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October 2014
Sexology
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PARAPHILIA

This term includes all pathological expressions that were once called perversions and sexual deviations.

Homosexuality has not been included under this term for approximately thirty years.
This fairly new term is intended to indicate that the deviation (para) is caused by an object which attracts the individual (philia). Having said this, some people suffer from problems that cause them to have problems with intimacy, also on an emotional level, but they are not necessarily pathological.   
Usually, pathological problems occur along with a sufficient desire but also the inability to invest one’s feelings in one person and the need to deal with feelings of emptiness. Fortunately, more mild forms of paraphilia still have a certain level of flexibility and the individual is not yet imprisoned without an escape route.

This is the case with organised paraphiliac forms though, which have a well defined diagnostic codification. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) produced by the American Association of Psychiatry:

the essential features of a Paraphilia are recurrent, intense sexually arousing fantasies, sexual urges or behaviours generally involving:

  1. nonhuman objects;
  2. the suffering or humiliation of oneself or one’s partner;
  3. children or other non-consenting persons.

It has to occur over a period of at least 6 months to be classified.

Editorial note:

This prolonged period (six months) of symptoms needed in order to define the diagnosis can be somewhat disconcerting because any single episode of paedophilia should be considered as a pathological expression.

The DSM-IV also adds that:

For some individuals, paraphilic fantasies or stimuli are obligatory for erotic arousal and are always included in sexual activity; in other cases, the paraphilic preferences occur only episodically. The fantasies, sexual urges or behaviours cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Paraphilic fantasies may be acted out with a non-consenting partner in a way that may be injurious to the partner (as in sexual sadism or paedophilia). The individual may be subject to arrest and incarceration. Sexual offenses against children constitute a significant proportion of all reported criminal sex acts, and individuals with exhibitionism, paedophilia and voyeurism make up the majority of apprehended sex offenders. [...] social and sexual relationships may suffer if others find the unusual sexual behaviour shameful or repugnant or if the individual's sexual partner refuses to cooperate with the unusual sexual preference. In some instances, the unusual behaviour (for example, exhibitionist acts or collecting fetish objects) may become the major sexual activity in the individual's life.

Paraphilia includes exhibitionism (exposing the genitals), feticism (using inanimate objects), frotteurism (touching or leaning against a non-consenting person), paedophilia (when one's sexual interest is focused on prepubescent children), sexual masochism (being humiliated or suffering), sexual sadism (causing humiliation or suffering), cross-dressing fetish (wearing clothes of the opposite sex) and voyeurism (watching sexual activities).

Exhibitionism

In this paraphilia, the individual gets pleasure out of showing his/her genitals to a stranger, and sometimes even masturbating. Usually he/she does not attempt to begin any further sexual activity. The onset is often before the age of 18, even if events can take place later on in life. In order for diagnosis to be satisfied, the individual must expose him/herself over a period of at least six months and fantasies, sexual impulses or behaviour must cause significant distress to others and an impairment in important areas of functioning, such as social or occupational areas. These specifications are also valid for the comprehensive definition of all diagnoses of paraphilia.

Feticism

This refers to the use of items (socks, underwear, bras, boots, etcetera) in order to become aroused. They are usually rubbed or sniffed during masturbation, or worn by the partner during intercourse. The fetish has fundamental importance for excitement and the male's erection because it will not occur if the desired object is not used. Its onset is usually early and it is normally acted upon in adolescence, even though the fetish may have been characterised by significant experiences during early childhood. Once acted upon, it tends to become chronic.

Frotteurism

The individual rubs or touches a non-consenting person, usually in crowded places (for example, sidewalks where many people pass through or on crowded means of public transport) so as to avoid the risk of being arrested. The most affected areas are the genitals, breasts, thighs and buttocks. The onset usually occurs in adolescence and the behaviour peaks between 15-25 years, then, from this age its frequency gradually reduces.

Paedophilia

A person who is at least 16 years old and at least 5 years older than the victim who practices sexual activity with prepubescent children is defined as paedophile. Paedophiles are usually older than late adolescents. The attraction to females, which is the most common, usually involves girls between 8-10 years old, while that for males involves boys who are slightly older. The DSM-IV notes: Individuals with paedophilia who act on their urges with children may limit their activity to undressing the child and looking, exposing themselves, masturbating in the presence of the child, or gentle touching and fondling of the child. Others, however, perform fellatio or cunnilingus on the child or penetrate the child's vagina, mouth, or anus with their fingers, foreign objects, or penis and use varying degrees of force to do so. These activities are commonly explained with excuses or rationalizations that they have "educational value" for the child, that the child derives "sexual pleasure" from them, or that the child was "sexually provocative" – themes that are also common in paedophilic pornography. Individuals may limit their activities to their own children, stepchildren, or relatives or may victimise children from outside their families. Some individuals with paedophilia threaten the child to prevent disclosure. Others, particularly those who frequently victimise children, develop complicated techniques for obtaining access to children, which may include winning the trust of a child's mother, marrying a woman with an attractive child, trading children with other individuals with paedophilia, or, in rare instances, taking in foster children from non-industrialised countries or abducting children from strangers. Except in cases in which the disorder is associated with sexual sadism, the person may be attentive to the child's needs in order to gain the child's affection, interest and loyalty and to prevent the child from reporting the sexual activity.
The disorder usually begins in adolescence, although some individuals with paedophilia report that they did not become aroused by children until middle age. The frequency of paedophilic behaviour often fluctuates with psychosocial stress. The progress of it is usually chronic, especially in those attracted to males. The recidivism rate for individuals with paedophilia involving a preference for males is roughly twice that for those who prefer females. 

Sexual masochism

This involves the individual actually being humiliated, beaten, tied up and made to suffer. There are some masochists who are disturbed by their fantasies, which may be evoked during masturbation, but they do not act them out.

Sexual sadism

This refers to actions that are carried out that cause physical and psychological suffering to the victim but which are sexually arousing to the sadist. They may be limited to unpleasant fantasies which occur during sexual activity which makes the sadist need to exert control over the victim and over the victim’s fear that these fantasies may translate into real actions.
Sadistic behaviour can be carried out with a consenting partner, but it is often done with a non-consenting partner. Sadists express themselves with behaviour that tends to humiliate the victim, imprison him/her, beat him/her, torture him/her, and even kill him/her.
The onset mainly occurs in early adulthood and becomes chronic. The severity of the sadistic acts usually increases with the passing of time.

Cross-dressing fetish

This normally concerns a man who collects women's clothes and wears them. Once dressed, he/she masturbates, associating the sexual act to the fantasy of being both the male and female in his/her sexual fantasy.
Some men wear women's underwear under their normal clothes and others wear women's clothes and makeup but normally, however not necessarily, the individual is heterosexual.

Voyeurism

This normally involves watching strangers when they are nude or engaged in sexual activity in order to get sexually aroused. These individuals often fantasise about having a sexual experience with the person they are secretly watching. In its most severe form, voyeurism is the only possible form of sexual activity. It usually begins before 15 years old and tends to become chronic.

PARAPHILIA

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