Paraphilia

A paraphilia (in Greek para παρά = besides and -philia φιλία = love)— is any of several persistent, intense sexual interests, fantasies, or urges involving nonhuman objects, pain or humiliation, children, or nonconsenting individuals. Some paraphilias may interfere with the capacity for sexual activity with consenting adult partners.[1] Paraphilias are a phenomenon of males nearly exclusively,[1] but some case studies of females with paraphilias have been published.[2] See also a list of paraphilias.

Origin

The term paraphilia (German: paraphile) was coined by Austrian ethnologist, Friedrich S. Krauss [2a][2b], as a "purely descriptive, morally neutral expression to replace the judgmental "perversion", "aberration", and "deviation" ", and adopted by Austrian physician and psychologist, Wilhelm Stekel.[2c]

Early descriptions

Albert Eulenburg (1914) noted a commonality across the paraphilias, using the terminology of his time, "All the forms of sexual perversion...have one thing in common: their roots reach down into the matrix of natural and normal sex life; there they are somehow closely connected with the feelings and expressions of our physiological erotism. They are...hyperbolic intensifications, distortions, monstrous fruits of certain partial and secondary expressions of this erotism which is considered 'normal' or at least within the limits of healthy sex feeling."[3]

Clinical definition

The clinical literature contains reports of many paraphilias, only some of which receive their own entries in the diagnostic taxonomies of the American Psychological Association or the World Health Organization.[4][5] There is disagreement regarding which sexual interests should be deemed paraphilic disorders versus normal variants of sexual interest. 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.
  • Pedophilia: a psychological disorder in which an adult experiences a sexual preference for prepubescent children,[6] or has engaged in child sexual abuse.[7][8][9]
  • 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.
  • Voyeurism: the recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing or engaging in sexual activities, or 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).[10][11] See also List of Paraphilias.

Intensity and specificity

Clinicians distinguish between optional, preferred and exclusive paraphilias, 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]

Optional paraphilias are far more common than preferred paraphilias, which are, in turn, far more common than exclusive paraphilias.[citation needed]

Optional paraphilias sometimes disrupt stable relationships when discovered by an unsuspecting partner. Preferred paraphilias often disrupt otherwise stable relationships. Open communication and mutual support can minimize or prevent such disruption in both of these cases. Exclusive paraphilias often preclude normal courtship and committed romantic relationships, even when the person in question desires such a relationship. Loneliness or social isolation are common consequences. In extreme cases, preoccupation with a preferred or exclusive paraphilia completely displaces the more typical desire for loving human relationships.[citation needed]

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 paraphilias, but it was abandoned because it is considered a cruel punishment and is now illegal in most countries. Psychotherapy, self-help groups, and pharmacotherapy (including the controversial hormone therapy sometimes referred to as "chemical castration") have all been used but are often unsuccessful.[citation needed] Here are some current drug treatments for these disorders.[12]

Hormone drug treatments

In humans, 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. 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.

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.[12]

Psychoactive drug treatments

Selective serotonin reuptake inhibitor (SSRI) class of antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), and paroxitine (Paxil), have all been used to treat paraphilias and related disorders by reducing impulse control problems and/or sexual obsessions with some success.

Tricyclic antidepressants (TCA), such as imipramine (Tofranil) and desipramine (Norpramin), are also used.

Lithium, the mood-stabilizing drug also known as Eskalith is typically used for the treatment of mania in bipolar disorder. There are some reports of reduced sexual compulsive behavior and a reduction in obsessive sexual thoughts in patients, which they attribute to the drug's enhancement of serotonergic functioning.

Anxiolytics are not considered a typical treatment for these type of disorders, however the efficacy of buspirone (BuSpar) has been clinically demonstrated.

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.[12]

Religious views

Various religious adherents view various paraphilias as deviations from a divine purpose for human sexuality, as understood through their religious tradition or laws. Depending in part on the nature of the paraphilia in question, judgements can differ as to whether religiously it should be considered a case of sexual sin, mental illness, or simply harmless sexual variation. Another variable is whether it is the acting out, or (less commonly) just the desirous thought alone, which is critically viewed in such cases. In any event, several paraphilias, such as bestiality or pedophilia, are viewed negatively by various religions.

Some religious traditions include forms of extreme asceticism, such as whipping , which, when practiced as sexual activities, would usually be considered masochism and popularly viewed as paraphilias. When practiced for non-sexual reasons, they are usually valued by the religious groups concerned as a part of their religious observance and submission to their god.

Legality

As a general rule, the law in many countries often intervenes in paraphilias involving young or adolescent children below the legal age of consent and sex with animals due to duty of care issues and general public abhorrence of the practice. There is also legal intervention concerning nonconsensual deliberate displays or illicit watching of sexual activity, illegal manipulation of dead people, harassment, nuisance, fear, injury, or assault of a sexual nature. Separately, it also usually regulates or controls censorship of pornographic material.

Exhibitionism, in cases where people who have not previously agreed to watch are exposed to sexual display, is also an offense in most jurisdictions, as is voyeurism when unarranged (see indecent exposure and peeping tom).

Non-consensual sadomasochistic acts may legally constitute assault and therefore belong in the list below. Some jurisdictions criminalize some or all sadomasochistic acts, regardless of legal consent, and impose liability for any injuries caused. For these purposes, non-physical injuries are included in the definition of grievous bodily harm in English law. (See Consent (BDSM), Operation Spanner)

References

1. ^ a b American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.
2. ^ Fedoroff, J. P., Fishell, A., & Fedoroff, B. (). A case series of women evaluated for paraphilic sexual disorders. Canadian Journal of Human Sexuality, 8.
2a. "Variations in Sexual Behavior" at the Magnus Hirschfeld Archive for Sexology, Humboldt University, Berlin.
2b. Friedrich Salomo Krauss, "Die anmut des frauenleibes", Schumann, 1904. eg. page 14
2c.Wilhelm Stekel, et al, in Psyche and eros, Volumes 1-2, publ. Psyche and Eros Publishing Co., 1920. eg. page 2
3. ^ Eulenburg (1914). Ueber sexualle Perversionen. Ztschr. f. Sexualwissenschaft, Vol. I, No. 8. translated in Stekel, Wilhelm.(1940). Sexual aberrations: The phenomena of fetishism in relation to sex. New York: Liveright, p. 4. OCLC 795528
4. ^ psyweb.com "Axis I. Clinical Disorders, most V-Codes and conditions that need Clinical attention". Retrieved: 23 November, 2007.
5. ^ World Health Organization, International Statistical Classification of Diseases and Related Health Problems, (2007), Chapter V, Block F65; Disorders of sexual preference. Retrieved 2007-11-29.
6. ^ World Health Organization, International Statistical Classification of Diseases and Related Health Problems: ICD-10 Section F65.4: Paedophilia (online access via ICD-10 site map table of contents)
7. ^ Finkelhor, David; Sharon Araji (1986). A Sourcebook on Child Sexual Abuse: Sourcebook on Child Sexual Abuse. Sage Publications, p90. ISBN 0803927495.
8. ^ "pedophilia". Encyclopædia Britannica.
9. ^ medem.com
10. ^ Padmal de Silva (March 2007). "Sexual disorder and psychosexual therapy". Psychiatry 6 (3): 130–134. Elsevier Ltd. doi:10.1016/j.mppsy.2006.12.009.
11. ^ King, M.B. (1990). "Sneezing as a fetish object". Sex Marital Therapy 5: 69–72. doi:10.1016/j.mppsy.2006.12.009.
12. ^ a b c M. Williams. Sexual Compulsivity: Defining Paraphilias and Related Disorders "Psychoactive Drug Treatments". Retrieved 23 November, 2007