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Paraphilia (in Greek para παρά = besides and -philia φιλία = love)—in psychology and sexology, is a term that describes a family of persistent, intense fantasies, aberrant urges, or behaviors involving sexual arousal to nonhuman objects, pain or humiliation experienced by oneself or one's partner, children or other nonconsenting individuals or unsuitable partners. Paraphilias may interfere with the capacity for reciprocal affectionate sexual activity. [1] Paraphilia is also used to imply non-mainstream sexual practices without necessarily implying dysfunction or deviance (see Clinical warnings section). Also, it may describe sexual feelings toward otherwise non-sexual objects.


Clinical context

Clinical literature discusses eight major paraphilias individually.[2][3] According to the Diagnostic and Statistical Manual of Mental Disorders, the activity must be the sole means of sexual gratification for a period of six (6) months, and either cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning" or involve a violation of consent to be diagnosed as a paraphilia.[4]


Clinical procedures

Observation of paraphiliac behavior has provided valuable scientific information on the mechanisms of sexual attraction and desire, such as behavioral imprinting. Investigation has also led to the tentative conclusions that biological processes may sometimes be manifested in idiosyncratic ways in at least some of the paraphilias, and that these manifestations are frequently associated with (and especially traumatic) events associated with early sexual experience. They tend to be caused by classical conditioning in that a sexual stimulus has been paired with stimuli and situations that do not typically result in sexual response and has then been perpetuated through operant conditioning because the sexual response is its own reward or positive reinforcement.[How to reference and link to summary or text]

According to Dr. Joseph Merlino, Senior Editor of the book Freud at 150: 21st Century Essays on a Man of Genius and psychiatry adviser to the New York Daily News, a paraphilia is by definition a disorder. "It's the blurring of what I might do that is a turn-on for me, and what might get me into problems with others," said Merlino in an interview. "Once you cross that line, it exists as a problem....the term itself is a diagnosis and if you look at the current listing of diagnoses, the one thing you will find as a qualifier on every one of them for it to be considered a disorder is that it must interfere with functioning, personal interrelationships, career, etc. Absent that, we can't give it a diagnosis."[5]

Intensity and specificity

Clinicians distinguish between optional, preferred and exclusive paraphilias, though the terminology is not completely standardized. An "optional" paraphilia is an alternative route to sexual arousal. For example, a man with otherwise unremarkable sexual interests might sometimes seek or enhance sexual arousal by wearing women's underwear. In preferred paraphilias, a person prefers the paraphilia to conventional sexual activities, but also engages in conventional sexual activities. For example, a man might prefer to wear women's underwear during sexual activity, whenever possible. In exclusive paraphilias, a person is unable to become sexually aroused in the absence of the paraphilia.

Optional paraphilias are far more common than preferred paraphilias, which are, in turn, far more common than exclusive paraphilias.[How to reference and link to summary or text]

Optional paraphilias sometimes disrupt stable relationships when discovered by an unsuspecting partner. Preferred paraphilias often disrupt otherwise stable relationships. Open communication and mutual support can minimize or prevent such disruption in both of these cases. Exclusive paraphilias often preclude normal courtship and committed romantic relationships, even when the person in question desires such a relationship. Loneliness or social isolation are common consequences. In extreme cases, preoccupation with a preferred or exclusive paraphilia completely displaces the more typical desire for loving human relationships.

Drug treatments

The treatment of men with paraphilias and related disorders has been challenging for patients and clinicians. In the past, surgical castration was advocated as a therapy for men with paraphilias, but it was abandoned because it is considered a cruel punishment and is now illegal in most countries. Psychotherapy, self-help groups, and pharmacotherapy (including the controversial hormone therapy sometimes referred to as "chemical castration") have all been used but are often unsuccessful. Here are some current drug treatments for these disorders.[6]

Hormone drug treatments

In humans, testosterone has a crucial role not only in the development and maintenance of male sexual characteristics but also in the control of sexuality, aggression, cognition, emotion, and personality. Testosterone is a major determinant of sexual desire, fantasies, and behavior, and it increases the frequency, duration, and magnitude of spontaneous and nocturnal erections. The deviant sexual fantasies, urges, and behavior of men with paraphilias also appear to be triggered by testosterone. Therefore, reducing testosterone secretion or inhibiting its action is believed to control these symptoms.

Antiandrogenic drugs such as medroxyprogesterone (also known as the long-acting contraceptive Depo Provera) have been widely used as therapy in these men to reduce sex drive. However, their efficacy is limited and they have many unpleasant side effects, including breast growth, headaches, weight gain, and reduction in bone density. Even if compliance is good, only 60 to 80 percent of men benefit from this type of drug. Long-acting gonadotropin-releasing hormones, such as Triptorelin (Trelstar) which reduces the release of gonadotropin hormones, are also used. This drug is a synthetic hormone which may also lead to reduced sex drive.[7]

Psychoactive drug treatments

Selective serotonin reuptake inhibitor (SSRI) class of antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), and paroxitine (Paxil), have all been used to treat paraphilias and related disorders by reducing impulse control problems and/or sexual obsessions with some success.

Tricyclic antidepressants (TCA), such as imipramine (Tofranil) and desipramine (Norpramin), are also used.

Lithium, the mood-stabilizing drug also known as Eskalith is typically used for the treatment of mania in bipolar disorder. There are some reports of reduced sexual compulsive behavior and a reduction in obsessive sexual thoughts in patients, which they attribute to the drug's enhancement of serotonergic functioning.

Anxiolytics are not considered a typical treatment for these type of disorders, however the efficacy of buspirone (BuSpar) has been clinically demonstrated.

Psychostimulants have been used recently to augment the effects of serotonergic drugs in paraphiliacs. In theory, the prescription of a psychostimulant without pretreatment with an SSRI might further disinhibit sexual behavior, but when taken together, the psychostimulant may actually reduce impulsive tendencies. Methylphenidate (Ritalin) is an amphetamine like stimulant used primarily to manage the symptoms of attention deficit hyperactivity disorder (ADHD). Recent studies imply that methylphenidate may also act on serotonergic systems; this may be important in explaining the paradoxical calming effect of stimulants on ADHD patients. Amphetamine is also used medically as an adjunct to antidepressants in refractory cases of depression.[8]

Religion and morality

Main article: Religion and sexuality

Some religious adherents view various paraphilias as deviations from a divine plan for human sexuality, as understood through their religious tradition or laws. Depending in part on the nature of the paraphilia in question, judgements can differ as to whether religiously it should be considered a case of sexual sin, mental illness, or simply harmless sexual variation. Another variable is whether it is the acting out, or (less commonly) just the desirous thought alone, which is critically viewed in such cases. In any event, several paraphilias, as with many other behavior patterns outside the mainstream, are viewed negatively by various religions.Template:Nonspecific

Some religious traditions include forms of extreme asceticism, such as whipping , which, when practiced as sexual activities, would usually be considered masochism and popularly viewed as paraphilias. When practiced for non-sexual reasons, they are usually valued by the religious groups concerned as a part of their religious observance and submission to God.

Controversy over the term

The definition of various sexual practices as paraphilias has been met with opposition. Advocates for changing these definitions stress that there is nothing inherently pathological about non-criminal paraphilic practices, and they are stigmatized by being lumped together with crimes. Those who profess such a view hope that, much as with the removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (see homosexuality and psychology), future psychiatric definitions will not include most of these practices, or that consensual paraphilias will be clearly separated from nonconsensual paraphilias.

Legality

Main article: Sex and the law

As a general rule, the law in many countries often intervenes in paraphilias involving young or adolescent children below the legal age of consent, nonconsensual deliberate displays or illicit watching of sexual activity, consensual sex with animals, illegal manipulation of dead people, harassment, nuisance, fear, injury, or assault of a sexual nature. Separately, it also usually regulates or controls censorship of pornographic material.

Exhibitionism, in cases where people who have not previously agreed to watch are exposed to sexual display, is also an offense in most jurisdictions, as is voyeurism when unarranged (see indecent exposure and peeping tom).

Non-consensual sadomasochistic acts may legally constitute assault and therefore belong in the list below. Some jurisdictions criminalize some or all sadomasochistic acts, regardless of legal consent, and impose liability for any injuries caused. For these purposes, non-physical injuries are included in the definition of grievous bodily harm in English law. (See Consent (BDSM), Operation Spanner)

The paraphilias listed below may carry a condition of illegality in some areas, even when they are performed between consensual partners.

The paraphilias listed below, that cannot involve consent since they involve non human animals or objects, may carry a condition of illegality in some areas:

List of paraphilias

Used in a sexual context, terms with the -philia suffix refer to conditions in which the person's primary sexual interest involves the stimulus or situation mentioned (the suffix is also used for non-sexual interest in or admiration of a subject). Terms with the -lagnia suffix refer to an action involving the stimulus or situation. For example, someone who is consistently sexually excited by feces would have coprophilia; any sexual act involving feces, even by someone for whom that is not a primary interest, would be coprolagnia.

The following terms mostly represent combinations of Greek or Latin words or roots, but few qualify as clinical paraphilias. Some of the following sexual interests are fairly common, while others are very rare.

  • Abasiophilia: love of (or sexual attraction to) people who are lame or crippled and/or who use leg braces or other orthopaedic appliances
  • Acousticophilia: sexual arousal from certain sounds
  • Algolagnia: sexual pleasure from pain
  • Amaurophilia: sexual arousal by a partner whom one is unable to see due to artificial means, such as being blindfolded or having sex in total darkness.
  • Acrotomophilia and apotemnophilia: sexual attraction to amputation or amputees.
  • Andromimetophilia (also gynemimetophilia): sexual attraction towards women dressed as men or who have had a sex change operation
  • Aquaphilia: arousal from water and/or in watery environments, including bathtubs and swimming pools
  • Aretifism: sexual attraction to people who are without footwear, in contrast to retifism
  • Autogynephilia: love of oneself as a woman (see Blanchard, Bailey, and Lawrence theory for discussion on controversy)
  • Autoassassinophilia: sexual arousal from fantasizing about or staging one's own murder
  • Biastophilia: sexual arousal from assault and rape.
  • Chronophilia: sexual attraction to a partner of the same chronological age, but whose sexuoerotic age is discordant with that chronological age.
  • Coprophilia: sexual attraction to (or pleasure from) feces.
  • Covert incestiphilia: arousal from non-contact sexual behavior with a child.
  • Dacryphilia: sexual pleasure in eliciting tears from others or oneself.
  • Dendrophilia: sexual attraction to trees and other large plants.
  • Emetophilia (also vomerophilia): sexual attraction to vomiting.
  • Ephebophilia (also hebephilia): sexual attraction towards adolescents.
  • Erotic asphyxia: sexual attraction from asphyxia (also called "breath control play" or "strangulation"), including autoerotic asphyxiation.
  • Erotic lactation (also galactophilia or lactophilia): sexual attraction to human milk or lactating women
  • Exhibitionism (also autagonistophilia or peodeiktophilia): sexual arousal by engaging in sexual behavior in view of third parties (also includes the recurrent urge or behavior to expose one's genitals to an unsuspecting person).
  • Fecophilia: sexual arousal from defacation or watching a partner defecate, particularly on oneself
  • Fetishes and partialisms
Anesthesia fetishism - Blood fetish(ism) (also haematophilia) - Breast fetishism - Breast expansion fetish - Crush fetishDiaper fetishism - Doll fetish - Fat fetishism (also lipophilia) - Foot fetishism (podophilia) – Garment fetishism (Clothing, garments, materials and uniforms) - Hand fetishismHypnofetishism - Impregnation fetish - Medical fetishism - Navel fetishism - Nose fetishism (also nasophilia) - Panty fetishismPregnancy fetishism - Robot fetishismShoe fetishismSilk/Satin fetishismSmoking fetishism (Capnolagnia) – Sneezing fetishismSpandex fetishismTickling fetishism (also acarophilia) - Total enclosure fetishism - Transformation fetish -
  • Food play: sexual arousal from food
  • Formicophilia: sexual attraction to smaller animals, insects, etc. crawling on parts of the body
  • Forniphilia: sexual objectification in which a person's body is incorporated into a piece of furniture
  • Frotteurism: sexual arousal from the recurrent urge or behavior of touching or rubbing against a non-consenting person
  • Gerontophilia: sexual attraction towards the elderly
  • Hebophilia: sexual attraction to adolescents (those who are no longer children, but have not completed puberty)
  • Homeovestism or Transvestic fetishism: sexual arousal by wearing the clothing of one's own gender
  • Human animal roleplay: sexual arousal by having oneself or a partner taking on the role of real or imaginary animal
  • Hybristophilia: sexual arousal to people who have committed crimes, in particular cruel or outrageous crimes
  • Incestophilia: sexual attraction to a member of one's own family
  • Japanese terms
    • Nyotaimori: sexual arousal by eating sashimi or sushi from the body of a (usually naked) woman
    • Omorashi: sexual arousal to one's or a partner's feeling of having a full bladder
    • Tamakeri: sexual arousal from having a male kicked in the groin by a woman
    • Wakamezake: sexual arousal by drinking alcohol from a woman's body.
  • Katoptronophilia: sexual arousal from having sex in front of mirrors
  • Kleptophilia: sexual arousal from stealing things
  • Klismaphilia: sexual pleasure from enemas
  • Lust murder (also homicidophilia or erotophonophilia): sexual arousal from committing (or trying to commit) murder
  • Macrophilia: sexual attraction to giants or giant body parts (such as breasts and genitalia)—the opposite of microphilia
  • Masochism: the recurrent urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made to suffer
  • Microphilia: sexual attraction to miniature people or miniature body parts—the opposite of macrophilia
  • Mysophilia: sexual attraction to soiled, dirty, foul or decaying material
  • Narratophilia: sexual arousal in the use of dirty or obscene words to a partner
  • Necrophilia: sexual attraction to corpses
  • Nepiophilia (also infantophilia): sexual attraction to children three years old or younger
  • Oenophilia Sexual arousal from wine
  • Olfactophilia: sexual stimulus with smells or odors. (see also Jock sniffing).
  • Paraphilic infantilism: sexual pleasure from dressing, acting, or being treated as a baby.
  • Parthenophilia: sexual attraction to virgins
  • Pedophilia: sexual attraction to prepubescent children (British spelling: paedophilia)
  • Pictophilia: sexual attraction to pictorial pornography or erotic art
  • Plushophilia: sexual attraction to stuffed animals and/or people dressed in animal costumes
  • Pyrophilia: sexual arousal through watching, setting, hearing, talking or fantasizing about fire
  • Sadism: deriving pleasure, or in some cases sexual arousal from giving pain
  • Salirophila: sexual arousal by soiling (only the appearance of) the object of one's desired partner
  • Sitophilia: sexual arousal by involving food in sex
  • Somnophilia: sexual arousal from sleeping or unconscious people
  • Statuephilia: sexual attraction to statues or mannequins or immobility
  • Sthenolagnia: sexual arousal from the demonstration of strength or muscles
  • Technophilia: sexual arousal from techno or technology.
  • Telephone scatologia: being sexually aroused by making obscene phone calls to strangers
  • Teratophilia: sexual attraction to deformed or monstrous people
  • Tightlacing: sexual arousal by wearing or having a partner wear a tightly laced corset
  • Trichophilia: sexual arousal from hair
  • Troilism: sharing a sexual partner with another person while looking on
  • Urolagnia: sexual attraction to urine, including urinating in public, urinating on others, and being urinated on by others
  • Urophagia: sexual attraction to drinking urine or watching others drink urine
  • Vorarephilia (also gynophagia): sexual attraction at the thought of being eaten by or eating another person or creature. It includes endosomataphillia—a sexual fetish of being within someone (a sub-genre is partial unbirthing—a sexual attraction to inserting an adult head into a vagina).
  • Voyeurism: sexual arousal through secretly watching others having sex (also includes scoptophilia—the recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing or engaging in sexual activities (see Peeping Tom)
  • Wet and messy fetishism: sexual arousal by having substances deliberately and generously applied to the naked skin, or to the clothes people are wearing
  • Xenophily: sexual attraction to foreigners (in science fiction, it can also mean sexual attraction to aliens)
  • Zelophilia: sexual arousal from jealousy
  • Zoophilia: sexual attraction to animals
  • Zoosadism: sexual gratification derived from causing pain and suffering to animals. Necrozoophilia (also necrobestiality) strictly applies to killing animals.

See also

References

  1. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed., text revision). Pp. 566-567.
  2. psyweb.com "Axis I. Clinical Disorders, most V-Codes and conditions that need Clinical attention". Retrieved: 23 November, 2007.
  3. World Health Organization, International Statistical Classification of Diseases and Related Health Problems, (2007), Chapter V, Block F65; Disorders of sexual preference. Retrieved 2007-11-29.
  4. Letter to the Editor of The American Journal of Psychiatry: Change in Criterion for Paraphilias in DSM-IV-TR. Russell B. Hilliard, Robert L. Spitzer. 2002. Retrieved: 23 November, 2007.
  5. Interview with Dr. Joseph Merlino, David Shankbone, Wikinews, October 5, 2007.
  6. M. Williams. Sexual Compulsivity: Defining Paraphilias and Related Disorders "Psychoactive Drug Treatments". Retrieved 23 November, 2007
  7. M. Williams. Sexual Compulsivity: Defining Paraphilias and Related Disorders "Psychoactive Drug Treatments". Retrieved 23 November, 2007
  8. M. Williams. Sexual Compulsivity: Defining Paraphilias and Related Disorders "Psychoactive Drug Treatments". Retrieved 23 November, 2007


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