Monday, November 21, 2005
Come Grow With Me: Learn About Paraphilias
Paraphilias are problems with controlling impulses that are characterized by recurrent and intense sexual fantasies, urges, and behaviors involving unusual objects, activities, or situations not considered sexually arousing to others. In addition, these objects, activities or situations often are necessary for the person's sexual functioning. With a paraphilia, the individual's urges and behaviors cause significant distress and/or personal, social or occupational dysfunction. Someone with a paraphilia may be referred to as "kinky" or "perverted," and these behaviors may have serious social and legal consequences.
What Behaviors Are Considered Paraphilias?
Exhibitionism ("Flashing")
Exhibitionism is characterized by intense, sexually arousing fantasies, urges or behaviors involving exposure of the individual's genitals to an unsuspecting stranger. The individual with this problem, sometimes called a "flasher," feels a need to surprise, shock or impress his victims. The condition usually is limited to the exposure, with no other harmful advances made, although "indecent exposure" is illegal. Actual sexual contact with the victim is rare. However, the person may masturbate while exposing himself or while fantasizing about exposing himself.
Fetishism
People with this problem have sexual urges associated with non-living objects. The person becomes sexually aroused by wearing or touching the object. For example, the object of a fetish could be an article of clothing, such as underwear, rubber clothing, women's shoes, or women's underwear or lingerie. The fetish may replace sexual activity with a partner or may be integrated into sexual activity with a willing partner. When the fetish becomes the sole object of sexual desire, sexual relationships often are avoided. A related disorder, called partialism, involves becoming sexually aroused by a body part, such as the feet, breasts or buttocks.
Frotteurism
With this problem, the focus of the person's sexual urges is related to touching or rubbing his genitals against the body of a non-consenting, unfamiliar person. In most cases of frotteurism, a male rubs his genital area against a female, often in a crowded public location. This disorder also is a problem because the contact made with the other person is illegal.
Pedophilia
People with this problem have fantasies, urges or behaviors that involve illegal sexual activity with a prepubescent child or children (generally age 13 years or younger). Pedophilic behavior includes undressing the child, encouraging the child to watch the abuser masturbate, touching or fondling the child's genitals and forcefully performing sexual acts on the child. Some pedophiles are sexually attracted to children only (exclusive pedophiles) and are not attracted to adults at all. Some pedophiles limit their activity to their own children or close relatives (incest), while others victimize other children. Predatory pedophiles may use force or threaten their victims if they disclose the abuse. Health care providers are legally bound to report such abuse of minors.
This activity constitutes rape and is a felony offense punishable by imprisonment.
Sexual Masochism
Individuals with this disorder use sexual fantasies, urges or behaviors involving the act (real, not simulated) of being humiliated, beaten or otherwise made to suffer in order to achieve sexual excitement and climax. These acts may be limited to verbal humiliation, or may involve being beaten, bound or otherwise abused. Masochists may act out their fantasies on themselves -- such as cutting or piercing their skin, or burning themselves -- or may seek out a partner who enjoys inflicting pain or humiliation on others (sadist). Activities with a partner include bondage, spanking, and simulated rape.
Sadomasochistic fantasies and activities are not uncommon among consenting adults. In most of these cases, however, the humiliation and abuse are acted out in fantasy. The participants are aware that the behavior is a "game," and actual pain and injury is avoided.
A potentially dangerous, sometimes fatal, masochistic activity is autoerotic partial asphyxiation, in which a person uses ropes, nooses or plastic bags to induce a state of asphyxia (interruption of breathing) at the point of orgasm. This is done to enhance orgasm, but accidental deaths sometimes occur.
Sexual Sadism
Individuals with this disorder have persistent fantasies in which sexual excitement results from inflicting psychological or physical suffering (including humiliation and terror) on a sexual partner. This disorder is different from minor acts of aggression in normal sexual activity; for example, rough sex. In some cases, sexual sadists are able to find willing partners to participate in the sadistic activities.
At its most extreme, sexual sadism involves illegal activities such as rape, torture, and even murder, in which case the death of the victim produces sexual excitement. It should be noted that while rape may be an expression of sexual sadism, the infliction of suffering is not the motive for most rapists, and the victim's pain generally does not increase the rapist's sexual excitement. Rather, rape involves a combination of sex and gaining power over the victim. These individuals need intensive psychiatric treatment and may be jailed for these activities.
Transvestitism
Transvestitism, or transvestic fetishism, refers to the practice by heterosexual males of dressing in female clothes to produce or enhance sexual arousal. The sexual arousal usually does not involve a real partner, but includes the fantasy that the individual is the female partner, as well. Some men wear only one special piece of female clothing, such as underwear, while others fully dress as female, including hair style and make-up. Cross-dressing itself is not a problem, unless it is necessary for the individual to become sexually aroused or experience sexual climax.
Voyeurism ("Peeping Tom")
This disorder involves achieving sexual arousal by observing an unsuspecting and non-consenting person who is undressing or unclothed, and/or engaged in sexual activity. This behavior may conclude with masturbation by the voyeur. The voyeur does not seek sexual contact with the person they are observing. Other names for this behavior are "peeping" or "peeping Tom."
How Common Are Paraphilias?
Most paraphilias are rare, and are more common among males than among females (about 20 to 1 of males to females). However, the reason for this disparity is not clearly understood. While several of these disorders are associated with aggressive behavior, others are not aggressive or harmful. Some paraphilias -- such as pedophilia, exhibitionism, voyeurism, sadism, and frotteurism -- are criminal offenses.
Having paraphilic fantasies or behavior, however, does not always mean the person has the mental illness. The fantasies and behaviors can exist in less severe forms that are not dysfunctional in any way, do not impede the development of healthy relationships, do not harm the individual or others, and do not entail criminal offenses. They may be limited to fantasy during masturbation or intercourse with a partner.
What Causes Paraphilia?
It is not known for certain what causes paraphilia. Some experts believe it is caused by a childhood trauma, such as sexual abuse. Others suggest that objects or situations can become sexually arousing if they are frequently and repeatedly associated with a pleasurable sexual activity. In most cases, the individual with a paraphilia has difficulty developing personal and sexual relationships with others.
Many paraphilias begin during adolescence and continue into adulthood. The intensity and occurrence of the fantasies associated with paraphilia vary with the individual, but usually decrease as the person ages.
How Is Paraphilia Treated?
Most cases of paraphilia are treated with counseling and therapy to help these people modify their behavior. Medications may help to decrease the compulsiveness associated with paraphilia, and reduce the number of deviant sexual fantasies and behaviors. In some cases, hormones are prescribed for individuals who experience frequent occurrences of abnormal or dangerous sexual behavior. Many of these medications work by reducing the individual's sex drive.
How Successful Is Treatment for Paraphilia?
To be most effective, treatment must be provided on a long-term basis. Unwillingness to comply with treatment can hinder its success. It is imperative that people with paraphilias of an illegal nature receive professional help before they harm others or create legal problems for themselves.
Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.
Edited by Cynthia Haines, MD, WebMD, February 2005.
What Behaviors Are Considered Paraphilias?
Exhibitionism ("Flashing")
Exhibitionism is characterized by intense, sexually arousing fantasies, urges or behaviors involving exposure of the individual's genitals to an unsuspecting stranger. The individual with this problem, sometimes called a "flasher," feels a need to surprise, shock or impress his victims. The condition usually is limited to the exposure, with no other harmful advances made, although "indecent exposure" is illegal. Actual sexual contact with the victim is rare. However, the person may masturbate while exposing himself or while fantasizing about exposing himself.
Fetishism
People with this problem have sexual urges associated with non-living objects. The person becomes sexually aroused by wearing or touching the object. For example, the object of a fetish could be an article of clothing, such as underwear, rubber clothing, women's shoes, or women's underwear or lingerie. The fetish may replace sexual activity with a partner or may be integrated into sexual activity with a willing partner. When the fetish becomes the sole object of sexual desire, sexual relationships often are avoided. A related disorder, called partialism, involves becoming sexually aroused by a body part, such as the feet, breasts or buttocks.
Frotteurism
With this problem, the focus of the person's sexual urges is related to touching or rubbing his genitals against the body of a non-consenting, unfamiliar person. In most cases of frotteurism, a male rubs his genital area against a female, often in a crowded public location. This disorder also is a problem because the contact made with the other person is illegal.
Pedophilia
People with this problem have fantasies, urges or behaviors that involve illegal sexual activity with a prepubescent child or children (generally age 13 years or younger). Pedophilic behavior includes undressing the child, encouraging the child to watch the abuser masturbate, touching or fondling the child's genitals and forcefully performing sexual acts on the child. Some pedophiles are sexually attracted to children only (exclusive pedophiles) and are not attracted to adults at all. Some pedophiles limit their activity to their own children or close relatives (incest), while others victimize other children. Predatory pedophiles may use force or threaten their victims if they disclose the abuse. Health care providers are legally bound to report such abuse of minors.
This activity constitutes rape and is a felony offense punishable by imprisonment.
Sexual Masochism
Individuals with this disorder use sexual fantasies, urges or behaviors involving the act (real, not simulated) of being humiliated, beaten or otherwise made to suffer in order to achieve sexual excitement and climax. These acts may be limited to verbal humiliation, or may involve being beaten, bound or otherwise abused. Masochists may act out their fantasies on themselves -- such as cutting or piercing their skin, or burning themselves -- or may seek out a partner who enjoys inflicting pain or humiliation on others (sadist). Activities with a partner include bondage, spanking, and simulated rape.
Sadomasochistic fantasies and activities are not uncommon among consenting adults. In most of these cases, however, the humiliation and abuse are acted out in fantasy. The participants are aware that the behavior is a "game," and actual pain and injury is avoided.
A potentially dangerous, sometimes fatal, masochistic activity is autoerotic partial asphyxiation, in which a person uses ropes, nooses or plastic bags to induce a state of asphyxia (interruption of breathing) at the point of orgasm. This is done to enhance orgasm, but accidental deaths sometimes occur.
Sexual Sadism
Individuals with this disorder have persistent fantasies in which sexual excitement results from inflicting psychological or physical suffering (including humiliation and terror) on a sexual partner. This disorder is different from minor acts of aggression in normal sexual activity; for example, rough sex. In some cases, sexual sadists are able to find willing partners to participate in the sadistic activities.
At its most extreme, sexual sadism involves illegal activities such as rape, torture, and even murder, in which case the death of the victim produces sexual excitement. It should be noted that while rape may be an expression of sexual sadism, the infliction of suffering is not the motive for most rapists, and the victim's pain generally does not increase the rapist's sexual excitement. Rather, rape involves a combination of sex and gaining power over the victim. These individuals need intensive psychiatric treatment and may be jailed for these activities.
Transvestitism
Transvestitism, or transvestic fetishism, refers to the practice by heterosexual males of dressing in female clothes to produce or enhance sexual arousal. The sexual arousal usually does not involve a real partner, but includes the fantasy that the individual is the female partner, as well. Some men wear only one special piece of female clothing, such as underwear, while others fully dress as female, including hair style and make-up. Cross-dressing itself is not a problem, unless it is necessary for the individual to become sexually aroused or experience sexual climax.
Voyeurism ("Peeping Tom")
This disorder involves achieving sexual arousal by observing an unsuspecting and non-consenting person who is undressing or unclothed, and/or engaged in sexual activity. This behavior may conclude with masturbation by the voyeur. The voyeur does not seek sexual contact with the person they are observing. Other names for this behavior are "peeping" or "peeping Tom."
How Common Are Paraphilias?
Most paraphilias are rare, and are more common among males than among females (about 20 to 1 of males to females). However, the reason for this disparity is not clearly understood. While several of these disorders are associated with aggressive behavior, others are not aggressive or harmful. Some paraphilias -- such as pedophilia, exhibitionism, voyeurism, sadism, and frotteurism -- are criminal offenses.
Having paraphilic fantasies or behavior, however, does not always mean the person has the mental illness. The fantasies and behaviors can exist in less severe forms that are not dysfunctional in any way, do not impede the development of healthy relationships, do not harm the individual or others, and do not entail criminal offenses. They may be limited to fantasy during masturbation or intercourse with a partner.
What Causes Paraphilia?
It is not known for certain what causes paraphilia. Some experts believe it is caused by a childhood trauma, such as sexual abuse. Others suggest that objects or situations can become sexually arousing if they are frequently and repeatedly associated with a pleasurable sexual activity. In most cases, the individual with a paraphilia has difficulty developing personal and sexual relationships with others.
Many paraphilias begin during adolescence and continue into adulthood. The intensity and occurrence of the fantasies associated with paraphilia vary with the individual, but usually decrease as the person ages.
How Is Paraphilia Treated?
Most cases of paraphilia are treated with counseling and therapy to help these people modify their behavior. Medications may help to decrease the compulsiveness associated with paraphilia, and reduce the number of deviant sexual fantasies and behaviors. In some cases, hormones are prescribed for individuals who experience frequent occurrences of abnormal or dangerous sexual behavior. Many of these medications work by reducing the individual's sex drive.
How Successful Is Treatment for Paraphilia?
To be most effective, treatment must be provided on a long-term basis. Unwillingness to comply with treatment can hinder its success. It is imperative that people with paraphilias of an illegal nature receive professional help before they harm others or create legal problems for themselves.
Edited by Cynthia Haines, MD, WebMD, February 2005.
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