Paraphilias are persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature. Although not innately pathological, a paraphilic disorder can evolve if paraphilia invokes harm, distress, or functional impairment on the lives of the affected individual or others.
A total of eight paraphilias are listed in the DSM V and include pedophilia, exhibitionism, voyeurism, sexual sadism, sexual masochism, frotteurism, fetishism, and transvestic fetishism.
Pedophilia is any sexual activity with a prepubescent child, where the offender is at least sixteen years of age, and the victim is at least five years younger. Exhibitionism is the exposure of an individual’s genitalia to unsuspecting strangers for sexual satisfaction. Voyeurism is the viewing of an unsuspecting person engaging in disrobing or sexual activity. Sexual sadism is when sexual arousal is gained from inflicting mental or physical suffering on a nonconsenting person. Sexual masochism is the derivation of sexual arousal from being the recipient of physical or mental abuse and/or humiliation. Frotteurism is the touching of or rubbing against a nonconsenting person. Fetishism is the use of nonliving objects, most commonly shoes and undergarments, for sexual pleasure. Transvestic fetishism is the derivation of sexual arousal from cross-dressing or dressing in clothes of the opposite sex.
There are many paraphilias such as biastophilia, somnophilia and many others.
Rape is primarily regarded as a crime against sexual integrity. If rape is the only way for an individual to get sexual satisfaction, it meets the criteria of paraphilia, i.e. a disorder of sexual preference. The correct technical term is “biastophilia”. Somnophilia generally refers to a sexual interest in engaging in sexual activity with a sleeping person. Subsequent definitions were broadened to encompass ‘unconscious’ people (e.g., Griffiths, 2014). ‘Other specified paraphilic disorder’ in DSM-5 includes necrophilia (corpses), zoophilia (animals), coprophilia (feces), klismaphilia (enemas), urophilia (urine) and other types of paraphilic disorders which are less frequent and do not meet diagnostic criteria for one of the specific categories. Obscene and sexual phone calls, sexually arousing fantasies, sexual urges or behaviors are present at least for six months in telephone scatologia. It is often accompanied by masturbation.
The DSM-5 diagnostic criteria for paraphilia states explicitly that the one must have experienced intense and recurrent sexual arousal from deviant fantasies for at least six months and must have acted on these impulses. A paraphilia becomes a pathology, or a paraphilic disorder, only when this behavior causes significant distress and impairment of functioning to the individual or if the paraphilia involves personal harm or risk of harm to others.
Differential Diagnosis
- Sexual dysfunction disorders
- Gender identity disorder
- Hypersexuality or sex addiction
- Nonparaphillic compulsive sexual disorders
- Psychological Issues (fears of intimacy, commitment, etc.)
- Other psychiatric disorders: Obsessive-compulsive disorder (OCD), depression, bipolar disorder (manic episodes), schizophrenia, personality disorder, anxiety disorders
- Other disorders: Substance intoxication, intellectual disability, dementia