Signs and Symptoms of Paraphilic Disorders

Paraphilic disorders are a group of mental health conditions that cause recurring and intrusive sexual thoughts, fantasies, and behaviors involving children, non-consenting people, or inanimate objects. They also cause people with these conditions to experience significant personal distress and limited functioning.

Sex is a normal part of life, and having unconventional sexual thoughts and fantasies isn’t unusual. However, when these urges and thoughts become so intense as to interfere with your daily functioning, it may be a paraphilic disorder. People with paraphilic disorders will often engage in sexual behaviors that can cause harm to themselves and others. Some paraphilias focus explicitly on causing pain and suffering to oneself or others. 

Not all paraphilic interests make up a paraphilic disorder. It’s important to distinguish between paraphilia and a paraphilic disorder. While the former includes unusual sexual urges and behaviors, the latter features recurrent and intense unusual sexual urges and behaviors that can cause impaired functioning and harm to yourself or others. 

Symptoms of Paraphilic Disorders

Symptoms of paraphilic disorders are wide and varying. A common thread in signs of paraphilic disorders is their potential to cause harm. They are often so intense that they cause significant distress and disrupt daily functioning. Many paraphilic disorders listed in The Diagnostic and Statistical Manual (DSM-5) must have persisted for at least six months before they may be classified as a disorder. 

Identifying Paraphilic Disorders

It’s important to note that there’s a distinct difference between paraphilias and paraphilic disorders. Paraphilias can be harmless if they aren’t causing harm or distress to yourself or others. If there’s a risk of harm, it could also be classified as a paraphilic disorder. For unknown reasons, paraphilias appear more common in men than women. To be diagnosed with a paraphilic disorder, the DSM-5 requires the following criteria to be met: 

• Feeling personal and not just societal distress as a result of your sexual interests urges, and behaviors
• Experiencing sexual desire that could cause physical harm or psychological distress to another person 
• A willingness to engage in sexual behaviors with non-consenting parties or people who cannot give consent. 
  

Causes of Paraphilic Disorders

It’s a little unclear what exactly causes paraphilic disorders. Scientists and researchers suspect that a combination of neurobiological, genetic, cognitive, and interpersonal factors play a role. In a 2019 study on paraphilic disorders, researchers observed that people with paraphilic disorders have elevated levels of serotonin and norepinephrine and decreased levels of a chemical messenger called dihydroxyphenylacetic acid (DOPAC).

Types of Paraphilic Disorders

According to the DSM-5, there are eight types of paraphilic disorders. They are: 

Fetishism Disorder

With fetishism, a person uses inanimate objects to create sexual pleasure. They could also focus on body parts without genitals to create sexual pleasure. Fetishism can be harmless. It’s only classified as a disorder when it causes significant distress or causes some form of harm and occurs for at least six months. Some common fetishes include food, hand, armpit, and leg fetishes. 

Frotteuristic Disorder 

A person with frotteurism will rub their genitals against another’s in a sexual manner without the other person’s consent. It’s a rare type of paraphilia, and much research still needs to be done to understand it. According to the DSM-5, for a person to be diagnosed with frotteurist disorder, they must have experienced an intense and recurrent urge to rub their genitals against a non-consenting party to achieve sexual gratification for at least six months. They must also have acted upon this urge and experienced significant distress as a result.

Sexual Sadism Disorder 

Sexual sadism involves inflicting physical or psychological pain on another person to achieve sexual gratification. It’s important to distinguish between sexual sadism disorder, a paraphilic disorder, and sadistic sexual behavior, which is not. It’s normal for mild sadistic sexual behavior to occur between two adults who consent. With sexual sadism disorder, the sadistic sexual urges cause significant distress. The desires must have been present for at least six months for it to be classified as a disorder. Sexual sadism disorder can be dangerous as it’s often carried out on non-consenting parties.

Exhibitionistic Disorder

People with an exhibitionistic disorder will expose their genitals to non-consenting people and experience sexual excitment. They may become distressed and unable to function properly due to their urges. On the other hand, exhibitionism which isn’t a paraphilic disorder, is simply the desire to expose your genitalia to a consenting party and become sexually excited afterward. 

Pedophilic Disorder

Pedophilia is sexual attraction to children. According to the DSM-5, a person with pedophilic disorder must have felt intense and recurrent sexual urges, behaviors, and fantasies toward prepubescent children for at least six months. A vital component of the condition is that it must bring significant distress or impairment to a person with it. It’s important to note that acting on sexual attraction to children is a crime. 

Sexual Masochism Disorder 

Sexual masochism may be seen as the flip side of sexual sadism. With sexual masochism, being beaten, humiliated, or abused will bring sexual excitement and gratification. Asphyxiophilia, a desire to have your breathing restricted during sexual activity, is sometimes considered a subtype of sexual masochism. 

Voyeuristic Disorder 

Voyeuristic disorder causes a person to have intense and recurrent urges to watch a non-consenting person engage in sexual activity. Voyeuristic disorder causes significant distress and can limit a person’s ability to function. Voyeuristc disorder is more common amongst men than women. 

Transvetstic Disorder 

A person who is sexually aroused by cross-dressing may have transvestic disorder. For it to be regarded as a disorder, the urges or behaviors must have been recurrent, intense, and present for at least six months. While people who cross-dress are typically happy to and may not experience sexual arousal from doing so, a person with this disorder is experiencing significant distress and limited functioning. 

Paraphilic disorders are not limited to the above eight types. People’s sexual interests are broad and diverse, creating possibilities for many paraphilic conditions not recognized by the DSM-V to crop up. 

Treatment for Paraphilic Disorders

Treatment for paraphilic disorders is highly individualized. It depends on various factors, including which type of paraphilic disorder you have and the personal goals of the person being treated. In general, different forms of therapy and medications are used in treating paraphilic conditions. A combination of psychotherapy and medication is often recommended for the most effective results. 

Medication 

Antiandrogen treatment is the first line of pharmacological treatment for men with severe paraphilic disorders. Antiandrogen treatments are particularly recommended for paraphilic disorders that can cause harm to others or lead to sexual offenses. Antiandrogen treatments work by reducing testosterone which in turn reduces sexual drive. In mild cases, selective serotonin reuptake inhibitors may be prescribed. There’s currently no medication explicitly approved for the treatment of paraphilic disorders. 

Psychotherapy 

Psychotherapy is recommended for all people with paraphilic disorders, regardless of the severity of their symptoms. Cognitive behavioral therapy (CBT) has been the most commonly used form of psychotherapy. However, in severe cases, CBT alone may prove to be ineffective.

A Word from Verywell 

Paraphilias and paraphilic disorders are two separate terms. Paraphilias are unusual sexual urges and behaviors. However, these behaviors are much more commonplace than you may think and shouldn’t alarm you if you’re experiencing them. With a paraphilic disorder, you will likely experience such intense feelings and urges that they bring about significant distress and limit daily functioning. It’s crucial to get treatment for a paraphilic disorder to save yourself from harm and prevent harm to others.