Paraphilic Disorders

Mikka Abelida, Reina Bustos, Kate Laroa, Daphne Medoza

 General Description
● Defined by recurrent sexual attraction to unusual objects or sexual
activities lasting at least 6 months.
● Intense and persistent sexual interests outside of foreplay and genital
stimulation with phenotypically normal, consenting adults.
● A paraphilic disorder requires both the presence of a paraphilic urges
and the existence of distress, dysfunction, and/or acting on the urges

The Child Molestation Research and Prevention Institute. What is a Paraphilia. Retrieved on Sept. 14 2017
from http://www.childmolestationprevention.org/pages/focus_on_the_cause.html
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5.
Washington, D.C: American Psychiatric Association.
Kring et al. (2014). Abnormal Psychology 12th Edition. MA, Danvers: John Wiley & Sons
 Types
The definition of paraphilia is broad
enough that there are dozens, even
hundreds, of identified paraphilias and
paraphilic disorders, all of which are
replete with ambiguity and controversy,
but DSM-5 specifically identifies only
eight: voyeuristic, exhibitionistic,
frotteuristic, sexual masochism, sexual
sadism, pedophilic, fetishistic, and
transvestic disorders.

Bressert, S. (2017). Frotteurism Symptoms. Psych Central. Retrieved on September 8, 2017,

from https://psychcentral.com/disorders/frotteurism-symptoms/
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders:
DSM-5. Washington, D.C: American Psychiatric Association.
Bressert, S. (2017). Sexual Masochism & Sadism Disorder Symptoms. Psych Central.
Retrieved on September 8, 2017, from https://psychcentral.com/disorders/sexual-masochism-
sadism-symptoms/
Kring et al. (2014). Abnormal Psychology 12th Edition. MA, Danvers: John Wiley & Sons
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synosis of Psychiatry 11th Edition. PA,
Philadelphia: Wolters Kluwer
Classifications:

Anomalous activity preferences: These disorders are subdivided into…

● Courtship disorders which resemble distorted components of human
courtship behaviour (voyeuristic, exhibitionistic, and frotteuristic
disorder)
● Algolagnic disorders which involve pain and suffering (masochism
and sadism disorder)

Anomalous target preferences:

● Directed to humans (pedophilic disorder)
● Directed elsewhere (fetishistic and transvestic disorder)
 Voyeuristic Disorder
Voyeuristic disorder or ‘scopophillia’ is
recurrent fantasies and acts which involves
looking, staring or observing unsuspecting
individuals who are doing sexual activities or
grooming themselves. This act is usually
followed or accompanied by masturbation to
orgasm.
 Exhibitionistic Disorder
It is a recurrent urge to expose
their genitals to a stranger or an
unsuspecting person. Sexual
excitement occurs when the
individual is anticipating the
exposure and orgasm is brought
about by masturbation during or
after the event.
 Frotteuristic Disorder
It is defined as the act of touching or rubbing
against a nonconsenting person. It involves
repetitive sexual fantasies, urges, arousal,
and behaviours of rubbing and touching a
nonconsenting individual.
 Sexual Masochism
Disorder
It is a condition wherein an individual is
sexually aroused by being humiliated, beaten,
or any other means of physical pain.
It is a recurrent, intense sexually arousing
fantasies, sexual urges, or behaviours
involving the act of being humiliated, beaten,
bound, or otherwise made to suffer
(Bressert,2017).
 Sexual Sadism Disorder

It is defined as a feeling of sexual excitement

resulting from administering pain, suffering, or
humiliation to another person.

The pain, suffering, or humiliation inflicted on

the other is real; it is not imagined and may be
either physical or psychological in nature.
 Pedophilic Disorder

Sexual attraction to prepubescent children

(generally age 13 years or younger).

Intense sexual sexual interest in children and

indicating that sexual interest to children is
greater than or equal to sexual interest in
physically mature individuals.
 Fetishistic Disorder

It is defined as a reliance on an inanimate

object or a non-genital part of the body for
sexual arousal. A fetish refers to the object of
these sexual urges, such as women’s shoes
or feet.

An individual with this disorder has recurrent

and intense sexual urges toward these
fetishes, and the presence of the fetish is
strongly preferred or even necessary for
sexual arousal.
 Transvestic Disorder
Identified separately from fetishistic disorder and
gender dysphoria, it involves cross-dressing, and
in most cases producing sexual arousal. This
disorder has been described mostly in
heterosexual and bisexual males. Transvestic
Fetishism is not diagnosed when cross-dressing
occurs exclusively during the course of Gender
Identity Disorder. Transvestic phenomena range
from occasional solitary wearing of female clothes
to extensive involvement in a transvestic
subculture. Some males wear a single item of
women's apparel (e.g., underwear or hosiery)
under their masculine attire.
Highlights of changes from
DSM-4 to DSM-5
Specifiers
● An overarching change from DSM-IV is the addition of the course specifiers “in a controlled environment”
and “in remission” to the diagnostic criteria sets for all the paraphilic disorders. These specifiers are added to
indicate important changes in an individual’s status.

Change to Diagnostic Names

● In DSM-5, paraphilias are not ipso facto mental disorders. There is a distinction between paraphilias and
paraphilic disorders. A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the
individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others. A
paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by
itself does not automatically justify or require clinical intervention.

● The distinction between paraphilias and paraphilic disorders was implemented without making any changes
to the basic structure of the diagnostic criteria as they had existed since DSM-III-R.

● The change for DSM-5 is that individuals who meet both Criterion A and Criterion B would now be diagnosed
as having a paraphilic disorder. A diagnosis would not be given to individuals whose symptoms meet
Criterion A but not Criterion B—that is, to those individuals who have a paraphilia but not a paraphilic
disorder.
 Etiology
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C:
American Psychiatric Association.

Kring et al. (2014). Abnormal Psychology 12th Edition. MA, Danvers: John Wiley & Sons
(2017, July 20). Frotteuristic Disorder. Retrieved from
https://www.psychologytoday.com/conditions/frotteuristic-disorder

(2017, April 18). Sexual Masochism Disorder. Retrieved from https://www.psychologytoday.com/conditions/sexual-masochism-

disorder

Encyclopedia of Mental Disorders. (2017). Sexual Sadism. Retrieved from http://www.minddisorders.com/Py-Z/Sexual-

sadism.html

Sperry L. (n.d.) Mental Health and Mental Disorders.

Jones, J., Fitzpatrick, J., Rogers, V. (2012). Psychiatric-Mental Nursing: An Interpersonal Approach. New York: Springer
Publishing Company, LLC.
 Biological Perspective
Majority of people with paraphilic disorder are
men, that’s why an assumption that androgens
such as testosterone are great factors behind the
condition. Androgens regulate sexual desire, and
sexual desire is reportedly high among those
people with paraphilic disorder (Kafka, 1997).
However some professionals reject this idea.
Men with paraphilic disorders do not appear to
have high levels of testosterone or other
androgens (Thibaut, De La Barra, Gordon, et al.,
2010).
Psychological Perspective
Behaviorists believe that paraphilic disorders are
caused by classical conditioning, accidentally
associating a certain unusual stimuli while
sexually aroused. “For example, a man might
have been imaging a woman wearing a black
boots while masturbating. According to this
theory, repetitions of these experiences will make
black boots sexually arousing” (Kring, Johnson,
Davison, & Neale, 2015).
In a psychoanalytic theory, persons with
paraphilic disorders failed to have undergone
normal development towards sexual adjustment.
Voyeuristic Disorder, Exhibitionistic Disorder
Childhood traumas, childhood abuse

Frotteuristic Disorder
Unavailability of consenting partners; sexual abuse may also be a factor, especially if the symptoms
appeared at young age

Sexual Masochistic and Sadistic Disorder

Form of escape

Pedophilic Disorder
Poor social skills
Clinical Features and
Diagnostic Criteria
Voyeuristic Disorder
DSM-4
Diagnostic Criteria
A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity.
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.

DSM-5
Diagnostic Criteria
A. Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is
naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors.
B. The individual has acted on these sexual urges with a non-consenting person, or the sexual urges or fantasies cause
clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The individual experiencing the arousal and/or acting on the urges is at least 18 years of age.
Specify if:
In a controlled environment: The specifier is primarily applicable to individuals living in institutional or other settings where
opportunities to engage in voyeuristic behavior are restricted.
In full remission: The individual has not acted on the urges with a non-consenting person, and there has been no distress or
impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.
Exhibitionistic Disorder
DSM-4
Diagnostic Criteria
A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the
exposure of one's genitals to an unsuspecting stranger.
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
DSM-5
Diagnostic Criteria
A. Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an
unsuspecting person, as manifested by fantasies, urges or behaviors.
B. The individual has acted on these sexual urges with a non-consenting person, or the sexual urges or fantasies cause
clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify whether:
Sexually aroused by exposing genitals to pre-pubertal children
Sexually aroused by exposing genitals to physically mature individuals
Sexually aroused by exposing genitals to pre-pubertal children and to physically mature individuals.
Specify if:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where
opportunities to expose one’s genitals are restricted.
In full remission: The individual has not acted on the urges with a non-consenting person, and there has been no distress or
impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.
Frotteuristic Disorder
DSM-4
Diagnostic Criteria
A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
involving touching and rubbing against a non-consenting person.
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.

DSM-5
Diagnostic Criteria
A. Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a non-
consenting person, as manifested by fantasies, urges, or behaviours.
B. The individual has acted on these sexual urges with non-consenting person, or the sexual urges or fantasies
cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings
where opportunities to touch or rub against a nonconsenting person are restricted,
In full remission: The individual has not acted on the urges with a nonconsenting person, and there has been no
distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an
uncontrolled environment.
Sexual Masochism Disorder
DSM-4
Diagnostic Criteria
A. Over a period of at least 6 months, recurrent, intense sexually arousingfantasies, sexual urges, or behaviors involving the act
(real, not simulated)of being humiliated, beaten, bound, or otherwise made to suffer.
B. The fantasies, sexual urges, or behaviors cause clinically significantdistress or impairment in social, occupational, or other
important areas of functioning.

DSM-5
Diagnostic Criteria
A. Over a period of at least 6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or
otherwise made to suffer, as manifested by fantasies, urges, or behaviours.
B. The fantasies, sexual urges, or behaviours cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
Specify if:
With asphyxiophilia: If the individual engages in the practice of achieving sexual arousal related to restriction of breathing.
Specify if:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where
opportunities to engage in masochistic sexual behaviours are restricted.
In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at last 5
years while in an uncontrolled environment.
Sexual Sadism Disorder
DSM-4
Diagnostic Criteria
A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts
(real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the
person.
B. The fantasies, sexual urges,or behaviors cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning

DSM-5
Diagnostic Criteria
A. Over a period of at least 6 months, recurrent and intense sexual arousal from the physical or psychological suffering of
another person, as manifested by fantasies, urges, or behaviors.
B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically
significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where
opportunities to engage in sadistic sexual behaviors are restricted.
In full remission: The individual has not acted on the urges with a non consenting person, and there has been no distress or
impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.
Pedophilic Disorder
DSM-4

Diagnostic Criteria
A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual
activity with a prepubescent child or children (generally age1-3 years or younger).
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
C. The person is at least age 1-6years and at least 5 years older than the child or children in Criterion A.
Note: Do not include an individual in late adolescence involved in an on-going sexual relationship with a 12-or13-year-old.

Specify if:
Sexually Attracted to Males
Sexually Attracted to Females
Sexually Attracted to Both
Specify if:
Limited to Incest
Specify type:
Exclusive Type (attracted only to children)
Non exclusive Type
DSM-5

Diagnostic Criteria
A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving sexual
activity with a prepubescent child or children (generally age 13 years or younger)
B. The individual has acted on these sexual urges, or the sexual urges, or fantasies cause marked distress or interpersonal
activity.
C. The individual is at least age 16 years or at least 5 years older than the child or children in Criterion A.
Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12 or 13-year-old.

Specify whether:
Exclusive type (attracted only to children)
Nonexclusive type
Specify if:
Sexually Attracted to Males
Sexually Attracted to Females
Sexually Attracted to Both
Specify if:
Limited to Incest
Fetishistic Disorder
DSM-4

Diagnostic Criteria
A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or
behaviors involving the use of nonliving objects (e.g., female undergarments).
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
C. The fetish objects are not limited to articles of female clothing used in cross-dressing (as in Transvestic
Fetishism) or devices designed for the purpose of tactile genital stimulation (e.g., a vibrator).
DSM-5

Diagnostic Criteria
A. Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects
or a highly specific focus on non-genital body part(s), as manifested by fantasies, urges, or behaviors.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social,
occupational, or other important areas functioning.
C. The fetish objects are not limited to articles of clothing used in cross-dressing (as in transvestic disorder) or
devices specifically designed for the purpose of tactile genital stimulation (e.g, vibrator).

Specify:
Body part(s)
Nonliving object(s)
Other
Specify if:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings
where opportunities to engage in fetishistic behaviors are restricted.
In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for
at least 5 years while in an uncontrolled environment.
Transvestic Disorder
DSM-4

Diagnostic Criteria
A. Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies,
sexual urges, or behaviors involving cross-dressing.
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.

Specify if:
With Gender Dysphoria: if the person has persistent discomfort with gender role or identity
DSM-5

Diagnostic Criteria
A. Over a period of at least 6 months, recurrent and intense sexual arousal from cross-dressing, as
manifested by fantasies, urges, or behaviors.
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.Specify if:
With fetishism: If sexually aroused by fabrics, materials, or garments.
With autogynephilia: If sexually aroused by thoughts or images of self as female.
Specify if:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other
settings where opportunities to cross-dress are restricted.
In full remission: There has been no distress or impairment in social, occupational, or other areas of
functioning for at least 5 years while in an uncontrolled environment.
Course and Prognosis

DSM-5

Voyeuristic Disorder
Usually adults with voyeuristic disorder
discover their sexual interest in watching
unsuspecting persons or people who are engaging
in sexual activities during their adolescent years.
There is a difficulty in differentiating age-related
puberty-related sexual curiosity and activity, so the
minimum age for diagnosing the voyeuristic disorder
is 18 years old.
A necessary precondition for voyeuristic
disorder is voyeurism; therefore, the risk factors of
voyeurism should also increase the rate of
voyeuristic disorder. There are also environmental
factors that is associated with voyeuristic disorder
such as; childhood sexual abuse, substance misuse
and sexual preoccupation.
Exhibitionistic Disorder
Individuals with the exhibitionistic disorder have
reported in saying that they have started to expose
their genitals to unsuspecting persons starting when
they were in their adolescence. There is very little
knowledge about its persistence over time even
though it begins during adolescence or early
adulthood.Advancing age may be associated also
with the decrease of exhibitionistic sexual preferences
and behavior.
Exhibitionistic disorder may increase in risk in
males with exhibitionistic sexual preferences when the
individual has antisocial personality disorder, alcohol
use disorder, and pedophilic interest. Environmental
causes may also increase the risk of the exhibitionistic
disorder when a person has childhood sexual and
emotional abuse and sexual preoccupation.
 Frotteuristic Disorder
Adult males with this disorder frequently
state that they became aware of their interest
during late adolescence, however; children and
adolescents may also exhibit the symptoms
without the diagnosis of frotteuristic disorder.
There is no minimum age for diagnosis. The
course of frotteuristic disorder is likely to vary
with age. Increasing age might decrease
frotteuristic sexual interest.
Sexual Masochism Disorder
According to the group of people with
paraphilias, the mean age of sexual
masochism disorder’s onset is 19.3 years old.
However, earlier ages such as puberty and
childhood have also been reported for the
onset.
The course of sexual masochism
disorder differs in age. Aging is likely to
decrease the effect of sexual preference
involving sexual masochism.
 Sexual Sadism Disorder
One study reported that individuals had
awareness of their sadomasochistic orientation as
young adults, and another reported that the mean
age at onset of sadism in a group of males was 19.4
years. Sexual sadism per se is probably a lifelong
characteristic, sexual sadism disorder may fluctuate
according to the individual’s subjective distress or
his or her propensity to harm nonconsenting others.
Advancing age is likely to have the same reducing
effect on this disorder as it has on other paraphilic
or normophilic sexual behavior.
Pedophilic Disorder
Pedophilia appears to be a lifelong condition.
Pedophilic disorder, however, necessarily includes
other elements that may change over time with or
without treatment: subjectively distress (e.g., guilt,
shame, intense sexual frustration, or feelings of
isolation) or psychosocial impairment, or the
propensity to act out sexually with children, or both.
Therefore, the course of pedophilic disorder may
fluctuate, increase, or decrease with age.
Advanced age is as likely to similarly diminish
the frequency of sexual behavior involving children as
it does other paraphilically motivated and normophilic
sexual behavior.
 Transvestic Disorder Fetishistic Disorder

The manifestation of transvestism in penile Paraphilia usually starts during an

erection and stimulation, like the manifestation of individual’s puberty, but fetishism can develop
other paraphilic as well as normophilic sexual prior to adolescence. Fetishistic disorder
interests, is most intense in adolescence and tends to have a continuous course that can
early adulthood. The severity of transvestic increase or decrease in intensity and
disorder is highest in adulthood, when the frequency of behaviours.
transvestic drives are most likely to conflict with
performance in heterosexual intercourse and
desires to marry and start a family. Middle-age
and older men with a history of transvestism are
less likely to present with transvestic disorder
than with gender dysphoria.
 Assessment Strategy

Seto, M.C., Bourget, D., & Kingston, D.A. (2014, June). Assessment of Paraphilias. Retrieved from
https://www.researchgate.net/publication/261717236_Assessment_of_the_Paraphilias
Yakely, J. & Wood, H. (2014, May). Paraphilias and paraphilic disorders: diagnosis, assessment and management.
Retrieved from http://apt.rcpsych.org/content/20/3/202
Kring et al. (2014). Abnormal Psychology 12th Edition. MA, Danvers: John Wiley & Sons
Assessment Steps (According to Jessica Yakely and Heather Wood’s article entitled “Paraphilias and
paraphilic disorders: diagnosis, assessment and management”):

First, the clinician should investigate about the person’s specific paraphilic fantasies and behaviours, their
onset, history, and duration.

Second, the clinician must also check if the person has multiple paraphilias and arrange the range of
sexual urges and interests for it changes over time. It is important to know that individuals who have illegal
paraphilias may be very reluctant to open about his or her disorder.

Lastly, the clinician should assess if the paraphilic behaviours that were mentioned causes distress to the
person’s everyday life. Checking the person’s document records such as police records is also a big help in
assessing and gaining the person’s paraphilic history.
Techniques

● Associated laboratory findings

Penile plethysmography has been used in research settings to assess various Paraphilias by measuring an
individual's sexual arousal in response to visual and auditory stimuli.
● Phallometry
In this approach, the changes in penile circumference or volume in response to the stimuli (it can be age,
violence, depending on the interest) are measured.
● Self-report of Sexual Interests
The patient should be questioned about his or her sexual fantasies, interests, and behaviours.
● Multiphasic Sex Inventory
It is a 300-item questionnaire use to assess sex offenders. It measures an individual’s interest in a variety of
paraphilias, such as pedophilia, coercive sex, exhibitionism, fetishism, and sadomasochism.
● Clarke Sex History Questionnaire
It is a 508-item questionnaire for males that focuses on sexual and personal history. Items are grouped into
23 scales that contain variety of domains such as childhood to adolescent experiences, sexual dysfunctions,
sexual outlets, fantasy, pornography, transvestism, fetishism, female gender identity disorder, and courtship
disorder.
 Treatments

Kring et al. (2014). Abnormal Psychology 12th Edition. MA, Danvers: John Wiley & Sons
Barlow, D.H. & Durand, V.M. (2015). Abnormal Psychology An Integrative Approach 7th Edition. CT, Stamford:
Cengage Learning
 ● “Because many of the behaviours involved in paraphilic disorders are illegal, some people
diagnosed with them are imprisoned and court-ordered into treatment. Much of the available
research on treatment focuses on men who have been charged with sexual offenses” (Kring
et al., 2015).
● Sex offenders usually don’t have the motivation to change their illness. They often deny their
illness, think of it as trivial, and point the blame into the victims. These are the ways to
improve the offenders’ motivation for treatment (Miller &Rollnick, 1991):

1. Empathize with the offender’s unwillingness to admit that he is an offender and to seek
treatment. This could reduce hostility.
2. Point out that treatment would improve his control of his actions.
3. Emphasize the negative consequences of rejecting treatments.
4. Explain that the psychophysiological assessment of the person’s sexual arousal will make it
harder to deny sexual proclivities to the authorities (Garland &Dougher, 1991).
 ● Cognitive Behavioural Development
This aim to counter the distorted thinking of people with paraphilic disorders (Kring et al., 2015).

● Biological Treatment
Hormonal agents that reduce androgen have been used to treat paraphilic disorders among men. Examples
of these are: medroxyprogesterone acetate, cyproterone acetate, and luteinizing hormone-releasing hormone
agents. Another one is cyproterone acetate which is also called as “chemical castration” which eliminates
sexual desires by reducing the amount of testosterone dramatically (Barlow and Durand, 2015).

● Covert sensitization
The patients associate sexually arousing images in their imaginations with some reasons why the behaviour is
harmful (Barlow & Durand, 2015). The patients know the consequences behind their paraphilic behaviours
even before treatment; it’s just that the immediate pleasure and strong reinforcement of the sexual activity
overshadows it.

● Relapse prevention
Patients are taught to recognize early signs of temptation and to facilitate different approaches of self-control
before their urges becomes much stronger.