Paraphilias

Paraphilias are conditions characterized by recurrent, intense sexually arousing fantasies, urges, or behaviors involving objects, situations, or sexual partners that are atypical or socially stigmatized. In clinical use, a paraphilic disorder is diagnosed when such interests cause distress or impairment, involve non-consenting persons, or pose a risk of harm to others.

Common examples include fetishism, where arousal centers on non-living objects or body parts; voyeurism, observing others naked or sexually engaged without consent; exhibitionism, exposing one's genitals to others without consent; frotteurism, rubbing against a non-consenting person; pedophilia, sexual interest in prepubescent children; sexual masochism and sexual sadism. Cross-dressing in DSM-5-TR is not itself disordered unless associated with distress or impairment. Many individuals with paraphilias do not have a disorder if their interests are non-harmful and consensual.

Diagnostic frameworks vary by jurisdiction. The DSM-5-TR distinguishes paraphilias as conditions that may or may not be disorders; a paraphilic disorder is diagnosed when the interest causes distress or impairment, acts on non-consenting individuals, or risks harm. The ICD-11 similarly classifies paraphilic disorders. Prevalence estimates differ and data are limited; many people have atypical sexual interests without meeting criteria for a disorder, and prevalence depends on definitions and populations studied.

Treatment emphasizes safety, risk management, and reducing distress or impairment. Approaches include psychotherapy, especially cognitive-behavioral therapy, and, in some cases, pharmacological options such as selective serotonin reuptake inhibitors or antiandrogen medications. Management may involve multidisciplinary teams, consent-focused risk assessment, and legal/ethical considerations. Ongoing research aims to clarify causes, comorbidity, and effective interventions while avoiding stigma.