Aparaphilia is an uncommon, intense, and persistentsexual arousal orattraction to anything not sexual by nature.[3][4] It has also been defined as a sexual interest in anything other than a legally consenting human partner.[5][6] Paraphilias are contrasted with normophilic ("normal") sexual interests,[7][8] although the definition of what makes a sexual interest normal or atypical remains controversial.
The exact number andtaxonomy of paraphilia is under debate;Anil Aggrawal has listed as many as 549types of paraphilias.[9][2] Several sub-classifications of paraphilia have been proposed; some argue that a fully dimensional, spectrum, or complaint-oriented approach would better reflect the evident diversity ofhuman sexuality.[10][11] Although paraphilias were believed in the 20th century to be rare among the general population, subsequent research has indicated that some level of paraphilic interests are relatively common.[8]
Coinage of the termparaphilia (paraphilie) has been credited toFriedrich Salomon Krauss in 1903, and it was used with some regularity byWilhelm Stekel in the 1920s.[12][13] The term comes from theGreek παρά (para), meaning 'other' or 'outside of', and φιλία (-philia), meaning 'loving'.[14] The word was popularized byJohn Money in the 1980s as a non-pejorative designation for unusual sexual interests. It was first included in theDSM in its 1980 edition.[14][15][16]
There is no broadscientific consensus for definitive boundaries between what are considered "unconventional sexual interests",kinks,fetishes, and paraphilias.[17][18] As such, these terms are often used loosely and interchangeably, especially in common parlance.
Many terms have been used to describe atypical sexual interests, and there remains debate regarding technical accuracy and perceptions of stigma.[14][15][16][19]John Money described paraphilia as "a sexuoerotic embellishment of, or alternative to the official, ideological norm".[20] PsychiatristGlen Gabbard writes that despite efforts byWilhelm Stekel and John Money, "the termparaphilia remains pejorative in most circumstances."[21]
In the late 19th century, psychologists and psychiatrists began to categorize various paraphilias so as to have a more descriptive system than the legal and religious constructs ofsodomy,[22] as well asperversion.[23] In 1914,Albert Eulenburg observed a commonality across paraphilias, using the terminology of his time writing, "All the forms of sexual perversion ... have one thing in common: their roots reach down into the matrix of natural and normal sex life; there they are somehow closely connected with the feelings and expressions of our physiological erotism. They are ... hyperbolic intensifications, distortions, monstrous fruits of certain partial and secondary expressions of this erotism which is considered 'normal' or at least within the limits of healthy sex feeling."[24]
Before the introduction of the termparaphilia in theDSM-III (1980), the termsexual deviation was used to refer to paraphilias in the first two editions of the manual.[25] In 1981, an article published inAmerican Journal of Psychiatry described paraphilia as "recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving":[26]
There is scientific and political controversy regarding the continued inclusion of sex-related diagnoses such as the paraphilias in the DSM, due to the stigma of being classified as a mental illness.[27] Some groups, seeking greater understanding and acceptance ofsexual diversity, have lobbied for changes to the legal and medical status of unusual sexual interests and practices.Charles Allen Moser, a physician and advocate for sexual minorities, has argued that the diagnoses should be eliminated from diagnostic manuals.[28]Ray Blanchard stated that the definition of paraphilia in the DSM done by concatenation (i.e., by listing a set of paraphilias) and that defining the term by exclusion (anything that is not normophilic) is preferable.[29]
Inclusion and subsequent exclusion of homosexuality
Homosexuality, a widely accepted variant of human sexuality, was once categorized as a sexual deviation.[30]Sigmund Freud and subsequentpsychoanalytic thinkers considered homosexuality and paraphilias to result frompsychosexual non-normative relations to theOedipal complex,[31][32] although not in the antecedent version of the 'Three Essays on Sexual Theory' where paraphilias are considered as stemming from an original polymorphous perversity.[33] As such, the termsexual perversion or theepithetpervert have historically referred togay men, as well as othernon-heterosexuals (people who fall outside the perceived norms of sexual orientation).[30][31][34][35]
By the mid-20th century, mental health practitioners began formalizing "deviant sexuality" classifications into categories. Originally coded as 000-x63, homosexuality was the top of the classification list (Code 302.0) until theAmerican Psychiatric Association removed homosexuality from the DSM in 1973.Martin Kafka writes, "Sexual disorders once considered paraphilias (e.g., homosexuality) are now regarded as variants of normal sexuality."[34]
A 2012 literature study by clinical psychologistJames Cantor, when comparing homosexuality with paraphilias, found that both share "the features of onset and course (both homosexuality and paraphilia being life-long), but they appear to differ on sex ratio,fraternal birth order,handedness,IQ andcognitive profile, andneuroanatomy." The research then concluded that the data seemed to suggest paraphilias and homosexuality as two distinct categories but regarded the conclusion as "quite tentative" given the current limited understanding of paraphilias.[35]
Paraphilias typically arise in late adolescence or early adulthood. Persons with paraphilias are generallyegosyntonic and view their paraphilias as something inherent in their being, although they recognize that their sexual fantasies lie outside the norm and may attempt to conceal them.[14] Paraphilic interests are rarely exclusive[36] and some people have more than one paraphilia.[37] Some people with paraphilias may seek occupations and avocations that increase their access to objects of their sexual fantasies (e.g., voyeurs working in rental properties to "peep" on others or pedophiles working with Boy Scouts).[14]
Research has found that some paraphilias, such asvoyeurism andsadomasochism, are associated with more lifetime sexual partners, contradicting theories that paraphilias are associated withcourtship disorders and arrested social development.[36] Scientific literature includes some single-case studies of very rare and idiosyncratic paraphilias. These include an adolescent male who had a strong fetishistic interest in the exhaust pipes of cars, a young man with a similar interest in a specific type of car, and a man who had a paraphilic interest in sneezing (both his own and the sneezing of others).[38][39]
Ego alien sexual interests in an individual can cause individuals to becomesuicidal due to the embarrassment or shame that it causes.[40]
The causes of paraphilias in people are unclear, but it is believed to be a mixture of neurological, cultural, andpsychodynamic factors. No two or more people with a paraphilia will develop it for the same reasons or be interested in the same qualities of the specific sexual interest.[41][42][43] The specific causes of the development of paraphilic sexuality are numerous and vary from person to person. A 2022 study found that the development of paraphilic sexuality correlated with childhood trauma, particularlyemotional abuse,neglect, andsexual abuse.[44][need quotation to verify]
A 2008 study analyzing the sexual fantasies of 200 heterosexual men by using the Wilson Sex Fantasy Questionnaire exam determined that males with a pronounced degree of fetish interest had a greater number of older brothers, a high 2D:4Ddigit ratio (which would indicate excessive prenatal estrogen exposure), and an elevated probability of beingleft-handed, suggesting that "disturbed" hemisphericbrain lateralization may play a role in paraphilic attractions.[45]Behavioral explanations propose that paraphilias areconditioned early in life, during an experience that pairs the paraphilics stimulus with intense sexual arousal.[46]Susan Nolen-Hoeksema suggests that, once established,masturbatory fantasies about the stimulus reinforce and broaden the paraphilic arousal.[46]
Genetic causes, particularly genes that encode the behavior ofneurotransmitter receptors andandrogen release have been implicated in studies, though others have shown no correlation between genetics and paraphilic behavior.[47][48]
It is possible for an individual to acquire a paraphilia from various types of brainlesions andepilepsy.[49]
Although paraphilic interests in the general population were believed to be rare, research has shown that fantasies and behaviors related to voyeurism, sadomasochism, and coupleexhibitionism are not statistically uncommon among adults.[36] The DSM-5 estimates that 2.2% of males and 1.3% of females in Australia engaged in bondage and discipline, sadomasochism, or dominance and submission within the past 12 months. The population prevalence of sexual masochism disorder is unknown.[50]
In a study conducted in a population of men, 62% of participants reported at least one paraphilic interest. In another sample of college students, voyeurism was reported in 52% of men.[37]
Paraphilias are often observed in women,[51][52] and there have been some studies focusing exclusively on females with paraphilias.[53] Men and women differ on the content of their sexual fantasies, with men reporting greater proportions offetishism, exhibitionism and, sadism, and women reporting greater proportions of masochism.[54] Sexual masochism has been found to be the most commonly observed paraphilia in women, with approximately 1 in 20 cases.[55][56]
Paraphilic fantasies and behaviors have been registered in multiple old and ancient sources. Voyeurism, bestiality, and exhibitionism have been described in theBible. Sexual relations with animals have also been depicted incave paintings.[57] Some ancient sex manuals such as theKama Sutra (450),Koka Shastra (1150), andAnanga Ranga (1500) discuss biting, marks left after sex and love blows. Although evidence suggests that paraphilic behaviors have existed prior to theRenaissance, it is difficult to ascertain how common they were and how many people had persistent paraphilic fantasies in ancient times.[8]
"Leda and the Swan" (fromthe Greek tale) by Esther Huillard
Bestiality has been depicted multiple times in Greek mythology, although the act itself usually involved a deity in zoomorphic form, such as Zeus seducingEuropa,Leda, andPersephone while disguised as a bull, a swan, and a serpent, respectively. Zeus was also depicted, in the form of an eagle, abductingGanymede, an act that alludes to both bestiality and pederastry. Some fragments ofHittite law include prohibitions of and permissions to engage in specific acts of bestiality.[58]
Havelock Ellis pointed to an example of sexual masochism in the fifteenth century. The report, written byGiovanni Pico della Mirandola, described a man who could only be aroused by being beaten with a whip dipped in vinegar.[8] Wilhelm Stekel also noted thatRousseau also discussed his own masochism in hisConfessions.[59] Other similar instances of persistent paraphilic fantasies were reported between 1516 and 1643 byCoelius Sedulius,Rhodiginus, Brundel andMeibomius.[8]
Paraphilic disorders occur in adults and occasionally adolescents, but as the behaviour must be persistent manysex crimes are not due to such disorders.[60]
^Stekel W (2004) [1930].Sexual Aberrations: The Phenomenon of Fetishism in Relation to Sex. Translated by Parker S (translated from the 1922 original German ed.). New York City:Boni & Liveright.ISBN978-1-4179-3834-6.
^Gabbard GO (2007).Gabbard's Treatments of Psychiatric Disorders. Philadelphia, Pennsylvania: American Psychiatric Press. p. 581.ISBN978-1-58562-216-0.
^Dailey DM (1989).The Sexually Unusual: Guide to Understanding and Helping. Philadelphia, Pennsylvania:Haworth Press. pp. 15–16.ISBN978-1-4179-3834-6.
^Purcell CE, Arrigo BA (2006).The psychology of lust murder: paraphilia, sexual killing, and serial homicide. Cambridge, Massachusetts:Academic Press. p. 16.ISBN978-0-12-370510-5.
^Eulenburg (1914).Ueber sexualle Perversionen. Ztschr. f. Sexualwissenschaft. Vol. I, No. 8. Translated byStekel, Wilhelm (1940).Sexual Aberrations: The Phenomena of Fetishism in rRelation to Sex. New York: Liveright, p. 4.OCLC795528.
^abKafka MP (1996). "Therapy for Sexual Impulsivity: The Paraphilias and Paraphilia-Related Disorders".Psychiatric Times.13 (6). New York City: MJH Associates.
^abcJoyal C, Antfolk J (2021),"Paraphilia", in Shackelford TK, Weekes-Shackelford VA (eds.),Encyclopedia of Evolutionary Psychological Science, Cham: Springer International Publishing, pp. 5692–5696,doi:10.1007/978-3-319-19650-3_3387,ISBN978-3-319-19649-7, retrieved24 January 2024
^American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). pp. 569–570, 572, 574, Washington, DC: Author.
^American Psychiatric Association (2013),Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (5th ed.), pp. 685–706,ASIN0890425558
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