PARAPHILIAS Note: Contact may involve the individual’s own

children, stepchildren or relatives, or strangers.

Paraphilias vs Paraphilic Disorder?
Paraphilias are recurrent, intensely sexually Note: Many individuals with pedophilia do not
arousing fantasies, sexual urges, or behaviors experience distress about their fantasies, urges, or
generally involving behaviors.

1. Nonhuman objects Fetishism “Objects”

2. The suffering or humiliation of one’s self Fetishism—Use of nonliving objects (the fetish) to
or partner obtain sexual excitement and/or achieve orgasm.
3. Children or other nonconsenting persons. Common fetishes include women’s underwear, bras,
lingerie, shoes, or other apparel. The person might
 More common in men. 50% are before age 18 masturbate while holding or rubbing the object. It
(APA, 2000). begins by adolescence and tends to be chronic.
 DSM-5-TR category
Transvestic Fetishism “Clothes of opposite
Paraphilic disorder with the term ‘disorder’ gender”
indicate a paraphilia that is inducing distress or Transvestic fetishism—Recurrent, intensely
impairment to the person or a paraphilia whereby sexually arousing fantasies, sexual urges, or
satisfaction caused personal harm, or risk of harm, behaviors involving cross-dressing by a
to others. heterosexual male.

Causes/Predisposing Factors Sexual sadism “You suffer, I’m happy”

Sexual sadism—Recurrent, intensely sexually
 Temporal lobe diseases. arousing fantasies, sexual urges, or behaviors
 Abnormal levels of androgens. involving acts in which the psychological or
 Limbic system destruction (in animal) physical suffering of the victim is sexually arousing
results in hypersexual behavior (Becker & to the person. It can involve domination (caging the
Johnson, 2008) victim or forcing victim to crawl, beg, plead),
restraint, spanking, beating, electrical shock, rape,
TYPES OF PARAPHILIA cutting, and, in severe cases, torture and death.

Pedophilia “Child” Victims may be consenting (those with

Pedophilia—Sexual activity with a prepubescent sexual masochism) or nonconsenting.
child (generally 13 years or younger) by someone at
least 16 years old and 5 years older than the child. Sexual Masochism “I suffer, I’m happy”
It can include the following activities done to a Sexual masochism—Recurrent, intensely sexually
child: arousing fantasies, sexual urges, or behaviors
 Fellatio (Male)- is an oral sex act involving a involving the act of being humiliated, beaten, bound,
person stimulating the penis or scrotum of or otherwise made to suffer. Some individuals act
another person by using the mouth, throat, or on masochistic urges by themselves, others with a
both. partner.
 Cunnilingus (Female)- also known as oral-
vulva or oral-vaginal sex in which someone Exhibitionism“Public Display and Self-touch”
uses its mouth to stimulate female genitals. Exhibitionism—Exposure of the genitals to a
 Penetration of the child’s vagina, anus, or stranger, sometimes involving masturbation;
mouth with the individual’s fingers or penis or usually occurs before age 18 and is less severe after
with foreign objects, with varying amounts of age 40.
force.
 Undressing the child and looking at the child; Frotteurism “Clothed Genital Rub”
Exposing himself or herself. Frotteurism—Touching and rubbing against a
 Masturbating in the presence of the child. nonconsenting person, usually in a crowded place
 Touching and fondling the child. from which the person with frotteurism can make a
quick escape, such as public transportation, a
shopping mall, or a crowded sidewalk. The
individual rubs his genitals against the victim’s  Sexual arousal by inflicting psychological or
thighs and buttocks or fondles her breasts or physical suffering on another individual.
genitalia with his hands. Acts of frottage occur  Sexual arousal from dressing in the clothes of
most often between the ages of 15 and 25; the opposite sex.
frequency declines after that.  Sexual arousal from observing unsuspecting
people either naked or engaged in sexual
Voyeurism “I see you” activity.
Voyeurism—Recurrent, intensely sexually arousing  Masturbation often accompanies the activities
fantasies, sexual urges, or behaviors involving the described when they are performed solitarily.
act of observing an unsuspecting person who is  The individual is markedly distressed by these
naked, in the process of undressing, or engaging in activities.
sexual activity.  Absence of sexual fantasies and desire for
sexual activity.
Voyeurism usually begins before age 15, is chronic,  Discrepancy between partners’ levels of desire
and may involve masturbation during the for sexual activity.
voyeuristic behavior.  Feelings of disgust, anxiety, or panic responses
to genital contact.
Not Specified Paraphilias  Inability to produce adequate lubrication for
sexual activity.
Telephone scatalogia- Obscene phone calling to an  Absence of a subjective sense of sexual
unsuspecting person. excitement during sexual activity.
 Failure to attain or maintain penile erection
Internet sex- the use of interactive computer until completion of sexual activity.
networks to sometimes compulsively send obscene  Inability to achieve orgasm (in men, to
messages by electronic mail or to transmit sexually ejaculate) following a period of sexual
explicit messages and video images. excitement judged adequate in intensity and
duration to produce such a response.
Necrophilia- Obsessions with having a sexual  Ejaculation occurs with minimal sexual
encounter with a cadaver (corpse). stimulation or before, on, or shortly after
penetration and before the individual wishes it.
Partialism- a concentration of sexual activity on  Genital pain occurring before, during, or after
one part of the body to the exclusion of all other sexual intercourse.
parts  Constriction of the outer third of the vagina
prevents penile penetration.
Zoophilia- incorporation of animals into sexual
activity ASSESSMENT
1. Demographic data assessment.
Urophilia- sexual activity that involves urinating 2. Mental status/condition of patient.
on one’s partner or being urinated on. 2. Sexual orientation and interests.
3. Patient’s behavior and temperament.
Hypoxyphilia- desire to achieve an altered state of 4. Health history (reproductive system).
consciousness secondary to hypoxia while 5. Physical, social, spiritual assessment.
experiencing orgasm; A drug such as nitrous oxide
may be used to produce hypoxia. PHARMACOLOGICAL/ MEDICAL MGT
1. Pharmacologic therapy (Mostly for paraphilic
MANIFESTATIONS disorders)
 Exposure of one’s genitals to strangers.  Aldosterone antagonists, selective
 Sexual arousal in the presence of nonliving - Block androgen receptors.
objects.  Antiandrogens (Cyproterone acetate etc.)
 Touching and rubbing of one’s genitals  Anxiolytics
against an unconsenting person.  Mood stabilizers
 Sexual attraction to, or activity with, a  Medroxyprogesterone (Depo-Provera)
prepubescent child. and Cyproterone- Progestin derivatives
 Sexual arousal from being humiliated, beaten, that decreases libido and break the
bound, or otherwise made to suffer. individual’s patterns of compulsive deviant
 sexual behavior. They work best in those
clients with high libido experiencing Determine stressors.
pedophilia and exhibitionism. It work less to Identify factors that affect client’s sexuality.
those with antisocial personality. Encourage discussion of disease process.
 Clomipramine and fluvoxamine- Sexual
obsessions, addictions, and paraphilias. Be accepting and nonjudgmental.
 SSRIs- fluoxetine to treat clients with Provide positive reinforcement
exhibitionism, voyeurism, pedophilia, and
person who have committed rape.
 Gonadotropin-releasing hormone
agonists
-Produce a hypogonadotrophic-
hypognadal state by down-regulation of the
pituitary gland.

3. Psychological and other nonpharmacologic

therapies
 Speech therapy
 Milieu therapy
 Counseling
 Behavioral therapy
 Cognitive therapy

4. Sexual reassignment surgery (SRS).

GOAL: To achieve sense of SATISFACTION

(derived from sexual activities) in an ACCEPTED
and APPROPRIATE ways without harming one’s
self or others.

NURSING DIAGNOSES
* Sexual dysfunction related to physical or
psychosocial abuse.
* Low self-esteem related to rejection by peers.

* Ineffective sexuality pattern related to conflicts

with sexual orientation or variant preferences.

* Disturbed personal identity related parenting

patterns that encourage culturally unacceptable
behaviors for assigned gender.

* Impaired social interaction related to socially and

culturally unacceptable behavior.

NURSING MANAGEMENT

Remember: DIE Bad Paraphilia!