Paraphilia comes with much stigmatization as “normal” sexual behavior is viewed as a consensual sexual activity aimed at reproduction. The DSM-V reduces the stigmatization of consensual abnormal sexual activity by distinguishing between paraphilias and paraphilic disorders. Pedophilic disorder is the only paraphilic disorder that can not be in remission or expressed in a “controlled environment.” This study aims to illustrate the discussion surrounding paraphilias (and disorders) and the changes in the DSM-V.
The concept of paraphilias presents many challenges in that what is defined as “normal” sexual behavior is not stable. Such definitions tend to center around genitalia and reproduction, establishing a kind of “repronormativity”. The concept of paraphilias is also somewhat unstable as to what extent a sexual act or desire has to be deviant for it to be considered paraphilic is not always clearly defined. Forensic psychiatry in the mid-1900s increased interest in paraphilias in trying to explain the psychological underpinnings of sexual crimes.
The DSM-V distinguishes between paraphilias and paraphilic disorders. This destigmatizes adults engaging in consensual atypical sexual behaviors. Paraphilic disorders center around distress and impairments resulting from paraphilic thoughts and behaviors. Paraphilias are much more prevalent in men than in women. The reason for this is unknown but some propose differences in sexual drives in men and women to be implicated. Paraphilic interests have also been shown to arise as a consequence of treatment for Parkinson’s disease. Treatment with dopinomimetic medication has also been shown to be accompanied by paraphilias and paraphilic disorders.
Pedophilia occurs in ~1% of men and is the most commonly known paraphilia. Most research on pedophilia uses samples of criminal offenders as it can not be acted upon in a consensual way (or in a controlled environment). Thus, very little is known about those with pedophilic urges who have not acted on them. New research points to pedophilia not necessarily being unchangeable or permanently fixed in someone’s personality. Brain imaging studies have not supported associations between pedophilia and disorders like frontal lobe disorder.
There is controversy surrounding hebephilia, sexual interest in pubertal adolescents, not having diagnostic criteria.
Sexual Sadism and Sexual Masochism
Sadism, feeling gratification from inflicting pain on others, and psychopathy have been shown to predict sexual and nonsexual violence. Sexual sadism is common among offenders of sexual murder. Sadism and psychopathy may both influence (non)sexual violence but do not necessarily occur at the same time with the same level of influence in each person.
The prevalence of paraphilias is largely unknown due to the difficulty of collecting accurate data. Some rare paraphilias include bestiality and vorarephilia. Bestiality is acting on a sexual interest in non-human animals. Vorarephilia is a sexual desire in eating or getting eaten by another person. Some rare paraphilias like klismaphilia have been identified as side effects of dopaminomimetic medication during treatment for Parkinson’s disease.
Counseling and psychotherapy are integral in treating paraphilias and paraphilic disorders. However, most healthcare professionals do not want to work with these clients. What makes certain sexual behaviors clinically abnormal is not clear-cut and diagnosis of paraphilic disorders is very stigmatizing.
Antiandrogen treatments are used to treat sexual offenders. They function to lower testosterone levels to the point of reducing or blunting sexual thoughts and behaviors, known as chemical castration. Antiandrogen treatments are not viewed as long term treatments and pose some ethical dilemmas.
Paraphilias occur much more in men than women. The reason why is unknown. More research into paraphilias in women is needed. The DSM-V made distinctions between paraphilias and paraphilic disorders, with the aim of lowering stigma around paraphilias. The origins and causes of paraphilias are largely unknown. There is a correlation between paraphilia and aggression in forensic samples (those who have committed crimes). Neuroimaging studies have not confirmed any neural underpinnings of paraphilic disorders. There is no clear consensus on the best therapeutic approach for treating paraphilic disorders. All in all, paraphilias (and disorders) are still not understood well, so more research is necessary.