Paraphilic Disorders: A double taboo

by Sanjana Karnik 
June 27, 2022
Paraphilic Disorders: A double taboo

It is not news that mental health is still a taboo concept in India. Likewise, sexual intercourse is a subject that is often shrugged off as it is believed to be humiliating and sinful to discuss, to the point that even expressing one’s sexuality and sexual orientation is deemed as vulgar. When coupled, sexual disorders can easily be termed a double taboo, considering the stigma surrounding mental health as well as sex. Consequently, most people, even therapists, are often uncomfortable discussing sexual issues, which leads to sexual disorders lurking in the backdrop, masking behind shame, fear of rejection, depression, anxiety, etc. Here, the aim is to present a brief overview of paraphilic disorders.

Paraphilic disorders are often misconstrued as an across-the-board definition for any unusual sexual behavior. However, most individuals with atypical sexual interests do not necessarily have a mental health disorder. In order to be diagnosed with a paraphilic disorder, DSM-5 mandates that individuals feel emotional distress concerning their sexual interests, not simply distress resulting from the society’s disapproval and/or having a sexual desire or behavior that affects another individual’s psychological distress, injury, or death. Additionally, it incorporates an appetite for sexual behaviors involving unwilling individuals or individuals unable to give legal consent. Paraphilic disorders are recurrent, intense, sexually arousing fantasies, urges, or behaviors that are distressing or disabling. It involves inanimate objects, children, or nonconsenting adults, which includes the suffering or humiliation of the individuals along with the potential to cause harm. The International Classification of Diseases categorizes paraphilias as “disorders of adult personality and behavior,” and paraphilic disorders are labeled “disorders of sexual preference.” Paraphilic disorders include eight conditions: Fetishism, Fetishistic Transvestism, Exhibitionism, Voyeurism, Pedophilia, Sadomasochism, Frotteurism, and Necrophilia.

· Fetishism relies on non-living objects (undergarments, stockings, rubber items, shoes, or boots) to stimulate sexual arousal and sexual gratification.

· Fetishistic transvestism primarily involves wearing clothes of the opposite sex to acquire sexual excitement.

· Exhibitionism is a recurrent tendency to reveal genitalia to strangers or individuals in public places without inviting or intending closer contact.

· Voyeurism is the persistent tendency to peek at people engaging in sexual or intimate behavior such as undressing.

· Pedophilia is the sexual preference for minors, typically prepubertal or early pubertal age.

· Sadomasochism refers to a preference for sexual activity that concerns bondage or the infliction of pain or humiliation.

· Frotteurism is defined as recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person for sexual stimulation. Lastly,

· Necrophilia involves the sexual attraction to a dead body.

The etiology of paraphilic disorders is relatively unexplored, and various theories circling the development of sexual deviance have been hypothesized. For example, from the psychodynamic perspective, the pattern of unusual arousal is usually well developed before puberty, and it is often attributed to anxiety or early emotional trauma that interferes with normal psychosexual development. On the other hand, the behavioral perspective argues that paraphilic disorders are learned and result from early classical and/or operant conditioning.

Paraphilic disorders primarily impact males with an average onset between ages 8 and 12. Additionally, Voyeurism is regarded as the most prevalent paraphilic disorder, affecting up to 12% of males and 4% of females (Raymond & Grant, 2008).

More often than not, there is much secrecy and shame around atypical sexual behaviors. Therefore, many individuals with paraphilic disorders do not seek professional help unless mandated or when it becomes disabling, making its treatment complicated. Psychotherapy and medication have been proven to be the most effective treatment methods. Cognitive-behavioral therapy, Behavior therapy, Social skills training, Relapse prevention, Couple therapy or family therapy, group therapy, twelve-step programs, and medications are some of the most commonly used and effective treatment approaches to tackle paraphilic disorders.

The domain of paraphilic disorders is a complex, inadequately understood, stigmatized, and insufficiently studied area. It is challenging to conduct studies concentrated on sexual disorders since considerable individuals diagnosed with paraphilias would not participate in research for reasons ranging from legality to societal acceptability. Therefore, it is not a diagnostically and therapeutically well-charted region.


Sanjana Karnik

Clinical Associate,


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