Paraphilias - Sexual Problems We May Not Want to Know About

By Erica Goodstone, Ph.D.

Most of us like to think of ourselves as normal. We like to believe that our attitudes, desires and behaviors are not that different from anyone else's. However, when it comes to sexual arousal fantasies and often actual sexual behaviors, your neighbor may be very different than you would even want to know. What I am talking about here is a topic that is often ignored when sexuality is being discussed. This is a topic that makes many of us extremely uncomfortable. This article is about paraphilias: sexual desires and fantasies that are not primarily focused on creating intimate, loving sexual relationships.

Paraphilia is a medical or behavioral science term for sexual behavior that is considered to be a disorder of sexual preference or repeated arousal to socially deviant, perverted, or unconventional stimuli. Paraphilias are usually a male problem, but sometimes also found among women. Usually, the symptoms first appear during puberty and become more fully developed by early adulthood. Symptoms include intense, recurring sexual fantasies, sexual urges or behaviors that involve non-human objects, non-intimate partners, non-consenting adults, or children and may involve suffering or humiliation of self or others. Behavior can be classified as a paraphilia if it has lasted as least six months and causes clinically significant distress or impairment in social, occupational or other important areas of life.

Some of the more common paraphilias include:

- Pedophilia (attraction to children)

- Exhibitionism (exposing one's genitals)

- Fetishism (arousal to non-human objects, e.g. rubber, pantyhose, etc)

- Frotteurism (rubbing against strangers)

- Sexual masochism (pain or humiliation of self), including

- Hypoxyphilia/Autoerotic Asphyxia (stopping breathing)

- Sexual sadism (pain or humiliation of others)

- Transvestic fetishism (aroused wearing clothing usually worn by the other sex)

- Voyeurism (peeping)

- Telephone Scatologia (obscene phone calls)

- Necrophilia (sex with corpses)

- Partialism (exclusive focus on specific parts of the body)

- Zoophilia (sex with animals)

- Coprophilia (arousal to feces)

- Klismaphilia (arousal with enemas)

- Urophilia (arousal to urine)

Treatment of Paraphilias

The goal of most treatment approaches is to suppress the paraphilia so that it occupies a smaller and more controllable place in the life of the person. In certain types of paraphilias which are not considered harmful to self or others, the goal of treatment may be to assist the patient to accept the paraphilia as part of his or her life and to contact others suffering from the same problem for support and greater self-acceptance.

Depending on the severity of the paraphilia and the degree of harm caused to self or others, treatment modalities to suppress the symptoms may vary from pharmacotherapy alone, pharmacotherapy along with psychotherapy, and, in extreme cases, surgical castration.

Psychotherapeutic approaches include:

- aversion imagery

- cognitive behavioral restructuring of cognitive distortions

- group therapy to break through denial

- empathy training

- social skills training

- basic sex education

- orgasmic reconditioning

- desensitization to the anxiety of intimate sex.

Pharmacological interventions include:

- antiandrogens (e.g., cyproterone [CPA - used in Canada and Europe] and medroxyprogesterone acetates [MPA - Amen, Depo-Provera - available in the U.S.). These drugs either completely reduce testosterone secretion and/or antagonize the action of testosterone at the level of the receptor. Research has shown that these drugs reduce recidivism rates in male sexual aggressors.

- selective inhibition of pituitary-gonadal function by continuous administration of triptorelin, a long-acting agonist analogue of gonadotropin-releasing hormone, together with supportive psychotherapy, may be an effective treatment for men with severe paraphilia.

- antidepressants (e.g., serotonin reuptake inhibitors, SSRI's: fluoxetine [Prozac], lithium, clomipramine [Anafranil], fluvoxamine [Luvox], sertraline [Zoloft]; tricyclic antidepressants, MAO inhibitors, buproprion [Wellbutrin], nefazodone [Serzone], venlafaxine [Effexor]. By enhancing central serotonin activity or inhibiting dopamine activity in the brain, these drugs may eliminate and reduce severity of the anxiety, depression, panic attacks, and obsessive-compulsive fantasies and behaviors that often accompany paraphilias. However, there are no published reports of recidivism rates of sex offenders treated with SSRI's.

Seeking Help

Does someone you are close to have a blatant paraphilia? Do you know someone who is exhibiting paraphilic-like behavior (sometimes occurring with obsessive and addictive web brousing on the internet)? Or, are you personally grappling with desires and fantasies that are preventing you from forming and sustaining loving, enduring, and intimate relationships? Take heart in knowing that there is help out there. There are psychological and pharmacological treatments, or a combination of both, that can truly help you or your loved one to gain control over his or her own brain and emotions.

Dr. Erica Goodstone has helped thousands of men, women, couples, and groups to develop greater awareness of the issues in their relationships and their lives, to overcome and alleviate stressors and discords, and revitalize their relationships and their own mind-body-spirit connection. Dr. Goodstone can be contacted through her web sites at http://www.DrEricaWellness.com and http://www.SexualReawakening.com