhance orgasm, but accidental deaths sometimes occur.

Sexual Sadism Individuals with this disorder have persistent fantasies in which sexual excitement results from inflicting psychological or physical suffering (including humiliation and terror) on a sexual partner. • This disorder is different from minor acts of aggression in normal sexual activity; for example, rough sex. • In some cases, sexual sadists are able to find willing partners to participate in the sadistic activities. • At its most extreme, sexual sadism involves illegal activities such as rape, torture, and even murder, in which case the death of the victim produces sexual excitement. It should be noted that while rape may be an expression of sexual sadism, the infliction of suffering is not the motive for most rapists, and the victim's pain generally does not increase the rapist's sexual excitement. Rather, rape involves a combination of sex and gaining power over the victim. These individuals need intensive psychiatric treatment and may be jailed for these activities. •

Voyeurism ("Peeping Tom") •

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This disorder involves achieving sexual arousal by observing an unsuspecting and non-consenting person who is undressing or unclothed, and/or engaged in sexual activity. This behavior may conclude with masturbation by the voyeur. The voyeur does not seek sexual contact with the person he is observing. Other names for this behavior are "peeping" or "peeping Tom."

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), Paraphilias4

necrophilia (corpses), partialism (exclusive focus on one part of the body), zoophilia (animals), coprophilia (feces), klismaphilia (enemas), urophilia(urine), emetophilia (vomit). Hormone drug treatments •

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.

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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.

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Antiandrogenic drugs such as medroxyprogesterone (also known as the long-acting contraceptive Depo Provera) have been widely used to reduce sex drive.

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efficacy is limited and they have many unpleasant side effects (breast growth, headaches, weight gain, and reduction in bone density).

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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) - reducing impulse control problems and/or sexual obsessions

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Tricyclic antidepressants (TCA) Paraphilias5

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Lithium, the mood-stabilizing drug also known as Eskalith is typically used for the treatment of mania in bipolar disorder. o There are some reports of reduced sexual compulsive behavior and a reduction in obsessive sexual thoughts in patients

Etiology: a.

Biologic Factors: destruction of the parts of the limbic system, temporal lobe disorders, abnormal levels of androgens

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Psychoanalytic theory: failure to resolve oedipal conflict, identification with parent of the opposite sex or selection of inappropriate object for libidinal cathexis.

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