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Overview of Paraphilias and Paraphilic Disorders

By George R. Brown, MD, Chief of Psychiatry;Professor and Associate Chairman, Department of Psychiatry, Mountain home VAMC, Johnson City, TN;East Tennessee State University

Paraphilias are frequent, intense, sexually arousing fantasies or behaviors that involve inanimate objects, children or nonconsenting adults, or suffering or humiliation of oneself or the partner. Paraphilic disorders are paraphilias that cause distress or cause problems functioning in the person with the paraphilia or that harm or may harm another person.

There are many paraphilias. The focus of the paraphilia may be a variety of objects, situations, animals, or people (such as children or nonconsenting adults). Sexual arousal may depend on the use or presence of this focus. Once these arousal patterns are established, usually in late childhood or near puberty, they are often lifelong.

Some degree of variety in sexual activity is very common in healthy adult sexual relationships and fantasies. When people mutually agree to engage in them, unusual sexual behaviors that cause no harm may be part of a loving and caring relationship. However, when sexual behaviors cause distress or harm or interfere with a person's ability to function in daily activities, they are considered a paraphilic disorder. The distress may result from other people's reactions or from the person's guilt about doing something socially unacceptable.

Paraphilic disorders can seriously impair the capacity for affectionate, reciprocal sexual activity. Partners of people with a paraphilic disorder may feel like an object or as if they are unimportant or unnecessary in the sexual relationship.

The most common paraphilic disorders are

Most people with paraphilias are men, and many have more than one type of paraphilia. Some of them also have a severe personality disorder, such as antisocial personality disorder or narcissistic personality disorder.

Some paraphilias, such as pedophilia, are against the law.