Updated: 6/17/2016

Paraphilias

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Introduction
  •  Clinical definition
    • preoccupation with sexual fantasies/behaviors for > 6 months with significant impairment
    • not done in experimentation
    • paraphilic disorder = paraphilia that causes distress or harm to the patient or others
    • paraphilia: does not necessarily cause distress or need treatment
  • Epidemiology
    • seen predominantly in men
    • onset in adolescence
Paraphilias
  • A 25-year-old often goes to the shopping mall in an overcoat during the winter.  He enjoys walking around the parking lot exposing his genitals to strangers.  He then sprints away avoiding getting caught.
    • exhibitionism
      • exposing one's genitals to strangers
  • A female brings her 29-year-old boyfriend to a couples therapist because she is uncomfortable with his behavior.  She found him clutching her feet during intercourse, and noticed that he insists on being able to see her feet while they engage in sexual acts.  
    • fetishism
      • arousal by specific objects
  • A 33-year-old male always takes the 5:30 pm subway home despite owning a car.  He likes to ride the subway because it is the most crowded at this time and tries to get close to young females to press his genitals against them.
    • frotteurism
      • rubbing one's genitals against strangers
  • A 35-year-old male gym teacher at a local elementary school insists that all his students take a shower after class despite it not being a requirement at the school.  He supervises the children showering and becomes sexually aroused.
    • pedophilic disorder (pedophilia in the DSM IV)
      • sexual arousal by children
  • A 23-year-old female sees her psychiatrist as she is unable to keep a boyfriend for longer than a month.  After several sessions, the patient reveals that when she enages in sexual intercourse with her partner she insists on causing him pain.
    • sexual sadism
      • arousal from inflicting pain on sexual partner
  • A 21-year-old male sees his psychiatrist because he is concerned that his behavior has resulted in his inability to maintain a relationship.  He reveals to his psychiatrist that he requires his partners to inflict pain and humiliate him in order for him to achieve and maintain an erection.
    • sexual masochism
      • arousal from being threatened or hurt during sexual activities
  • A 19-year-old male college student was reported by others for spying through the windows of his fellow female dormmates.  
    • voyeurism
      • observing unsuspecting persons naked or performing sexual activities
  • A 17-year-old young male is brought into the clinic by his father.  He is concerned because he has caught his son on several different occasions wearing makeup, a dress, and heels.  He was hoping you could treat his son.
    • transvestism
      • acting or dressing in a manner that is typically associated with behaviors seen in the opposite gender
Treatment
  •  Psychotherapy
    • insight-oriented, behavioral therapy
  • Pharmacologic
    • SSRI's have some role in impulse control for these disorders - particularly if concomitant depression
    • antiandrogens
      • used for paraphililic activity
Prognosis, Prevention, Complications
  •  Complications
    • incarceration if act violates the law (paraphilic acts)
 

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