PARAPHILIAS Eylül YERAL

Paraphilia; intense and persistent sexual interests outside of foreplay and genital stimulation with phenotypically normal, consenting adults. Paraphilic disorder; requires both the presence of a paraphilic urges and the existence of distress, dysfunction, and/or acting on the urges. DSM 5 defines paraphilic disorders as «sexual disorders in which persons have frequent and recurring instances of intense sexually arousing thoughts, ideas, urges, fantasies, or behaviors involving non-human objects, humiliation of self and partner, children or other non-consenting people, over a long period - at least 6 months.»

Psychoanalytical theory K.Freund Courtship disorder hypothesis (biastophilia, exhibitionism, frotteurism and voyuerism) Courtship is composed of the following 4 phases: -Search phase : Location of a potential partner -Pretactile interaction phase :Talking or flirting with a potential partner -Tactile interaction phase : Physical contact with a potential partner, usually consisting of touching, hugging, hand-holding, and similar actions (this could also be considered foreplay) -Genital union phase (ie, sexual intercourse)

Behavioral theory «If nonsexual objects are frequently and repeatedly associated with a pleasurable sexual activity, then the object becomes sexually arousing.» If an individual experiences unpleasant consequences with normal sexual activity, an aversion to sex may occur, resulting in the development of deviant behavior. An example of this would be a young boy who is humiliated and punished by his parents for proudly displaying his erect penis. As the boy matures, he may associate guilt and shame with normal sexual behavior.

Sociobiological theory Dawkin’s theory;  the different paraphilias may be responsible for enhancing society’s level of sexual excitation. This higher level of excitation, in turn, would increase the likelihood that people would engage in sex acts that would ultimately lead to procreation.

Voyeuristic disorder Sexual gratification on seeing other people perform private activities such as undressing, being naked and/or seeing people performing a sexual act. Highest lifetime prevalence for Voyeuristic disorder is approx. 12% in male and 4% in female Considered to be the most common of law-breaking sexual behaviors Arousal comes from knowing that the victim is unaware of it. Hypersexuality and other paraphilic disorders, especially exhibitionistic disorder, are common comorbid conditions occurring with Voyeuristic Disorder

Exhibitionistic Disorder A person with recurrent, intense urges, fantasies, or behaviors that involve exposing his genitals to others (usually strangers) in appropriate circumstances and without their consent. After the act of self-exposure, there is generally no attempt at further sexual activity with the stranger, though the exhibitionist may feel a desire to shock the stranger or may entertain a fantasy that the observer will become sexually aroused. Highest possible prevalence for exhibitionistic disorder in male: 2-4% About half of adult women have witnessed indecent exposure at some point in their lives.

Frotteuristic Disorder In an act of frotteurism (frottage), the (usually male) offender typically rubs his genital area against the (usually female) victim’s thighs or buttocks or fondles a woman’s genitalia or breasts with his hands. While committing the act, the frotteur typically fantasizes about an exclusive, caring relationship with the victim. Often occurs in crowded subway or other public place

Sexual Masochism Masochistic acts commonly involve a wide range of activities, such as restraint, blindfolding, beating, electrical shock, cutting, piercing, and humiliation (eg, being urinated or defecated on, forced to bark, verbally abused, or forced to cross-dress). Hypoxyphilia is a dangerous form of masochism that involves sexual arousal by oxygen deprivation achieved by means of chest compression, noose, ligature, plastic bag, mask, or chemicals. Oxygen deprivation may be accomplished either alone or with a partner. Data from the United States, England, Australia, and Canada indicate that 1-2 deaths per million population as a result of this practice are reported each year.

Sexual Sadism The word «sadism» is originated with Marquis de Sade. Sadistic fantasies or acts may involve activities such as dominance, restraint, blindfolding, beating, pinching, burning, electrical shock, rape, cutting, stabbing, strangulation, torture, mutilation, and killing.

Pedophilic Disorder Is diagnosed when an adult has recurrent, intense sexual urges or fantasies about sexual activity with a prepubertal child Pedophiles’ sexual interaction with children involves manual or oral contact with a child’s genitals A residual category of offenders includes people with mental retardation, psychosis, alcoholism, senility, or dementia.  37% of sexual assault victims reported to law enforcement agencies were juveniles (< 18 years); 34% of all victims were younger than 12 years. One in 7 victims is younger than 6 years. Forty percent of offenders who victimized children younger than 6 years were juveniles (< 18 years).

Fetishistic Disorder The prevalence of fetishistic disorder is unknown Common fetishistic objects are Female underwear,rubber, plastic, or leather garments,pecific articles of clothing, such as shoes or boots,bodily items, such as hair, odors, or feces Most often occurs in men

Transvestic disorder Typically, individuals with transvestic disorder derive sexual gratification from wearing clothes usually worn by the opposite sex. No desire to be of the opposite sex Often comorbid with other paraphilias(especially masochism) Most people with this disorder are heterosexual married men. Onset of transvestisism is during adolescence and involves masturbation while wearing female clothing or undergarments

Other paraphilias Telephone scatologia - The making of obscene phone calls Necrophilia - An erotic attraction or sexual interest in corpses (rare and seldom reported to the police); patients typically work in mortuaries and funeral parlors; there exists a danger that the individual might actually acquire infections from the corpse Zoophilia - Sexual activity with animals (ie, both actual sexual contact and sexual fantasies) Coprophilia - Sexual activity involving feces Klismaphilia - Sexual activity involving enemas Urophilia - Sexual activity involving urine Autogynephilia - A man’s propensity to be sexually aroused by thoughts or images of himself as a woman (with female attributes) Video voyeurism - The derivation of sexual gratification from videos, usually of women doing natural acts or involved in sexual activity Infantophilia - A newer subcategory of pedophilia, in which the victims are younger than 5 years

Treatment Cognitive-behavioral therapy Orgasmic reconditioning Social skills training Twelve-step programs Group therapy Individual expressive-supportive psychotherapy Pharmacological Therapy(SSRIs,long-acting gonadotropin-releasing hormones such as leuprolide acetate and triptorelin antiandrogens, such as medroxyprogesterone acetate (10 mg q12hr, with the dosage doubled every 3 days to a maximum of 200 mg/day, then maintained for 1 month and adjusted as necessary) Phenothiazines, such as fluphenazine Mood stabilizers

REFERENCES https://www.theravive.com/therapedia/voyeuristic-disorder-dsm--5-302.82-(f65.3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769077/#bib-012 http://emedicine.medscape.com/article/291419-overview http://jaapl.org/content/42/2/191