Paraphilic

Disorders
Paraphilia
- denotes any intense and persistent sexual interest other than sexual interest in genital
stimulation or preparatory fondling with phenotypically normal, physically mature,
consenting human partners
- defined as any sexual interest greater than or equal to nonparaphilic sexual interests.

Paraphilic Disorders
- 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
Knowledge Check √
A paraphilia is a necessary but not a sufficient condition for having
a paraphilic disorder. A paraphilia by itself does not necessarily
justify or require clinical intervention.

a. The first statement is true. The second statement is false.

b. The first statement is true. The second statement is true.
c. Both statements are true.
d. Both statements are false.
Importance of Paraphilic Disorders in DSM
These disorders have traditionally been selected for specific listing and
assignment of explicit diagnostic criteria in DSM for two main reasons:
they are relatively common, in relation to other paraphilic disorders, and some
of them entail actions for their satisfaction that, because of their noxiousness
or potential harm to others, are classed as criminal offenses.
Classification Schemes

The first group of disorders is based on anomalous activity preferences.

- courtship disorders, which resemble distorted components of human courtship
behavior (voyeuristic disorder, exhibitionistic disorder, and frotteuristic disorder)
- algolagnic disorders, which involve pain and suffering (sexual masochism disorder and
sexual sadism disorder)

The second group of disorders is based on anomalous target preferences.

- one directed at other humans (pedophilic disorder)
- two directed elsewhere (fetishistic disorder and transvestic disorder)
 In the diagnostic criteria set for each of the listed paraphilic disorders, Criterion A
specifies the qualitative nature of the paraphilia and Criterion B specifies the negative
consequences of the paraphilia.

 In keeping with the distinction between paraphilias and paraphilic disorders, the term
diagnosis should be reserved for individuals whose paraphilic interests or behaviors meet
both Criteria A and B.

 If an individual’s paraphilic interests or behaviors meet Criterion A but not Criterion B

for a particular paraphilia—a circumstance that might arise when a benign paraphilia is
discovered during the clinical investigation of some other condition—then the individual
may be said to have that paraphilia but not a paraphilic disorder.
 Voyeuristic Disorder
- spying on others in private activities
Exhibitionistic Disorder
- exposing the genitals
 Frotteuristic Disorder
touching or rubbing against a nonconsenting
person
 Sexual Masochism Disorder
- undergoing humiliation, bondage, or suffering
 Sexual Sadism Disorder
- inflicting humiliation, bondage, or suffering
Etiology

1. Psychodynamic theory postulates that adverse events during specific phases of

psychosexual development can lead to paraphilias. Significant anecdotal evidence
supporting this theory is derived from case history.

2. Unknown inborn biologic factors have also been cited as possible causes of paraphilias;
however, there is clear evidence.
Assessment Tools

- Penile plethysmography (PPG) has historically been a standard tool for the assessment and measurement of deviant sexual arousal,
exposing the individual to visual or auditory stimuli to assess their penile responsiveness. However, more recently its usefulness has
been questioned on the grounds of concerns regarding standardization, reliability and validity (Reference MarshallMarshall 2006).

- The Abel Assessment for Sexual Interest (AASI) (Reference Abel, Huffman and WarbergAbel 1998) is a less intrusive alternative to
PPG, measuring length of time a person spends looking at various images presented to them on a computer screen. (Voyeurism)

- Cognitive Tests such as the Implicit Association Test (IAT) (Reference Greenwald, McGhee and SchwartzGreenwald 1998) have been
validated and are used to assess pedophilia and other paraphilias (Reference Camilleri, Quinsey, Laws and O'DonohueCamilleri 2008).
The IAT is based on the assumption that a person who holds a favorable view of a topic (e.g. sex with a child) is more likely to
respond faster when sexual words are paired with child images compared with a person who does not hold such a view (
Reference Gray, Brown and MacCullochGray 2005).

- Polygraphy or ‘lie detection’ is widely used in the USA and is currently being introduced in England and Wales,
following a successful pilot trial of mandatory polygraph testing of sex offenders released on probation (
Reference Gannon, Wood and PinaGannon 2012). In addition to detecting reoffending if it occurs, polygraph testing of
convicted sex offenders has been shown to provide more accurate information about the offender’s history, improve the
identification and targets of treatment, and enhance supervision by acting as a deterrent to reoffending (Reference
Grubin, Madsen and ParsonsGrubin 2004).
Treatments

- Biological approaches (Surgical castration)

- Anti-androgen medication in the form of cyproterone acetate

- Luteinizing hormone-releasing hormone (LHRH) agonists such as triptorelin and goserelin

- Antilibidinal drugs

- Selective serotonin reuptake inhibitors (SSRIs)

• National and international guidelines for the biological treatment of paraphilias are available (
Reference Thibaut, de la Barra and GordonThibaut 2010), and all patients should have a thorough medical assessment
and be monitored throughout treatment.

- Psychological approaches (Psychological therapy)

- Cognitive–behavioral therapy

- Relapse prevention therapy

- Good Lives Model (The Good Lives Model of Offender Rehabilitation (GLM))

- Psychodynamic therapy
Related Research Studies