Paraphilias

DSM
Formal name Source of arousal
code

Abasiophilia People with impaired mobility

Acrotomophilia People with amputations

Agalmatophilia Statues, mannequins and immobility

Pain, particularly involving an erogenous zone;

differs from masochism as there is a biologically
Algolagnia
different interpretation of the sensation rather than
a subjective interpretation

Female-to-male transsexuals; also known as

Andromimetophilia
gynemimetophilia

Apotemnophilia Having an amputation

Asphyxiophilia Asphixiation or strangulation

Autagonistophilia Being on stage or on camera

Autassassinophilia Being in life-threatening situations

Arousal by a biological female imagining herself as

Autoandrophilia
a male

Self-induced asphyxiation, sometimes to the point of

Autoerotic asphixiation
near unconsciousness
 Arousal by a biological male imagining himself as a
Autogynephilia
female]

Autopedophilia Being prepubescent

Arousal based on the rape of an unconsenting

Biastophilia
person

Chremastistophilia Being robbed or held up

Chronophilia Partners of a widely differing chronological age

Coprophilia Feces; also known as scat, scatophilia or fecophilia

Dacryphilia Tears or crying

Dendrophilia Trees

Emetophilia Vomit

Erotic asphyxiation Asphyxia of oneself or others

Erotophonophilia Murder]

Exposing oneself sexually to others, with or without

Exhibitionism 303.4
their consent

Formicophilia Being crawled on by insects

Frotteurism Rubbing against a non-consenting person 302.89

Gerontophilia Elderly people

Women with penises, men cross-dressed as women,

Gynandromorphophilia
or male-to-female transsexuals

Hebephilia Pubescent children

Homeovestism Wearing clothing emblematic of one's own sex

Criminals, particularly for cruel or outrageous

Hybristophilia
crimes

Infantophilia Children five years old or younger

Kleptophilia Stealing; also known as kleptolagnia

Klismaphilia Enemas

Lactaphilia Breast milk

Liquidophilia Attraction, or desire to immerse genitals in liquids

Giants, primarily domination by giant women or

Macrophilia
men

Breasts; also known as mammagynophilia and

Mammaphilia
mastofact

The desire to suffer, be beaten, bound or otherwise

Masochism 302.83
humiliated

Menophilia Menstruation
Morphophilia Particular body shapes or sizes

Mucophilia Mucus

Mysophilia Dirtiness, soiled or decaying things

Obscene words, colloquially known as "talking

Narratophilia
dirty"

Nasophilia Noses

Necrophilia Cadavers

Olfactophilia Smells

Paraphilic infantilism Being a baby; also referred to as autonepiophilia

Partialism Specific, non-genital body parts

Pedophilia Prepubescent children, also spelled paedophilia 302.2

Peodeiktophilia Exposing one's penis

Pedovestism Dressing like a child

Pictophilia Pornography or erotic art, particularly pictures

Pyrophilia Fire
Raptophilia Committing rape

Sadism Inflicting pain on others 302.84

Salirophilia Soiling or dirtying others

Observing others' sexual activities; also known as

Scoptophilia
scopophilia and more commonly as voyeurism

Sexual fetishism Nonliving objects 302.81

Somnophilia Sleeping or unconscious people

Sthenolagnia Muscles and displays of strength

Stigmatophilia Body piercings and tattoos

Symphorophilia Witnessing or staging disasters such as car accidents

Obscene phone calls, particularly to strangers; also

Telephone scatologia
known as telephonicophilia

Wearing clothes associated with the opposite sex;

Transvestic fetishism 302.3
also known as transvestism

Transvestophilia A transvestite sexual partner

Trichophilia Hair

Troilism Cuckoldism, watching one's partner have sex with

someone else, possibly without the third party's
 knowledge; also known as triolism

Urination, particularly in public, on others, and/or

Urolagnia
being urinated on

Ursusagalmatophilia Teddy bears

Drawing or drinking blood; also known as

Vampirism
murphyism

Eating or being eaten by others; usually swallowed

Vorarephilia
whole, in one piece

Watching others while naked or having sex,

Voyeurism 302.82
generally without their knowledge

Zoophilia Animals (actual, not anthropomorphic)

Zoosadism Inflicting pain on or seeing animals in pain

Technical terms for non-paraphilic sexual interests

• Androphilia: Sexual interest in men
• Analloerotic: Lacking in sexual interests towards others (but not lacking in
sexual drive—see asexuality)[14][37]
• Ephebophilia: Sexual preference for individuals in mid-to-late adolescence,[38]
typically ages 15–19.[23]
• Gynephilia: Sexual interest in women
• Teleiophilia: Sexual interest in adults (as opposed to pedophilia, etc.)[39]
Paraphilias
What are paraphilias?

Paraphilias are sometimes referred to as sexual deviations or perversions. Paraphilias include

fantasies, behaviors, or sexual urges focusing on unusual objects, activities, or situations.
Paraphilias include:

• Sexual urges or sexual fantasies with non-human objects

• Sexual behaviors with non-human objects
• Sexual behaviors involving humiliation or suffering of oneself or another person
• Adult sexual behavior that involves children or nonconsenting adults

Some of the common paraphilias include:

• Exhibitionism
• Fetishism
• Frotteurism
• Pedophilia
• Masochism
• Sadism
• Transvestitism
• Voyeurism

• Exhibitionism: Exhibitionism is a tendency to sexually expose oneself to others. For

example, a man’s behavior is exhibitionistic when he exposes part his naked body,
usually his genitals, to a total stranger. The sexual behavior is almost always limited to
the genital exposure, and the person may make no further harmful advances toward the
stranger. Most often exhibitionism begins during adolescence and continues into
adulthood.

• Fetishism: People with a fetish experience sexual urges and behavior which are
associated with non-living objects. For example, the object of the fetish could be an
article of female clothing, like female underwear. Usually the fetish begins in adolescence
and tends to be quite chronic into adult life.

• Frotteurism: Men have a paraphilia called Frotteurism when the focus of their sexual
urges are related to the touching or rubbing of their body against a non-consenting,
unfamiliar woman. Usually the male rubs his genital area against the female. Most
 commonly, the man chooses to attack in a crowded public location and then he
disappears into the throng of people. Frotteurism usually begins in adolescence and the
abnormal behavior tends to decrease when the man reaches his late twenties.

• Pedophilia: A pedophile is a person, most frequently a man, who focuses his sexual
fantasies and behavior toward children. People who enjoy child pornography or "kiddie
porn" are pedophiles. Some pedophiles are sexually attracted only toward children and
are not at all attracted toward adults. Pedophilia is usually a chronic condition.

When a pedophile becomes sexually active with a child he/she may:

o Undress the child
o Encourage the child to watch them masturbate
o Touch or fondle the child’s genitals
o Forcefully perform sexual acts on the child

• Masochism: Masochism is the getting of pleasure, often sexual, from being hurt or
humiliated. Sometimes the masochistic acts are limited to verbal humiliation or
blindfolding. However, masochistic behavior might include being bound or beaten.
Masochism may become even more harmful, however, when a person permits another to
use arm or leg restraints accompanied by acts of beating, whipping, or cutting.

• Sadism: Sadism is deriving pleasure, often sexual, from mistreating others. Like other
paraphilias, some people have fantasies which are sadistic, but they never act upon
them. Also, some people have sexual urges of a sadistic nature, and they find a willing
partner who agrees to participate in the sadistic activity. There are people, however, who
have sadistic sexual urges who find others whom they victimize with their behavior. Some
of the severe activities involved in sexual sadism include burning, beating, stabbing,
raping, and killing. Usually the thoughts and/or behaviors of sexual sadism begin in
adolescence or early adulthood. The behaviors are not only chronic, but they usually
increase in severity with time.

• Transvestitism: Cross-dressing by heterosexual males is called transvestic fetishism or

transvestitism. The male with this fetish usually has a variety of female clothes that he
uses to cross-dress. While some males will wear only one special piece of female
apparel, others fully dress as a female and use full facial make-up to achieve a total
female appearance. Often this disorder begins in childhood. It tends to be chronic in
nature.

• Voyeurism: Voyeurism is seeking sexual pleasure by secretly observing another.

Another name for the behavior is “peeping” or “peeping Tom”. The activity brings on
sexual excitement and may conclude with masturbation by the voyeur. Voyeurism usually
starts in adolescence and tends to persist into adulthood.

Do paraphilias affect males, females, or both?

Paraphilias are primarily male disorders.

At what age do paraphilias appear?

Most paraphilic fantasies begin in late childhood or adolescence and continue throughout
adult life. Intensity and occurrence of the fantasies are variable, and they usually
 decrease as people get older.

How are paraphilias treated?

Cognitive, behavior, and psychoanalytic therapies are used to treat individuals with
paraphilias. Some prescription medicines have been used to help decrease the
compulsive thinking associated with the paraphilias. Hormones are prescribed
occasionally for individuals who experience intrusive sexual thoughts, urges, or
abnormally frequent sexual behaviors. Almost always the treatment must be long-term if
it is to be effective.

What happens to someone with paraphilias?

The course of paraphilias is usually chronic in nature. The prognosis for complete
recovery is generally considered to be guarded.

What can people do if they need help?

If you, a friend, or a family member would like more information and you have a therapist
or a physician, please discuss your concerns with that person.

"Parasexual" redirects here. For parasexuality in microbiology, see bacterial

conjugation.
Paraphilia (in Greek para παρά = besides and -philia φιλία = love) is a biomedical term
used to describe sexual arousal to objects or situations that are not part of normative
stimulation and that can cause distress or serious problems for the paraphiliac or persons
associated with him or her.[1] The term was coined by Wilhelm Stekel in the 1920s[2] and
popularized by John Money in the 1960s, who described paraphilia as "a sexuoerotic
embellishment of, or alternative to the official, ideological norm."[3]

Psychologists and psychiatrists codified paraphilias as disorders, as a replacement for the

legal constructs of sodomy[4] and perversion.[5] They previously listed homosexuality as a
paraphilia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-I and
DSM-II), but they removed it in the 1980 version of the DSM-III. That edition describes
paraphilia as "recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
generally involving:

1) nonhuman objects, or
2) the suffering or humiliation of oneself or one's partner, or
3) children or other nonconsenting persons."[6]

Sexual arousal in association with objects that were designed for sexual purposes is not
DSM diagnosable (DSM, p. 570).[6] Some people diagnosed with paraphilias undergo
voluntary or involuntary intervention to alter their behavior.
The view of paraphilias as disorders is not universal. Groups seeking greater
understanding and acceptance of sexual diversity have lobbied for changes to the legal
and medical status of unusual sexual interests and practices. Charles Allen Moser, a
physician and advocate for sexual minorities, has argued that the diagnoses should be
eliminated from diagnostic manuals.[7] Psychiatrist Glen Gabbard writes that despite
efforts by Stekel and Money, "the term paraphilia remains pejorative in most
circumstances." [8]

Paraphilias are defined by DSM-IV-TR as sexual disorders characterized by "recurrent,

intense sexually arousing fantasies, sexual urges or behaviors generally involving (1)
nonhuman objects, (2) the suffering or humiliation of oneself or one's partner, or (3)
children or other nonconsenting persons that occur over a period of 6 months" (Criterion
A), which "cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning" (Criterion B). DSM-IV-TR describes 8 specific
disorders of this type (exhibitionism, fetishism, frotteurism, pedophilia, sexual
masochism, sexual sadism, voyeurism, and transvestic fetishism) along with a ninth
residual category, paraphilia not otherwise specified (NOS).[20] Criterion B differs for
exhibitionism, frotteurism, and pedophilia to include acting on these urges, and for
sadism, acting on these urges with a nonconsenting person.[6]

Some paraphilias may interfere with the capacity for sexual activity with consenting adult
partners.[6] According to the DSM, "Paraphilias are almost never diagnosed in females,"[6]
but some case studies of females with paraphilias have been published.[21]

The DSM provides clinical criteria for these paraphilias:

• Exhibitionism: the recurrent urge or behavior to expose one's genitals to an

unsuspecting person. (Can also be the recurrent urge or behavior to perform
sexual acts in a public place, or in view of unsuspecting persons.)
• Fetishism: the use of inanimate objects to gain sexual excitement. Partialism
refers to fetishes specifically involving nonsexual parts of the body.
• Frotteurism: the recurrent urges of behavior of touching or rubbing against a
nonconsenting person.
• Paedophilia: a psychological disorder in which an adult experiences a sexual
preference for prepubescent children,[22] or has engaged in child sexual abuse.[23][24]
[25]

• Sexual Masochism: the recurrent urge or behavior of wanting to be humiliated,

beaten, bound, or otherwise made to suffer for sexual pleasure.
• Sexual Sadism: the recurrent urge or behavior involving acts in which the pain or
humiliation of a person is sexually exciting.
• Transvestic fetishism: arousal from "clothing associated with members of the
opposite sex."[6][26]
 • Voyeurism: the recurrent urge or behavior to observe an unsuspecting person who
is naked, disrobing or engaging in sexual activities, or activities which may not be
sexual in nature at all.

Under Paraphilia NOS, the DSM mentions 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). The DSM's Paraphilia NOS is equivalent to the ICD-9's Sexual Disorder NOS.

The literature includes single-case studies of exceedingly rare and idiosyncratic

paraphilias. These include an adolescent male who had a strong fetishistic interest in the
exhaust pipes of cars, a young man with a similar interest in a specific type of car, and a
man who had a paraphilic interest in sneezing (both his own and the sneezing of others).
[27][28]
See also List of paraphilias.

[edit] Intensity and specificity

Clinicians distinguish between optional, preferred and exclusive paraphilias,[6] though the
terminology is not completely standardized. An "optional" paraphilia is an alternative
route to sexual arousal. For example, a man with otherwise unremarkable sexual interests
might sometimes seek or enhance sexual arousal by wearing women's underwear. In
preferred paraphilias, a person prefers the paraphilia to conventional sexual activities, but
also engages in conventional sexual activities. For example, a man might prefer to wear
women's underwear during sexual activity, whenever possible. In exclusive paraphilias, a
person is unable to become sexually aroused in the absence of the paraphilia.[citation needed]

[edit] Drug treatments

The treatment of paraphilias and related disorders has been challenging for patients and
clinicians. In the past, surgical castration was advocated as a therapy for men with
pedophilia, but has been abandoned for the time being because most governments
consider it a cruel punishment where the express willingness and consent of the patient is
not objectively indicated. Psychotherapy, self-help groups, and pharmacotherapy
(including the controversial hormone therapy sometimes referred to as "chemical
castration") have all been used. Other drug treatments for these disorders do exist,
however.[29]

[edit] Hormonal

Antiandrogenic drugs such as medroxyprogesterone (also known as the long-acting

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.[29]

[edit] Psychoactive

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.[29]