Paraphilia is characterized by repetitive sexual fantasies or acts involving non-consenting partners or objects. It is defined in DSM-V as a persistent sexual interest other than genital stimulation with consenting adult partners. Types include fetishism, voyeurism, exhibitionism, pedophilia and zoophilia. Causes may include biological factors, learning from environment, and early sexual experiences. Treatment involves medical approaches like anti-androgens and anti-psychotics, as well as behavioral therapies like victim identification, covert conditioning, and aversion therapy.

1. Paraphilia (disorder of
Sexual preferences)

2. Contents:
 Introduction
 Definition
 Types
 Causes
 Treatment

3. Introduction
 “Para’ abnormal & ‘philia’ Attraction
 Paraphilia disorders are characterized by repetitive or
preferred sexual fantasies or acts that involve non-
human objects or non consenting partner.
 Paraphilic imagery( clothes, shoe, child) is necessary for
erotic arousal it must be included in masturbatory or
coital fantasies.
 But, in the absence of paraphilias imagery, there is no
relief from non erotic tension an sexual excitement .
 They are of legal and social significance.

4. Definition
 In DSM-V, the term paraphilia is defined as “ any
intense and persistent sexual interest other than sexual
interest in genital stimulation or preparatory fondling
with phenotypically normal, physiologically mature,
consenting human partners”
 The term ‘disorder’ added to DSM-V indicate a
paraphilia that is causing distress or impairment to the
individual or a paraphilia where by satisfaction entailed
personal harm, or risk of harm to others.

5. Epidemiology
 Exact prevalence is not known
 Disorders are apparently rare
 Virtually all cases have been in males
 Over 50% of these patients develop the onset of the
paraphilic arousal prior to age 18.

6. Types
1) Fetishism
2) Fetishistic Transvestism
3) Voyeurism
4) Exhibitionism
5) Sexual Masochism
6) Sexual Sadism
7) Pedophilic
8) Zoophilia
9) Frotteurism
10) Others, Nevrophilia & Urophilia

7. Fetishism
 Fetishism is where a person feels a strong recurrent
sexual attraction to a non-living object.
 People with this are always pre occupied with the
object of desire and they become dependent to it as
object for sexual gratification
 Objects : Shoe, Gloves, Underwear, stockings,
swimsuits, etc

8. Characteristic of Fetishism
 They do unusual actions to the desired object like
sucking , licking, smelling, rubbing, & cutting.
 Have no desire to intercourse with the partner with the
desire object, rather they would masturbate to the
desired object.
 It involves compulsive rituals that are beyond the
control of the individual which can cause distress and
interpersonal problems.

9. Fetishistic Transvestism
 A syndrome found only in males { heterosexual male}
 A disorder in which there is an uncontrollable urge to
wear a woman’s clothing, as primary means of
achieving sexual gratification.
 and accompanied by masturbate.

10. Voyeurism
 the word comes from the term ‘Voir’ meaning ‘to
see’.
 A sexual disorder where an individual compulsively
seeks sexual gratification from observing nudity or
sexual activity of theirs who are unaware that they are
being watched.
 This disorder is more common in men

11. Characteristic of Voyeurism
 Masturbate while watching or masturbate later while
remembering what they saw
 watching pornography is not included

12. Exhibitionism
 The person has intense sexual urges and arousing
involving the exposure of genitals to a group of
strangers (usually female, child or adults) .
 Peak age: twenties and common in male

13. Characteristic of
Exhibitionism
 He/she does not expect a sexual reaction from the
stranger but finds the shock or fear in the outlook to
be arousing.
 Seeking unwilling vicitms
 Usually, they don’t try to touch their victims.

14. Sexual Masochism
 Disorder marked by an attraction to achieving sexual gratification by
having painful stimulation applied to one’s own body either alone or
with a partner.
 Men and Women with this disorder achieve sexual satisfaction by
such means like binding, ropes, or injuries.

15. Sexual Sadism
 The converse of Sexual masochism. It involves deriving
sexual gratification from activities that harm, or from
urges to harm, another person. Seeing or imaging
another’s pain excites the person
 In contrast to Sexual Masochism, which does not
require a partner, sexual sadism clearly requires a
partner to enact sadistic fantasies.

16. Pedophilic
 Pedophilia is where an adult (16yrs above) has
uncontrollable sexual urges to sexually immature
children (13 yrs below)
 Persists from months to even years
 Forms of sexual acts against children include
kidnapping, sexual abuse, fondling and penetration or
intercourse

17. Zoophilia
 Term used to describe a human being who is sexually
aroused by animal

18. Frotteurism
 Derived from the word ‘Fotter’ meaning ‘ to rub’
 Refers to the masturbation that involves rubbing
against another person
 Characteristics
 Obsessed with rubbing of selves to unsuspecting
strangers, finding it sexually pleasurable
 Often acts quickly or undetected.
 Fantasies that they are in an intimate relationship with
stranger.

19. Causes
Various theories have put forth to explain the development of
paraphilas.
1) Biological theories:
- lesions in some part of limbic system, temporal lobe disease and
abnormal levels of androgens have been implicated in the
causation of paraphilas.
2) Social Learning theories:
- learned from his/her environment
- also incorporates ‘modeling’ learn behavior by watching
someone else in the same manner or even by their own sexual
abuse.
- Example: children who have seen their parents having intercourse
may grow up to become aroused by viewing others engaging in
sexual activity as in voyeurism.

20. Causes contd…
3) Psychoanalytic theory:
- early perverse sexual experiences are common in patients
with paraphilia
- a transvestic fetishist gives a record that his mother dressed
him as girls’ clothes when he was a child. A sadist gives a
history of being beaten.
- ‘Victim become Abuser’ : victims acting like aggresors
which is relieving a trauma by placing them in the power
position.
- theory states that such abuses results in the inability to
form healthy intimate relationship. Instead, the individual is
motivated to satisfy urges through non relational means (
such as fetish object ), pseudo relationship (exhibitionism,
voyeurism, or frotteurism )

21. Causes contd…
 Cognitive- behavioral and learning theory:
- highlights the importance of early sexual experience in
relation to motivation behind paraphilia
- based on the principle that whatever stimuli were
present during an initial sexual experience becomes
paired with sexual arousal and orgasm
- Example: When an individual looks into someone’s open
window and witnesses’ nudity or sexual activity may
become sexually aroused. If the individual continues to
look and begin to masturbate or replays for sexual
satisfaction, voyeurism has now been associated

22. Treatment
 Medical Treatment:
SN. CLASS DRUGs DOSES MOA
1 Anti-
androgens
i. Medroxyprogesteron
Acetate
ii. Flutamiae, Cyproterone
acetate
7.5mg
QID
250mg /
day
- Appears to act by
blocking testosterone
synthesis resulting
decrease in libido
2. Anti-
psychotics
Chlorpromazine, Haloperidol
3. Mood
stabilizer
Lithium, Proparanolol,
Carbamazepine,
Clonazepam
They become widely
distributed in the CNS
and interacts with a no. of
neurotransmitters
increasing serotonin
synthesis.
4. Anti-
depressant
Fluoxetine hydrochloride 20-80
mg/day
selective serotonin
reuptake inhibitors
(SSRIs)

23. Treatment contd…
 Behavorial therapies:
1) Victim identification
 exhibitionism, frotterism, pedophilia, sexual sadism,
and voyeurism
 Exercises such as role reversal may be used and the
client may be asked how the victim might feel both
during and after the victimizing act
 The goal of this therapeutic approach is for the
client to develop empathy towards their victims
 If the client is able to develop sufficient empathy
toward their victims, they may reduce or discontinue
the behavior because it is less pleasurable.

24. Treatment contd…
2) Covert conditioning:
⁻ This type of intervention can be used with nearly all of
the paraphilias
⁻ is a behavioral method in which undesirable behavior
becomes less desirable and is eventually eliminated
⁻ the client is asked to imagine feeling of shame when
friends or family members observe him engaging in
the behavior associated with the paraphilia.

25. Treatment contd…
3) Aversion therapy:
- In this type of treatment the client is encouraged to become
aroused by the deviant fantasies and is immediately bombarded
with an unpleasant smell or electric shock.
- The pairing of deviant fantasies with unpleasant sensations is
thought to decrease both fantasies and behaviors.
4) Group therapy:
- this focuses on establishing family support, building relationship
and social skills, and cognitive restructuring
- Thus, treatment that focuses on social skills may be helpful which
include some of the tactics we have already discussed (i.e., victim
identification) and may also help the client to develop a new way of
looking at things.