Paraphilias Health Article

Definition

Paraphilias are sexual feelings or behaviors that may involve sexual partners that are not human, not consenting, or that involve suffering by one or both partners.

Description

According to the Diagnostic and Statistical Manual of Mental Disorders (known as the DSM) fourth edition text revised (DSM-IV-TR), the manual used by mental health professionals to diagnose mental disorders, it is not uncommon for an individual to have more than one paraphilia. The DSM-IV-TR lists the following paraphilias: exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, transvestic fetishism, and voyeurism. The DSM-IV-TR also includes a category for paraphilia not otherwise specified, which is the category for the less common paraphilias, including necrophilia, zoophilia, and others.

Exhibitionism

Exhibitionism is the exposure of genitals to a nonconsenting stranger. In some cases, the individual may also engage in autoeroticism while exposing himself. Generally, no additional contact with the observer is sought; the individual is stimulated sexually by gaining the attention of and startling the observer.

Fetishism

People with this disorder achieve sexual gratification with the use of objects, most commonly women's under-garments, shoes, stockings, or other clothing items.

Frotteurism

Individuals with this disorder are gratified by touching or rubbing a non-consenting person. This behavior often occurs in busy, crowded places, such as on busy streets or on crowded buses or subways.

Pedophilia

Pedophilia involves sexual activity with a child, generally under age 13. The DSM-IV-TR describes a criterion that the individual with pedophilia be over 16 years of age and be at least five years older than the child. Individuals with this disorder may be attracted to either males or females or both, although incidents of pedophilic activity are almost twice as likely to be repeated by those individuals attracted to males. Individuals with this disorder develop procedures and strategies for gaining access to and trust of children.

Sexual masochism

Masochism is a term applied to a specific sexual disorder but which also has a broader usage. The sexual disorder involves pleasure and excitement produced by pain, either inflicted by others or by oneself. It usually begins in childhood or adolescence and is chronic. An individual with this disorder achieves gratification by experiencing pain. Masochism is the only paraphilia in which any noticeable number of women participate— about 5% of masochists are female. The term comes from the name of a nineteenth-century Austrian writer, Leopold von Sacher-Masoch, whose novels often included characters who were obsessed with the combination of sex and pain.

In the broader sense, masochism refers to any experience of receiving pleasure or satisfaction from suffering pain. The psychoanalytic view is that masochism is aggression turned inward, onto the self, when a person feels too guilty or is afraid to express it outwardly.

Sexual sadism

A sadistic individual achieves sexual gratification by inflicting pain on another person.

In psychoanalytic theory, sadism is related to the fear of castration, while the behaviorist explanation of sadomasochism (the deviant sexual practice combining sadism and masochism) is that its constituent feelings are physiologically similar to sexual arousal. Separate but parallel descriptions are given for sexual sadism and sexual masochism in the DSM-IV-TR. The clinical diagnostic criteria for both are recurrence of the behavior over a period of at least six months, and significant distress or impairment of the ability to function as a result of the behavior or associated urges or fantasies. Either type of behavior may be limited to fantasies (sometimes while one is engaged in outwardly nondeviant sex) or acted out with a consenting partner, a non-consenting partner, or in the case of masochism, alone. Sadomasochism occurs in both males and females, and in both heterosexual and homosexual relationships.

Transvestic fetishism

This disorder is characterized by heterosexual males who dress in women's clothing to achieve a sexual response. The activity may begin in adolescence, and in secret; later, as an adult, the man may dress as a woman completely and in public. Not all men who cross-dress are unhappy with their gender, but some are. In a small minority of men with transvestic fetishism, gender dysphoria (unhappiness with original gender) may emerge, and those men may eventually seek hormonal treatments or surgical sex reassignment to enable them to live permanently as women.