Most people have some knowledge or experience with mental illness, but not as many people are familiar with Paraphilia. This is a condition that involves sexual fetishes where one’s sexual arousal and gratification depend on fantasizing about, and engaging in, sexual behavior that is atypical and extreme (Kafka, 2010). This behavior may be centered on objects such as people, clothing, or toys; as well as certain acts like; beating, nudity, or even making obscene phone calls.
There are several different types of paraphilia, over 500, which generally lie in two different categories psychosexual disorders and NOS (not otherwise specified) paraphilias. Although paraphilia has been studied for quite some time, there is still little knowledge on the cause of this condition as well as determining a successful treatment. Categorization of paraphilia first came into history in the late 1800s. The first terms used to describe this condition were sodomy and perversion. Later, in the first two editions of the DSM (Diagnostic and Statistical Manual of Mental Disorders) manual, the term sexual deviation was used.
In 1980 the term paraphilia was presented in the DSM-III (Kafka, 2010). Since the discovery of paraphilia, classification has been a major area of focus. Determining which types of this condition can be considered psychiatric disorders is ever changing in the Diagnostic and Statistical Manual of Mental Disorders. The difficulty lies in deciding what type of sexual behavior is normal and what is not. In the past homosexuality was considered a form of paraphilia and it was classified as so in the DSM. Today it is regarded as a variant of normal sexuality.
Also toys, sexual role-play, and different aspects of some fetishes which are considered normal adult entertainment have often been confused with this condition (Carroll, 2010). There is also trouble with deciphering whether certain types of paraphilia fall under the psychiatric disorder category. “The necessary features of a Paraphilia are recurrent, intense sexually arousing fantasies, sexual urges, or behavior, that occur over a period of at least 6 months, generally involving nonhuman objects, the suffering or humiliation of oneself or one’s sex partner, children or other non-consenting persons” (Pedophilia).
A paraphilic disorder is defined as a paraphilia that causes distress or impairment to the individual or harm to others. Many of these forms of paraphilia are well known by most. Pedophilia is any type of sexual behavior that involves prepubescent children, this includes; thoughts or fantasies, arousal, or engaging in sexual contact. Another disorder that is in the DSM is Sadism. This is a condition when people are aroused by causing physical, mental, or emotional pain or suffering to another person. Sadism may be so severe that it leads to a crime (Fedoroff, 2008).
Masochism is yet another form of paraphilia that generally involves inflicting some sort of pain, but in this instance it is the paraphiliac that receives these inflictions (Masochism, 2011). Both sadism and masochism involve anywhere from mild to severe activities, both can become extremely dangerous and even life threatening. Other harmful types of paraphilia that are less known to most people but are illegal in the United States are Voyeurism, Exhibitionism, and Erotophonophilia.
Most people would refer to people with Voyeurism as a “Peeping Tom. This act involves watching other people undressing, or while they are naked, and even watching them during sexual encounters without their knowledge. The high risk of them being caught is what gives them arousal. Exhibitionism is the act of showing one’s genitals to others, generally in public. These paraphiliacs obtain arousal from the shock or look on the unsuspecting victims face. Also known as “indecent exposure” this act of exposing oneself, “account for about one-third of all sex convictions in the United States, Canada, and Europe” (Carroll, 2010).
There is not much information on the last type of paraphilia, although it is common among serial killers. Erotophonophilia is getting aroused by murdering someone. The category of “Not Otherwise Specified” (NOS) for DSM-based psychiatric diagnosis has typically retained diagnoses whose rarity, empirical criterion validation or symptomatic expression has been insufficient to be codified” (Kafka, 2010). Non- psychiatric disorders are paraphilias that are generally considered as non-typical sexual behaviors that do not cause harm to others and are less common than other types.
One of these types is coprophilia, which is sexual excitement from feces. Another is Uralagnia sexual arousal from urinating on another person, or being urinated on. Also there is Zoophilia attraction to, or fantasizing about animals. Telephone scatologia is making obscene phone calls to strangers and is also known as Telephonicophilia (Berger). These are just a few of the many types of NOS paraphilias. Some rare and unusual forms of paraphilia include Paraphilic Infantilism which is sexual excitement from being treated or dressed as a baby, wearing diapers is one of the main components of this type of paraphilia.
Someone that is aroused by enemas is a Klismaphiliac. Necrophilia consists of sexual arousal from viewing or even having sexual intercourse whit a corpse. There are many of these rare forms of paraphilia, but they are less common and not as many people practice these forms of the condition. Like the two categories used in the DSM some professionals also use subcategories to describe paraphilia in a different way. These include optional, preferred, or exclusive paraphilias.
Optional paraphilia basically means that the person generally has normal sexual experiences, but may sometimes include paraphilia for enhancement of the experience. The term preferred refers to people that have typical and atypical sexual encounters, but they prefer the paraphilia or atypical experience. Exclusive paraphilia involves cases in which the person cannot be aroused without the paraphilia being present (Paraphilia, 2010). It is apparent that many types of paraphilias exist; the main question of many specialists is what causes these behaviors.
Just as the number of people with any form of this condition is unknown, so is the reason that they occur, however there are many theories out there. One of these theories is the biological theory. “Some researchers believe that brain tumors, lesions, or chemical differences in the brain may lead to paraphiliac behaviors. Also others believe that higher levels of some hormones, like testosterone, may be a key determinant in this condition” (Carroll, 2010). Many of the treatments today focus on hormone levels, which will be discussed later. Psychoanalytic theories center on the fact that the oedipal stage and castration crisis during infancy may have been difficult for the person to negotiate. This may explain why the condition is found more in males than females. Females continue to identify with their mothers while males must separate from their mothers and identify as a male” (Carroll, 2010). Mothers play a very important role in a child’s life at this time and having to separate themselves can be a traumatic experience for young males.
Last is the developmental theory, which basically suggests that we may learn to be attracted to certain things from society and media. For example, one may develop a sexual fantasy about cars, Mechaphilia, by seeing a commercial that involves cars being depicted as sexy or arousing. Although all of these theories may have some merit to the causes of paraphilia, there is not one in particular that can fully explain the different aspects of this condition. Because the true cause of paraphilias is unknown, finding a successful treatment for this condition has proved to be problematic for professionals.
There is also the additional factor that many paraphiliacs do not desire to “be treated,” and even further, many paraphiliacs including those involved in criminal behavior do not think that they have a problem at all. Many paraphiliacs that do seek treatment are generally not doing so voluntarily; court systems and family members usually play a role in people seeking treatment for this condition. This factor also adds to the already difficult dilemma faced by professionals. Despite these factors, many different forms of treatment are available today, although some prove to be more successful than others.
To begin treatment specialists must first assess the different aspects of the person’s condition. Some of these factors include: severity, type, and how often the person partakes in the behavior. There are many different methods used for assessment. First is self-reporting, relying on the person to explain the details of their condition, which may not always be the complete truth due to many different factors including embarrassment or one being ashamed of their actions. Second, there are several types of tests that can be used to determine the type of intervention that may be most useful.
Some of these tests are as simple as a written personality test and others are more complex like the “penile plethysmography, which is most often used with male sex offenders. This test is the most reliable form of assessment and is used by showing offenders pictures of the preferred stimulus and the test then records his penile blood volume, similar tests exist for women” (Carroll, 2010). After assessment specialists can then determine the best treatment, or what they think will most likely be successful.
Treatment may involve different forms of therapy, hormone medication, and sometimes a combination of both is used. There are many different conventional types of therapy such as individual, family and group therapy that may assist some people with paraphilia in controlling undesirable behavior. Also behavioral therapy is used; these forms of treatments have been successful for some, one of which is shame aversion. This is when specialists try to link the person’s behavior to the feeling of shame. An example of this type of therapy may be asking an exhibitionist to expose themselves in front of a large audience” (Carroll, 2010). This form may help the person resist partaking in the action, but it does not necessarily “cure” their condition. Satiation therapy is another form of treatment sometimes used, “this involves having the person masturbate to a conventional fantasy, and then again to the undesirable fantasy in hopes that the decreased sex drive and low responsiveness will make the experience less exciting than usual” (Carroll, 2010).
These forms of treatment are considered acceptable in most situations; however, there is one form of treatment that is extremely controversial in the treatment of paraphiliacs. Castration is sometimes used to treat, or “cure” many criminal paraphiliacs, like pedophiles. Castration can be accomplished both surgically and through different methods of hormonal leveling medication. “Testosterone- suppressing drugs, also called antiandrogens, have been used to create castration levels of testosterone for up to five years” (Carroll, 2010).
This form may be preferred to the other more drastic method, surgery. Many specialists have argued that “although castration does reduce testosterone levels it does nothing to stop a person’s sexual desires. Also some sex offends use objects on their victims, so the inability to achieve erection may not impede their activity” (Carroll, 2010). The fact that every person is different and many different objects and situations cause arousal in paraphiliacs makes it very difficult to address all of the necessary aspects of the problem.
Even if an action is corrected the person’s inner desires are still there. However, these various treatments have been successful for some. There are many different types of paraphilia and some are considered more acceptable than others. Although some of these are harmless to others, there are many that are illegal and even dangerous. Many paraphiliacs do not feel they have a problem and do not have a desire to seek treatment. Paraphilia and the causes of the condition are still somewhat of a mystery to professionals, which makes finding a successful treatment difficult.