Paraphilias

This contribution discusses paraphilias, also known as disorders of sexual preference. Some historical and cultural aspects are briefly noted. The paraphilias given in DSM-IV are listed, along with brief descriptions. Some unusual paraphilias are also noted, with case examples from the literature. Theories of aetiology of paraphilias are commented on, noting that a multifaceted model is the most plausible. Clinical presentations are described. The assessment of paraphilias is considered; the need for comprehensive assessment is stressed. Finally, the clinical management of paraphilias is discussed. Various treatment approaches are noted, including psychological control techniques such as aversion therapy, and pharmacological interventions. The alternative approach, the incorporation of the paraphilia where feasible into the sexual repertoire of the person, is also discussed. It is argued that therapy for paraphilias often requires a package consisting of several elements used in combination.