ABSTRACT
This chapter provides an overview of the author's current efforts to develop a classification of the broad spectrum of disorders traditionally grouped under the heading of sexual perversions, and now referred to as paraphilias. It provides a diagnostic frame helpful both in establishing prognosis and in developing guidelines for treatment of these patients. Psychoanalysis is the treatment of choice for sexual perversions in patients with a neurotic personality organization, and for patients with a narcissistic personality disorder who have sufficient capacities for anxiety tolerance, impulse control, and sublimatory functioning, and who are able to maintain reasonable stability with regard to work, social adaptation, and some degree of emotional intimacy. From a psychodynamic viewpoint, a consensus has been evolving in the psychoanalytic literature dividing the perversions into major groups according to the level of severity of the illness. In the psychoanalytic literature on perversion, narcissistic features have been suggested as a general characteristic.
