Paraphilias: Symptoms, Description and Treatment

Please see our separate note on Treatment, Mental Disorders and Basic Science for important caveats on the role and definition of diagnostic criteria.

What are the Paraphilias?

According to the DSM, paraphilias are sexual impulse disorders characterized by intensely arousing, recurrent sexual fantasies, urges and behaviors (of at least six months' duration) that are considered deviant with respect to cultural norms and that produce clinically significant distress or impairment in social, occupational or other important areas of psychosocial functioning.

The paraphilias include:

• Exhibitionism
• Fetishism
• Frotteurism
• Pedophilia
• Sexual Masochism
• Sexual Sadism
• Transvestic Fetishism
• Voyeurism

Treatment for Paraphilias, Including Exhibitionism, Fetishism and Voyeurism

Paraphilias and sexual impulse disorders are commonly treated either with pharmacotherapy (drug therapy) or with counselling/psychotherapy. While the latter has traditionally been associated with the psychoanalytic tradition (where practitioners focus on hidden or repressed urges, and on the importance of childhood experiences and relationships with parent figures), more modern approaches include cognitive behavioural therapy.

Two distinct classes of psychopharmacological agents -- namely, antiandrogens and serotonergic antidepressants -- are prescribed as part of the treatment of paraphilias and paraphilia-related disorders. According to Bradford (1995), antiandrogens have been shown to reduce recidivism rates in male sexual offenders, the group most commonly prescribed these medications. With regard to serotonergic antidepressants, research suggests that decreased central serotonin and increased dopamine neurotransmission may disinhibit or promote sexual behavior and, conversely, enhancing central serotonin activity or inhibiting dopamine receptors in the brain may inhibit sexual behavior. Increasing evidence suggests that that serotonergic antidepressants, including SSRIs, can ameliorate both paraphilias and paraphilia-related disorders even in the absence of a comorbid mood disorder (Kafka 1994).

Selected References on Paraphilia Treatment

Bradford, JMW. (1995) 'Pharmacological treatment of the paraphilias', in: JM Oldham and MB Riba MB, eds. American Psychiatric Press Review of Psychiatry, Vol. 14. Washington, D.C.: American Psychiatric Press.

Kafka, MP. (1994) 'Sertraline pharmacotherapy for paraphilias and paraphilia-related disorders: an open trial', Annals of Clinical Psychiatry 6(3):189-195.