ABSTRACT
Introduction 294
Defining and Conceptualizing the Paraphilias 294
Prevalence 295
Gender and the Paraphilias 296
Comorbidity 297
The DSM-IV-TR Listed Paraphilias 298
Voyeurism, Exhibitionism, and Frotteurism 298
Voyeurism 298
Exhibitionism 298
Frotteurism 300
Sexual Sadism and Sexual Masochism 300
Fetishism and Transvestic Fetishism 302
Fetishism 302
Transvestic Fetishism 303
Pedophilia 305
Paraphilia Not Otherwise Specified 306
Etiology of the Paraphilias 307
Psychoanalytic Models of Etiology 307
Psychoanalytic View of Fetishism 307
Psychoanalytic View of Transvestic Fetishism 307
Psychoanalytic View of Exhibitionism 308
Psychoanalytic View of Sadomasochism 308
Family Dysfunction Models of Etiology 309
Behavioral Models of Etiology 309
Conditioning Theories of Paraphilia 309
Deviant Arousal Theory of Paraphilia 310
Courtship Disorder Theory of the Paraphilias 311
Personality Theories of the Paraphilias 311
Biological Theories of the Paraphilias 312
Treatment of the Paraphilias 314
Pharmacological Treatment of the Paraphilias 314
Antidepressants 314
Antiandrogens 315
Neuroleptics and Other Agents 316
Psychological Treatment of the Paraphilias 317
Psychiatric Assessment of Paraphilias 318
Cognitive-Behavioral Treatment 320
Conclusion 322
References 323
INTRODUCTION
One literal translation of paraphilia-love beyond the usual-casts a benign, if
not romantic, hue over a subject that has been marked by considerable pro-
fessional dissidence (1). Although this chapter will not provide a critique of
the paraphilia construct, any responsible discussion of the paraphilias must
acknowledge the cultural underpinnings of efforts to define normality vs.
abnormality in human behavior. This theoretical debate plays out in the literature,
where a range of positions are evident, from loyal adherence to traditional defi-
nitions of pathological sex to advocacy for the elimination or radical revision of
the paraphilia diagnostic category (2-4). Only a greater empirical base will
resolve this controversy and provide a reasonably objective basis on which clin-
icians can define the boundary between “normal” and “abnormal” sexuality.
