Paraphilia

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A paraphilia is a condition involving sex fetishes where a person's sexual arousal and gratification depend on fantasizing about, and engaging in, sexual behavior that is atypical and extreme. A paraphilia can revolve around a particular sex fetish like an object (e.g., children, animals, underwear) or around a particular sex fetish act (e.g., inflicting pain, exposing oneself).

Most of the paraphilias are far more common in men than in women. The focus of a paraphilia is usually very specific and unchanging. For example, for someone who derives sexual pleasure from exposing his genitals, watching others engaging in sexual activity will not generally provide sexual gratification.

A paraphilia is distinguished by a preoccupation with the object or behavior to the point of being dependent on that object or behavior for sexual gratification. In most cases, types of sexual activity outside the boundaries of the paraphilia lose their arousal or satisfaction potential unless the person fantasizes about the paraphilia at the same time.

Although many of the paraphilias seem so foreign or extreme that one could not imagine how the object or behavior can be arousing to anyone, they are easier to understand if one thinks of those behaviors that, in less extreme versions, are quite common and not considered abnormal. For instance, having a partner "talk dirty" occasionally may be a "turn-on" for some people, but when talking dirty is the only way that sexual arousal or satisfaction can occur, it would be considered a paraphilia.

Others want to be bitten, scratched, or spanked, or find that watching their partner undress is highly arousing. Viewing a nude person or watching sexually explicit videos can be arousing for most people. Each of these acts is innocuous unless magnified to the point of psychological dependence.

Paraphilia — Unusual Sexual Behaviors
There are numerous paraphilias. Some of the major types are:

• Fetishism: A fixation on an object or body part that is not primarily sexual in nature, and the compulsive need for its use in order to obtain sexual gratification. The fetish object is almost invariably used during masturbation and may also be incorporated into sexual activity with a partner in order to produce sexual excitation. Fetishists usually collect the object of their favor, and may go to great lengths, including theft, to acquire just the "right" addition for their collection. Some of the more common objects that have served as fetishes include women's undergarments, high-heeled shoes, or specific materials, like silk, leather or fur. Some people have a fetish for particular body parts such as feet, hair or legs. For more on this fixation, go to fetishism.

• Transvestism: A paraphilia in which heterosexual males repeatedly and persistently get sexual pleasure from dressing in women's clothing. Transvestism is not simply dressing up in the other sex's garments for fun or for temporary effect. The transvestite needs to cross-dress to achieve full sexual and emotional release. This is very different from the female impersonator or the drag queen (male homosexuals who occasionally dress in women's clothing), both of whom are usually playing social roles rather than expressing sexual needs.
• Voyeurism: Deriving sexual satisfaction from watching people undressing or nude, or observing them during sexual acts without their knowledge or consent. Voyeurs (from the French verb meaning "to see") or Peeping Toms are usually unmarried males in their 20s and 30s. They generally prefer to peep at women who are strangers and they are often most sexually excited when the risk of being discovered is high. Many voyeurs confine their sexual activity to masturbation while peeping or while fantasizing about previous peeping escapades.
• Exhibitionism: Compulsive act of inappropriately exposing one's sex organs to unsuspecting strangers for the purpose of sexual arousal and gratification. Also known as "indecent exposure" and "flashing," this paraphilia is found almost exclusively in males and the peak age of occurrence is reported to be in the twenties. Many exhibitionists have erectile difficulties in other forms of sexual activity and seem to be pushed by an uncontrollable urge that leads to their impulsive behavior. For some, the primary intent of exhibitionism is to evoke shock or fear in their victims, not necessarily to achieve an erection or to ejaculate. They derive their pleasure from the visible reaction of their victims. It is generally agreed that the exhibitionist is unlikely to rape or assault his victims, but there are exceptions to this rule, especially when an exhibitionist is unsatisfied with his victim's response. Police catch more exhibitionists than any other category of paraphiliacs. The risk of being caught may be an important element of the turn-on, leading some exhibitionists into behavior almost guaranteed to result in arrest, such as repeatedly performing at the same street corner.
• Sadomasochism: A paraphilia that combines sadistic and masochistic roles in sexual interaction. Sadism is the intentional infliction of pain on another person or the threat to do so, for sexual excitement. Masochism is a condition in which a person derives sexual gratification from being subjected to pain or to the threat of pain. A sadomasochist is a person who can derive sexual pleasure from either role. Forms of sadism run the gamut from the fairly common carefully controlled play-acting with a willing partner, in which the mild forms of pain that result from such acts as spanking or biting are not actually experienced as painful (think of having one's back scratched — the same intensity can sometimes feel good and sometimes hurt depending on the circumstances), to the very rare assaultive behaviors that may include torture, rape, or even murder. Some extreme sadists require an unwilling victim to derive pleasure; others become sexually aroused only when they see their victim suffering.

• Masochism: Can range from mild versions to extremes. In the mild renditions, activities might include bondage (being tied up for the purpose of sexual arousal), being spanked, or being overpowered by physical force. The crucial point is that they are mainly symbolic enactments done under carefully controlled conditions with a trusted partner. At the opposite end of the spectrum are genuinely painful activities such as whippings, semi-strangulation, being trampled and self-mutilation. Although sadomasochistic acts in their extreme forms can be physically and psychologically dangerous, the majority of people engaging in these behaviors do so with an understanding of the risks and stay within carefully predetermined limits.
• Pedophilia: An adult's preferred or exclusive method of sexual excitement is fantasizing or engaging in sexual activity with prepubescent children. About two thirds of the victims of pedophiles are girls, most often between the ages of 8 and 11. Pedophilia predominately occurs in males, but there have been documented cases of women who have repeated sexual contact with children. The popular stereotype of the child molester as a stranger who lurks around playgrounds with a bag of candy to lure victims is not entirely correct. It is not uncommon that the pedophile is a relative, neighbor, or acquaintance of the victim. Pedophiles commonly fall into three distinct age groups: over 50, the mid-to-late 30s, and the teens. Most are heterosexual and many are married fathers. Strictly speaking, the person who has only isolated sexual contact with children is not a pedophile and may be inappropriately expressing sexual frustration, loneliness, or personal conflict. There is no single pattern of sexual activity that fits all pedophiles.
• Bestiality: Engaging in sexual contact with animals. When the act or fantasy of sexual activity with animals is a repeatedly preferred or exclusive means of sexual gratification, it is called zoophilia. Bestiality usually involves curiosity, a desire for novelty, or a desire for sexual release when a partner is unavailable. Zoophilia sometimes involves sadistic acts that may harm the animal.

Obscene Telephone Calls
Making repeated obscene telephone calls for the purpose of sexual excitement is also considered a paraphilia. The relative safety and one-sided anonymity of the telephone provides an idealized setting for masturbatory fantasies with no worries about face-to-face contact.

There are three basic types of obscene phone calls. In the first, the caller boasts about himself and describes in detail his masturbatory act. In the second type, the caller directly threatens the victim ("I've been watching you" or "I'm going to find you"). In the third type, the caller tries to get the victim to reveal intimate details about her life. Sometimes the obscene phone caller repeatedly calls the same victim, but more often, unless the victim shows a willingness to stay on the phone and play his game, he'll move on to others.

Rare Sexual Attractions
There are some paraphilias that are relatively rare. Apotemnophilia refers to the sexual attraction to amputations. Coprophilia and urophilia refer respectively to sexual excitement deriving from contact with feces and urine. Klismaphilia is sexual excitement resulting from the use of enemas. Frotteurism is sexual arousal resulting from rubbing the genitals against the body of a fully clothed person in crowded situations, and necrophilia is sexual arousal derived from viewing or having sexual contact with a corpse.

Causes of Paraphilia Unclear
It is unclear what causes a paraphilia to develop. Psychoanalysts theorize that an individual with a paraphilia is repeating or reverting to a sexual habit that arose early in life. Behaviorists suggest that paraphilias begin through a process of conditioning. Nonsexual objects can become sexually arousing if they are repeatedly associated with pleasurable sexual activity. Or, particular sexual acts (such as peeping, exhibiting, bestiality) that provide especially intense erotic pleasure can lead the person to prefer that behavior. Although the origins of most paraphilias are not understood, in some cases there seems to be a predisposing factor such as difficulty forming person-to-person relationships.

Whatever the cause, paraphiliacs rarely seek treatment unless an arrest or discovery by a family member traps them into it. In most cases, the paraphilia results in such immense pleasure that giving it up is unthinkable. Treatment approaches have included traditional psychoanalysis, hypnosis, and behavior therapy techniques.

Research on the outcome of these therapies has been incomplete, but often they have not be very successful. More recently, a class of drugs called antiandrogens that drastically lower testosterone levels temporarily have been used in conjunction with these forms of treatment. The drug lowers the sex drive in males and reduces the frequency of mental imagery of sexually arousing scenes. This allows concentration on counseling without as strong a distraction from the paraphiliac urges. Increasingly, the evidence suggests that combining drug therapy with cognitive behavior therapy can be effective.

Copyright 2002 Sinclair Intimacy Institute