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Paraphilias - Paraphilias Symptom, Cause, Treatment
Paraphilias are sometimes referred to as sexual deviations or perversions. Paraphilia is also used to imply non-mainstream sexual practices without necessarily implying dysfunction or deviance. The disorder is characterized by a 6-month period of recurrent, intense, sexually arousing fantasies or sexual urges involving a specific act, depending on the paraphilia. Richard Von Krafft-Ebing, a German psychiatrist credited with formally introducing the study of Sexology as a psychiatric phenomenon, identified paraphilias first in his 1886 Psychopathia Sexualis (Sexual Psychopathy). Some psychiatrists discuss whether paraphilias are a part of the impulse control disorders or if they fall within the spectrum of obsessive-compulsive disorders. In descending order, the most common are pedophilia (sexual activity with a child usually 13 years old or younger), exhibitionism (exposure of genitals to strangers), voyeurism (observing private activities of unaware victims) and frotteurism (touching, rubbing against a nonconsenting person), while fetishism (use of inanimate objects), sexual masochism (being humiliated or forced to suffer), sexual sadism (inflicting humiliation or suffering) and transvestic fetishism (cross-dressing) are far less common. There is also a sense of distress within these individuals. There is also a category called Paraphilia Not Otherwise Specified to cover paraphilias not falling into the already named diagnoses such as those involving dead people, urine, feces, enemas and obscene phone calls
Symptoms of Paraphilias
Some are common symptoms of Paraphilias :
- The person has occasionally exposed himself (three targets or fewer) and has difficulty controlling urges to do so.
- A fourth level of severity, catastrophic, would not be found in exhibitionists without other paraphilias.
- For instance, having a partner "talk dirty" may be a "turn-on" for some people, but when talking dirty is the only way that sexual arousal or satisfaction can occur, it would be considered a paraphilia.
- They may experience distressed or impaired functioning because of the sadistic behaviors or fantasies.
- Individuals with sexual sadism derive sexual excitement from physically or psychologically administering pain, suffering, and/or humiliation to another person, who may or may not be a consenting partner.
- The person has recurrent fantasies of exposing himself, but has rarely or never acted on them.
Causes of Paraphilias
The common causes of Paraphilias :
- Several studies have shown that emotional abuse in childhood and family dysfunction are both significant risk factors in the development of exhibitionism.
- an individual who is dressed in a woman's clothes as a form of parental punishment
- There are a small number of documented cases of men becoming exhibitionists following traumatic brain injury (TBI) without previous histories of alcohol abuse or sexual offenses.
- physiological problems
- Some researchers believe that paraphilias are related to such other problems as brain injury, schizophrenia , or another mental disorder.
- Look for both hard and soft neurological signs involving the striato-thalamo-cortical processing loop (theory).
Treatment of Paraphilias
- Long-term individual or group psychotherapy is usually necessary and may be especially helpful when it is part of multimodal treatment that includes social skills training, treatment of comorbid physical and psychiatric disorders (eg, seizure disorders, attention deficit disorder, depression), and hormonal treatment.
- This form of therapy is used to get patients past the denial frequently associated with paraphilias, and as a form of relapse prevention.
- This approach is particularly helpful for patients who are married and whose marriages and family ties have been strained by their disorder.
- In the USA, IM medroxyprogesterone acetate is the treatment of choice; cyproterone acetate is used in Europe.
- Social skills training is used with either of the other approaches and is aimed at improving a person's ability to form interpersonal relationships.
- The medications that may be used include female hormones (most commonly medroxyprogesterone acetate, or MPA), which speed up the clearance of testosterone from the bloodstream; antiandrogen medications, which block the body's uptake of testosterone; and the selective serotonin reuptake inhibitors, or SSRIs.
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