Why do some people pretend to be ill?

These people have an internal desire to be seen as weak, ill or injured. However, in many cases there is no intention of gaining any financial benefit from this behavior. These individuals often undergo unnecessary painful and very risky medical tests and procedures in order to obtain empathy and attention which is normally given to sick people.

People who feign medical disorders: A look at Factitious Disorder

With a factitious disorders the individual behaves as if he or she has a physical or mental illness when, in fact, he or she has intentionally produced his or her symptoms. Individuals with factitious disorders purposely create or embellish symptoms of an illness in many ways. These individuals may falsify or mimic symptoms of an illness, injure themselves to bring on symptoms, or manipulate laboratory and diagnostic tests (such as purposefully contaminating a urine or blood samples).

Can one prevent a phobia?

There is no way to prevent phobias because the cause is not well understood. However, it is essential for parents to seek help for their phobias because they can sometimes pass it on to their children from their actions.

How are phobias generally treated?

Once the phobia is diagnosed, there are treatments for this mental disorder. In most cases, a combination of medication and behavior therapy can help reduce the phobia. In the majority of cases, a phobia will never get better if it is left alone.  There is no cure for phobia but the therapies can help reduce the fear and anxiety. The behavior therapies can help you manage your reactions to the phobic-causing situation. The types of medications used to treat phobia range from beta-blockers to reduce the symptoms of fast heart rate and sweating, anti depressants and sedatives. Behavior therapy can help one adjust to the phobia. The therapies emphasize learning and developing a sense of behavior control of thoughts and actions.

What can happen if I do not seek treatment for my phobia?

Phobias may appear trivial but can be distressing to the individual. Phobias lead to social isolation, withdrawal from society, depression and alcohol/substance abuse.

What causes phobias?

Like most things in psychiatry, the cause of phobias is not known but the disorder does tend to run in families. Phobias generally present in the 20s and 30s but may start earlier. Women tend to be more affected than men, but this possibly thought to be due the fact that men do not complain or seek help. Many men tend to hide the problem so that they are not seen as weaklings. In some cases, phobias may be precipitated by a traumatic event like an animal attack or a frightening plane ride. 

What are general symptoms of a phobia?

The symptoms of phobia can be intense and range from uncontrolled anxiety, a  feeling that one must do something to get away from the situation, inability to think rationally, develop sweating, fast heart beat, rapid breathing and a feeling of severe panic. Phobias in children may present as excess clinging, crying or severe behavior alterations. 

I sometimes feel afraid for no apparent reason. What do you think is wrong?

Phobia is defined as an intense and irrational fear of a situation or an object that in reality poses little risk. A phobia is different from anxiety and can be long lasting, cause severe physical and emotional reactions that can affect one’s ability to function normally. There are many types of phobias- some people hate closed spaces, others fear certain animals, some are afraid to get in the elevator and so on. In general, phobia does not need treatment if it does not affect you daily life. 

Can mood disorders exist with other illness?

Mood disorders also tend to coexist with other mental and physical disorders. Anxiety is a commonly associated disorder in individuals with depression. Substance abuse, excess use of prescription drugs and personality disorders are extremely common in people with mood disorders.

The biggest difficulty with mood disorders is that many individuals have no idea they have the illness and are unwilling to accept such a stigmatized diagnosis.

Is there a downside to having a mood disorder?

There is an erroneous belief among lay people that mood disorders are benign. This is far from the truth. The most dreaded complication of major depressive disorder is suicide. At least 10-15 percent of patients who have been hospitalized for depression go on to commit suicide. Worldwide the numbers are much higher and close to 30 percent of all depressed individuals commit suicides.  Completed suicides are more widespread among individuals who have severe paranoia or psychotic symptoms, addictive personalities, those who experience stressful life events, have a chronic medical illness or a family history of suicidal behavior. In the US, men go on to kill themselves four times more often than women. The magnitude of mood disorder is enormous and has reached epidemic proportions in some parts of the country. With the recent downturn in economy, murder and suicides are reported almost on a daily basis.

Why do people with mood disorders not seek help?

The sad fact is that only a few patients with mood disorders seek professional help for fear of embarrassment or ridicule. Most of these individuals are diagnosed with a mood disorder when seeking help for another medical disorder. Today, mood disorders account for a large portion of health care costs. Many individuals do not want to be stigmatized. These individuals usually ask for expensive and unnecessary tests to look for another cause that may account for their symptoms. Many individuals go through unnecessary therapies for physical disorders which do not exist, whilst the mood disorder remains undiagnosed and untreated.

Which mood disorder is most common in North America?

The one mood disorder that is predominant in American society is major depressive disorder. This chronic illness is twice as common in women and accrues a considerable morbidity. Women between the ages of 18 and 45 comprise the majority of those with major depression.  Depression also has a venomous blow on the economy, both in reduced productivity and more consumption of limited health care resources. In the workplace, depression is a principal cause of absenteeism and diminished productivity.

Do mood disorders lead to complications?

The disability suffered by an individual with a mood disorder is broad. Besides the individual, spouses, parents, children, siblings, friends and colleagues all experience fury, blame, aggravation, financial woes and on occasion even physical abuse in their efforts to alleviate or manage with the mental anguish. Many individuals eventually end up with hassles with the law. 

Why is there a low incidence of mood disorders in the East?

The biggest difference between western society and eastern cultures is that mental disorders are accepted as a bona fide illness by the former; whereas in many oriental cultures, mood disorders are not accepted even among physicians.  There tends to be a belief that these people are malingering or faking an illness. Psychiatry is not even well practiced in many parts of the world. The taboo associated with mental disorders has left many orientals suffering in silence. In many other cultures, superstition and religious beliefs override all mental illness. If you act crazy in some countries, rather than give you Prozac you are regarded as holy and even worshipped.

Is anyone immune from mood disorders?

Mood disorders are more common in every segment of society including single, divorced and separated individuals.  There is no correlation with social status, age, class or color. Risk factors for mood disorders include a positive family history, personality factors, environmental strain(s) and a possible imbalance of certain chemicals in the brain. No society, culture, race or gender is immune from mood disorders. 

Which mood disorders are common in North America

The clusters of mood orders which are common include depression, bipolar disorder, anxiety, schizophrenia and eating disorders. Mood disorders are diagnosed when the symptoms fall beyond the normal fluctuations of sadness or happiness. What is not appreciated is that mood disorders have severe consequences on the individual, family and friend and carry a significant morbidity and mortality. Worldwide, mood disorders rank in the 10 causes of major illnesses. At the top of the list is unipolar depression followed by bipolar. 

Are mood disorders common?

Humans have been plagued with mood disorders since time immemorial. One of the first expressions for depression, melancholy, literally implying "black bile" dates back to the ancient days of Hippocrates. Since earliest recorded history, mood disorders occurring outside of the norm have been recognized and charted.

The exact number of people suffering from mood disorders in the USA is not known but the numbers are high. Estimates from mental health clinics reveal that anywhere from 7-18 percent of the population suffers from mood disorders and there are countless others who have not been diagnosed for fear of embarrassment or lack of money to see a health care professional.

Do mood disorders affect everyone?

At some point in time, all individuals will experience a heartbreaking event or unanticipated loss of a loved one, or deep sadness, grief or anguish. Indeed this is just a range of normal behavior and emotions. However, when the symptoms or signs of mood disorders are prolonged and tend to affect the individual or others around, a diagnosis of mood disorder is generally made. The story does get complicated because of overlapping symptoms and today psychiatrists use the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a guide. This bible of psychiatry provides diagnostic criteria for the majority of mental disorders. The DSM now in its 5^th edition is widely used by psychiatrists in the US, health care workers, pharmaceutical manufacturers and policy makers all over the world.

How does one treat schizoid personality?

The treatment of schizoid personality is difficult as most individuals are non compliant or have trouble interacting with the therapist. There are no specific medications but some may require anti psychotics to help reverse the flat emotion. Some may benefit from group therapy because it provides social support. Early intervention in childhood may help diminish problematic behaviors in a few individuals but by far, the majority continue to worsen.

What are complications of having schizoid personality?

Individuals with schizoid personality rarely seek professional help and only come to attention after legal or social problems. Schizoid personality suffers are at a great risk for developing drug addiction, depression, anxiety, panic or social phobia. Many of these individuals are naïve, are prone to victimization and often are preyed upon by others. These individuals always underestimate ill intentions of others and are often physically and emotionally hurt.

When does schizoid personality present in life?

The cause of schizoid personality disorder is unknown. Schizoid personality may be seen early in life and peaks around adolescence. Both genders are affected but the disorder is slightly more common in males. The majority of individuals with this personality live a quiet solitary life, living in a family basement and work late night shifts where they do not have to interact with others. One important feature to understand about this personality is that unlike schizophrenics, they do not experience delusions, paranoia or psychotic episodes. These individuals may have a slow speech but usually do not say anything that is bizarre or odd.

What causes schizoid personality?

Like most personality disorders, the cause of schizoid personality is a mystery. Factors that increase risk include child abuse, having emotionally detached parent(s) or childhood neglect. Bad genes and bad luck explain a lot of things in psychiatry.

What is a schizoid personality?

 Schizoid personality disorder is a disorder where by an individual avoids social interactions and consistently withdraws from interaction with others. Individuals with Schizoid personality are usually loners and lack the ability to interact with others or form any type of constructive relationship. Individuals with schizoid personality disorder usually appear as aloof with a dry humor and are alone in a social environment. These individuals have very limited range of emotions, have a flat affect and usually remain indifferent to the surrounding environment. Most have little desire of experiencing sex, have very little to say, lack motivation, under perform and appear dull or boring to others. However, the inner life of these individuals is full of turmoil, confusion, ambivalence and wanting some type of emotional comfort. When given a chance to develop a relationship, these individuals quickly feel suffocated and retreat.

Does Transvestic Fetishism require treatment?

Most people who practice this type of fetish behavior do not want to be treated because they usually are not harming anyone. For those who feel like their behavior is interfering their work and relationships, treatment comprises of cognitive behavior therapy and use of certain medications (SSRIs) to diminish the urge to cross dress. Unfortunately, despite treatment relapse rates are high.

Is Transvestic Fetishism illegal?

Transvestic fetish is usually performed in private but many males do wear female under-garments to work. Of course, the clothing is worn under regular work clothes. Transvestic fetishism and trans-sexual disorder are not the same. With the former, the individual still wishes to live his/her life as a member of the opposite sex.

Transvestic fetishism is not considered illegal or criminal and most of these individuals lead normal lives. Just like some people like to watch porno movies for sexual arousal, these individuals like to cross dress for the purpose of sexual arousal. Problems usually arise when this type of fetish is combined with other paraphilias like pedophilia or voyeurism.

Are there many people into Transvestic Fetishism?

The exact number of people who are into Transvestic fetishism is unknown because it is a behavior performed at home and not many people brag about it. What is known is that the behavior usually starts in early adolescence and continues throughout life. Men who practice this behavior are often sexually aroused by wearing female garments which may include bras, panties, corsets, slips, girdles, stocking, shoes and even jewelry. These individuals will often masturbate while wearing clothing or may get aroused from just fondling the items. 

The majority of people who practice this behavior are heterosexuals, usually married and have partners who are fully aware of the fetish. In many cases, these people also have children and lead an otherwise normal life.

Transvestic Fetishism: Sexual arousal from cross dressing

Transvestic fetishism is a disorder where one derives sexual arousal from wearing clothes of the opposite sex. The majority of such cases involve males wearing female clothing, but there are some reports that females also derive similar sexual pleasure from wearing men’s clothes. The disorder is only considered a problem if the individual has been deriving sexual pleasure from cross dressing for at least 6 months. Moreover, the urge to cross dress must cause some type of personal stress and affect both lifestyle and interpersonal relationships.

Can one prevent conversion disorder?

Unfortunately there is no way to prevent conversion disorder, but if you have been diagnosed with any type of mental health disorder, ensure that you are being properly treated.

Is there any specific treatment for conversion disorder?

In most cases, the symptoms of conversion disorder do improve without any treatment; the best treatment is reassurance that the symptoms have no serious underlying pathology. If the symptoms do recur, then one may benefit from psychotherapy, physical therapy or use of medications. Many individuals with recurrent conversion disorder are treated with anti anxiety agents, sedatives or beta blocking drugs. In some cases, anti depressants have helped relieve the symptoms. There are reports that certain individuals may benefit from hypnosis and mind relaxing techniques. Recently, brain magnetic stimulation has been attempted in individuals with conversion disorder. The results so far are mediocre and not everyone responds to the treatment. 

How is the diagnosis of conversion syndrome made?

There are certain criteria that one must meet to be diagnosed with a conversion syndrome.

-Your symptoms are out of your control and may mimic another medical disorder.

-The  symptoms must be recent and follow a stressful event

-You did not deliberately cause the symptoms.

-Your symptoms cannot be explained by drug use, any organic lesion or cultural behaviour.

-Symptoms must induce intense impairment in your social life, work or other environments.

-Symptoms are not related to pain or sexual problems and cannot be accounted by any other mental disorder.

 Because the symptoms of conversion disorder may mimic a real physical disorder, many individuals go through extensive investigations before a diagnosis of conversion disorder is made. Conversion disorders can mimic syphilis, Parkinson’s disease, stroke, lupus, spinal cord trauma, or a muscle movement disorder like myasthenia gravis.

What is the outlook for people with conversion disorder?

In most patients, simple reassurance will help improve the disorder but at least 25% of individuals develop recurrent symptoms. Individuals who develop recurrence because of failure to seek treatment, have an underlying serious mental health disorder or have tremors/seizures not related to seizures. There are reports that some patients who have a neurological disorder can also develop a conversion disorder.

What are risk factors for conversion disorder?

Female gender especially 20-30 years of age

Recent emotional trauma or stress

Already having a diagnosis of generalized anxiety, major depression or having a certain personality (hysterical)

Having a close family member with conversion disorder

History of physical or sexual trauma

Financial hardship

What causes conversion disorder?

The exact cause of conversion disorder is unknown but it is believed that the area of brain responsible for muscle control somehow is now controlled by emotions. It is believed that this is one way in which the brain reacts to an apparent menace.

What is a Conversion Disorder?

Conversion disorder is a situation where psychological stress (e.g. depression) is manifested in a physical way. Conversion disorder frequently develops after an intensely stressful event. The physical features of Conversion disorder may have no underlying cause and one has not control over the symptoms. In most cases, conversion disorder will present with an inability walk or use the arms, have difficulty hearing or seeing or one may not be able to speak. In rare cases, one can even have seizures, hallucinations, inability to feel pain and inability to urinate. The symptoms may be very dramatic but in the majority there is rapid improvement in several days or weeks.

Besides drugs, how else can I treat my anxiety attacks?

Life style and home remedies may help diminish anxiety. Try to exercise regularly, eat healthy, avoid alcohol and prescription medications, use some type of relaxing technique like yoga or meditation and get adequate sleep. Exercise is one of the most powerful reducers of stress and can help improve your mood and keep you healthy. Perform exercises that you like and gradually increase the intensity. 

Other alternative remedies that can be used to relieve anxiety include the use of Kava, valerian and vitamin B. Remember, except for the vitamins there is no solid evidence that any herb can relieve anxiety. Moreover, these plant products are also expensive and can have side effects. To help you manage anxiety, join an anxiety support group and address what is bothering you. Try not to dwell on the past and break the cycle when you feel anxious by going for a long walk.  Socialize with friends and family as these interactions can help reduce stress and develop loving relationships.  

Why Do I Keep on Physically Hurting My Body? A Look at Self Injury

There are, unfortunately, some people who deliberately harm their own bodies. Self injury is not intended to be a suicide attempt but rather a detrimental means to cope with emotional pain, anger, frustration or hopelessness. Self injury brings a transient sense of calm and a release of stress but this is soon followed by guilt, humiliation and going back to the same agonizing emotions. Self injury usually starts as minor injuries but can lead to severe disfigurement.Self injury is felt to be an impulsive behavior problem but may be associated with depression, an eating disorder (bulimia) and borderline personality. Individuals who self injure may have a variety of symptoms including physical scars, scratches, broken bones, being lonely, having difficulty with interpersonal relationship, wearing long sleeved garments even in hot weather or blaming the injury on others. Self injury is not only cutting oneself but may involve piercing the skin, breaking bones, head banging, biting, pulling out hair and making the wounds worse by probing.

Self injury is rarely a one-time episode and for some people it is a repetitive behavior that is often impulsive. Like most things in psychiatry, the cause of self injury is a mystery. Some people simply are not able to cope with their emotions and find self injury one way to relieve the psychological pain. It is believed that the physical injury distracts the individual from the painful emotions. Some people self injure their bodies to chastise themselves for alleged faults, and in others self injury may be a way of manipulation or getting attention.

Besides the direct physical injury to the body, this behavior also has other complications including accidental suicide, permanent scars, disfigurement or worsening of shame and guilt. The number of people who self injure themselves remains unknown but the disorder appears to be slightly more common in women. The disorder tends to peak in the second or third decade of life.

Self injury is a very difficult disorder to treat. There is no one treatment for everyone.The treatment is usually long-term psychotherapy, which can help one learn skills to manage stress control emotions, enhance a better body image, and develop a healthy lifestyle.There are no drugs to treat self injury but sometimes anti depressants may be prescribed to improve depression, reduce anxiety or control the impulse behavior. 

Depending on the degree of injury, one may even need hospitalization. Because of the seriousness of the problem, there are national hotlines where one can call for immediate help. The national suicide prevention lifeline (800- 273-8255) is available 24 hours a day. For people who have this problem, it is recommended that they try to reach out to their family and friends for support. Try to enroll in a support group and do not underestimate your ability to change. Avoid abuse of drugs and alcohol and get to know more about your medical illness. Unfortunately there is no way to prevent this behavior. For people who have no mental health disorder and injure themselves, the prognosis is good but for those who have other mental health problems, the prognosis is poor.

How does one develop an anxious personality?

The truth is that no one knows. As with most mental health disorders, there are many speculations and everything or everyone has been blamed at one point in time. Experts believe that it is perhaps due to altered level of neurotransmitters in the brain but why the levels of these darn chemicals change is a mystery. Bad genes and bad environment are two universal themes for almost all mental health disorders.

Anxiety disorders tend to develop 1) in females more often than males, 2) in those who have had a trouble childhood, 3) those with a certain personality (A-type) and 4) in those who abuse illicit drugs or alcohol. When the disorder is not treated it can leads to severe anxiety, depression, trouble sleeping, headaches, teeth grinding and problems with the bowel. Moreover, severe anxiety can affect interpersonal relationships, your job and make life for everyone around you miserable.

I think I may have anxiety. Is there any online testing available for my disorder?

Yes, there are several anxiety disorder tests available online that can help determine if you have an anxious personality. All humans develop some degree of anxiety but the symptoms are always well controlled and rapidly disappear. However, in some people, anxiety takes over the person’s mind and can be very troubling. Over the long period, one can develop anxiety, depression, panic attacks, hysteria, paranoia and the quality of life becomes poor.  There are many online mental health sites that offer social anxiety tests and the results are available instantly. In fact, many of these tests are free. 

The tests for anxiety are in a simple question and answer format. The questions pertain to everyday life scenarios. Moreover, the questions also ask if you have any physical symptoms when you develop anxiety. For example, one may develop tremors, sweating, fast heart rate, rapid breathing or even diarrhea during an anxiety attack. Other aspects of the social anxiety tests include your emotional mood. Are you very afraid of trivial things, do you develop intense anger, disappointment, are you depressed or have uncontrolled episodes of crying or feelings of helplessness?  The tests for anxiety  will also determine your behavior during the attack like fidgeting, pacing, cussing or avoidance. What should be understood that everyone has such symptoms to some degree. However, if these symptoms persist and affect your life style, then the anxiety is serious.

Is ginseng good for the mind?

For decades Orientals have been ingesting ginseng in large amounts. Now this fad has started in North America. Ginseng is a herb widely touted to treat many medical disorders of the brain and nerves. This herb is always listed as a best seller and brings in billions of dollars to the health supplement industry. But does it really work?

The latest studies show that ginseng when administered to healthy individuals does have very mild benefits on behavior cognition and quality of life. However, the results were not very impressive, not seen in all individuals and only seen with the panaz ginseng.

So the bottom line is that if you have money, then buy ginseng. If you do not have money, eat a healthy diet of fruit and vegetables, walk everyday and do not smoke- these simple lifestyle changes beat ginseng any day.

 

What is Fetishism?

Fetishism is sexual excitement with use of inanimate objects. Fetishism is a mental health disorder classified by DSM criteria. The disorder usually presents with intense sexual arousal, excitement and erotic fantasies involving inanimate objects for at least 6 months. Moreover, the disorder can cause a variety of behavior changes and interferes with normal social behavior and interpersonal relationships. In rare cases, the fetish can be so intense that it also interferes with work.

Fetishism is not a rare disorder. While the exact number of people who dabble into this type of behavior is not known, it is estimated that at least 1-5 percent of the population has some degree of fetishism. Most fetishists tend to be males. Fetishism tends to peak in early adolescence and continues as long as the individual is sexually active. Both men and women while masturbating may fantasize about a fetish object or they may rub, suck, wear or insert the item(s) into their body orifices. In most cases, fetishism is a solitary sexual behavior but it is not unusual for couples to practice fetishism. Some people smell the fetish or may ask the sexual partner to wear the object during sexual activity. It is believed that close to 30% of couples practice fetishism in their sexual relationships- however, the fetish is controlled and does not affect their personal lives.

One may develop a fetish to any number of objects but the most common are rubber, plastic, shoes, leather, underwear, hair, high heel shoes, boots, stockings and clothing. In many cases, the fetish is so strong that without it, the individual may be unable to achieve a sexual satisfaction. Practicing fetishism is not illegal but when the individual starts to combine it with other sexual disorders like voyeurism or pedophilia, then it results in criminal behavior.

It is widely believed that fetishism is a learned behavior and not something, that is genetically acquired. Individuals with fetishes often tell of physical or sex abuse during childhood.  Many males who have fetishes also practice other sexual behaviors like masochism, sadism and transvestism

People who are into fetishism enjoy the behavior and find it erotic. Thus, most people never willingly seek help.  Some individuals run into trouble with the law and are required to seek help. The treatment of fetishism is a combination of cognitive behavior therapies and medications.  Common drugs used to treat fetishes include drugs which reduce sexual hormones and anti anxiety agents. In most cases, therapy is not required for fetishes.

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.