Presented by John Venson Cea

 Derived from the greek words

 “Para” meaning ‘abnormal’ or ‘along side’
 “Philia” meaning ‘love’ or ‘affection’

“ abnormal love or affection”

Paraphilia – term coined by psychologists in early 1900s
previously called perversions.
Richard von Krafft-Ebing, a German psychiatrist who introduced the
study of sexology as a psychiatric phenomenon.
He identified paraphilias first in his book, 1886 Psychopathia
Sexualis (Sexual Psychopathy)
 “Recurrent, intense sexually arousing fantasies, sexual urges, or
behaviors generally involving
 1. Non Human Objects
 2. Suffering or humiliation of oneself or one’s partner, or
 3. (Children) or other non-consenting persons that occur over a period
of 6 months
 It denotes any intense and persistent sexual interest other than sexual
interest in genital stimulation or preparatory fondling with typically normal,
physically mature, consenting human partners.

Paraphilic disorder
 is a paraphilia that is causing distress or impairment to the individual, or
 a paraphilia whose satisfaction has entailed personal harm, or risk of harm
to others.
 CRITERION A
Specifies the qualitative nature of the paraphilia (e.g. an erotic focus
to children or on exposing genitals to strangers)

 CRITERION B
Specifies the negative consequences of the paraphilia (i.e. distress,
dysfunction, danger, etc.)
 Aside normal sexual behaviors, paraphilic disorder involves aggression,
victimization, and extreme one-sidedness.
 The behaviors harms or exclude others and disrupt the social aspect (i.e. bonding,
interact or socialize) between persons.
 Causes intense personal distress in social, work or other areas of life functioning.
 Usually lasts for 6 months
 Always thinking to act or carry out their unusual behavior
 Overly obsessed that if the individual cannot release their urge or their desired
object, they get stressed.
 The individual will concentrate on the fulfillment of their sexual desires.
 Paraphilias commonly involve sexual arousal & orgasm. Typically achieved through
masturbation and/or fantasy.
 No known exact etiology.
But may corelates to,
 Biological Factors
 Sexual deviance is associated with frontal and/or temporal lobe damage.

 Psychoanalytical Theory
 Fixation or Regression at early level of psychosexual development.

 Behaviorist Theory
 Process of conditioning.
 If a non-sexual object are frequently or repeatedly associated with pleasurable sexual
activity.
 Biological Factors
 Sexual deviance is associated with frontal and/or temporal lobe damage.
DSM-5 DIAGNOSTIC CRITERIA
 A. Over a period of at least 6 months, recurrent and intense
sexual arousal from observing an unsuspecting person
who is naked, in the process of disrobing, or engaging in
sexual activity, as manifested by fantasies, urges, or
behaviors.
 B. The individual has acted on these sexual urges with a
nonconsenting person, or the sexual urges or fantasies
cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
 C. The individual experiencing the arousal and/or acting
on the urges is at least 18 years of age
DIAGNOSTIC CRITERIA DSM-5
 A. Over a period of at least 6 months, recurrent and
intense sexual arousal from the exposure of one’s genitals
to an unsuspecting person, as manifested by fantasies,
urges, or behaviors.
 B. The individual has acted on these sexual urges with a
nonconsenting person, or the sexual urges or fantasies
cause clinically significant distress or impairment in
social, occupational, or other important areas of
functioning.
 Specify whether:
 Sexually aroused by exposing genitals to prepubertal children
 Sexually aroused by exposing genitals to physically mature
individuals
 Sexually aroused by exposing genitals to prepubertal children and
to physically mature individuals
DIAGNOSTIC CRITERIA
 A. Over a period of at least 6 months, recurrent and intense
sexual arousal from touching or rubbing against a
nonconsenting person, as manifested by fantasies, urges, or
behaviors.
 B. The individual has acted on these sexual urges with a
nonconsenting person, or the sexual urges or fantasies
cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning
DIAGNOSTIC CRITERIA
 A. Over a period of at least 6 months, recurrent and
intense sexual arousal from the act of being humiliated,
beaten, bound, or otherwise made to suffer, as manifested
by fantasies, urges, or behaviors.
 B. The fantasies, sexual urges, or behaviors cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
 The three main characteristics of masochism are pain, loss
of control, and humiliation.
DIAGNOSTIC CRITERIA DSM-5
 A. Over a period of at least 6 months, recurrent
and intense sexual arousal from the physical or
psychological suffering of another person, as
manifested by fantasies, urges, or behaviors.
 B. The individual has acted on these sexual
urges with a nonconsenting person, or the
sexual urges or fantasies cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning
 The onset of the disorder is usually before the age of 18 years, and most persons with
sexual sadism are male .
Krafft-Ebing sub classified sexual sadism into several categories including
 I. Lust-murder;
 II. Mutilation of corpses or necrophilia;
 III. Injury to females (stabbing);
 IV. Defilement of women;
 V. Other kinds of assaults on women—symbolic sadism in which, for example, the
perpetrator cuts the hair of his victims rather than harming them directly;
 VI. Ideal sadism or sadistic fantasies alone without acts;
 VII. Sadism with other objects, for example, whipping boys;
 VIII. Sadistic acts with animals. In some individuals sadistic fantasies and compulsions
lead to rape or homicide
DIAGNOSTIC CRITERIA DSM-5
 A. Over a period of at least 6 months, recurrent, intense sexually
arousing fantasies, sexual urges, or behaviors involving sexual
activity with a prepubescent child or children (generally age 13
years or younger).
 B. The individual has acted on these sexual urges, or the sexual
urges or fantasies cause marked distress or interpersonal
difficulty.
 C. The individual is at least age 16 years and at least 5 years
older than the child or children in Criterion A.

Note: Do not include an individual in late adolescence involved in

an ongoing sexual relationship with a 12- or 13-year-old.
 Specify whether:
 Exclusive type (attracted only to children)
 Nonexclusive type

 Specify if:
 Sexually attracted to males
 Sexually attracted to females
 Sexually attracted to both

 Specify if:
 Limited to incest
DIAGNOSTIC CRITERIA DSM-5
 A. Over a period of at least 6 months, recurrent and intense sexual arousal from either the use
of non-living objects or a highly specific focus on non-genital body part(s), as manifested by
fantasies, urges, or behaviors.
 B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
 C. The fetish objects are not limited to articles of clothing used in crossdressing (as in
transvestic disorder) or devices specifically designed for the purpose of tactile genital
stimulation (e.g., vibrator).
Specify: Body part(s)/Non-living object(s)/Other
Partialism
 Another variant of Fetishism.
 People with Partialism are solely interested in the sexual gratification from a specific body
part, examples are feet, neck, underarms, back, etc.
DIAGNOSTIC CRITERIA DSM-5
 A. Over a period of at least 6 months, recurrent and intense
sexual arousal from cross dressing, as manifested by
fantasies, urges, or behaviors.
 B. The fantasies, sexual urges, or behaviors cause clinically
significant distress or impairment in social, occupational, or
other important areas of functioning.
 Specify if:
 With fetishism: If sexually aroused by fabrics, materials, or
garments.
 With autogynephilia: If sexually aroused by thoughts or images of
self as female.
  Penile pletysmography – measurement of patient’s sexual arousal (of blood flow to
the penis) in response to audio or visual imagery
 DSM-5 criteria

 Paraphilic behaviors emerge in adolescence and early adulthood.

 In general paraphilic behaviors are chronic.
 Individuals may cross over from one paraphilia to another
 Difficult to treat.
 Five types of psychiatric interventions are used to treat persons with paraphilic
disorder and paraphilic interests: external control, reduction of sexual drives,
treatment of comorbid conditions (e.g. Depression or anxiety), cognitivebehavioral
therapy, and dynamic psychotherapy.
 Paraphiliacs seldom seek treatment because of their guilt, shame, and fear of
social ostracism and legal problems
 Pharmacological Treatments includes,
 Antiandrogens – reduces libido, erections, ejaculations and spermatogenesis.
 Hormonal Agents such as Leuprolide and Triptorelin
 Selective Serotonin Reuptake Inhibitors (SSRIs) such as Setraline, Fluvoxamine and
Fluoxetine
 Cognitive-behavioral therapy is used to disrupt learned paraphilic patterns and
modify behavior to make it socially acceptable.
 The interventions include social skills training, sex education, cognitive
restructuring, relaxation technique, and learning what triggers the paraphilic
impulse so that such stimuli can be avoided are also taught.
 Insight-oriented psychotherapy is a long-standing treatment approach.