PARAPHILIAS

(in Greek para παρά = besides and -philia φιλία = love)

By: Froilan Z. Astillo, RN

 PARAPHILIAS
Definition:

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
(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)
Brief History:
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. The term was coined by Wilhelm Stekel
in the 1920s and popularized by John Money in
the 1960s, who described paraphilia as "a
sexuoerotic embellishment of, or alternative to
the official, ideological norm."
Brief History:
Psychologists and psychiatrists codified
paraphilias as disorders, as a replacement
for the legal constructs of sodomy and
perversion.They previously listed
homosexuality as a paraphilia in the
Diagnostic and Statistical Manual of Mental Di
(DSM-I and DSM-II), but they removed it
in the 1980 version of the DSM-III.
 DSM-IV-TR describes 8 specific
disorders
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.)
Most often exhibitionism begins during
adolescence and continues into adulthood.
 Fetishism:
 The use of inanimate objects to gain sexual
excitement. Partialism refers to fetishes specifically
involving nonsexual parts of the body.
 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:
 Undress the child
 Encourage the child to watch them masturbate
 Touch or fondle the child’s genitals
 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.
 Intensity and
specificity:
"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
 Intensity and specificity:
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.
 Intensity and specificity:

Exclusive paraphilias

 A person is unable to become sexually

aroused in the absence of the paraphilia.
MANAGEMENT
 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
 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
 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
Facts:
Paraphilias are primarily male disorders.

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.

The course of paraphilias is usually chronic in nature.

The prognosis for complete recovery is generally
considered to be guarded.

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.
 Thank you for
Listening!!!
God bless Us Always

FZA