Paraphilia- disorder of sexual preference

Paraphilia is a medical term to denote sexual deviation, sexual perversion or a disorder of sexual preference. Unlike curiosity, paraphilia is characterized by repetitive, strong sexual arousal to unusual stimuli (not always sexual). Not all Paraphilias as such are illegal (like cross-dressing), but some like pedophilia are considered criminal.

The recognition of paraphilia as deviant sexual behavior was established by Von Krafft Ebbing in 1886. Since then the study of paraphilias has been exhaustive in the field of forensic psychiatry. Today, paraphilias are bona fide disorders recognized in the category of sexual and gender identify disorders in the DSM IV.

For some unknown reason paraphilias occur almost exclusively in males. The paraphilia often starts during early puberty and is almost fully developed by the end of the 2^nd decade of life. Men in all cultures have been reported to develop different paraphilias. In many cases, multiple paraphilias may co-exist at the same time. At least 5-10 percent of men have as many as 5-7 paraphilias.

In most cases, the individual never seeks help and is only seen by health professional after legal troubles starts. To make a diagnosis of a paraphilia one must have intense and recurrent sexual fantasies or sexual urges that usually involve inanimate objects, children, and non-consenting adults. The behavior is often associated with torment or humiliation of others. In addition, the activity must have lasted at least 6 months and caused significant emotional distress and difficulties in interpersonal relationships.

Some of the common paraphilias include:

• Pedophilia –sexual activity involving children
• Exhibitionism -exposing one's genitalia
• Fetishism  is a love for specific objects like underwear or pantyhose
• Frotteurism is rubbing against strangers (esp. in crowded places)
• Sexual masochism (pain or humiliation of self
• Sexual sadism which involves pain or humiliation of others
• Transvestic fetishism –involves wearing clothes of the opposite sex
• Voyeurism involves peeping

Other rare paraphilias include:

- Telephone scatologia- making obscene sexually explicit phone calls

- Necrophilia- have love of dead bodies

- Zoophilia is having sex with animals

- Corprophilias is love of fecal material

- Urophilia is love of urine

The majority of paraphiliacs also have other issues like a history substance abuse, personality disorders, history of aggression and most are loners. Even after diagnosis is made, paraphiliacs are not motivated to undergo treatment. Most become non-complaint because in fact there are no good treatments for these disorders. The few motivated patients can be helped with cognitive behavior therapy to reduce the sexual urges.

Drug therapy is often used with psychosocial treatments for maximal benefit. The commonly used drugs to diminish the sex drive include provera, lupron and androcur. In addition, SSRIs are also used to decrease the sexual urges. There are no real data on prognosis but anecdotal reports suggest that treatment is difficult and relapses are common.  Most people with paraphilia remain addicted to these behaviors and often end up with legal problems. The majority eventually remain incarcerated.