482 CHAPTER 11
Paraphilias
One of the reasons that Mike was so disturbed about Sam’s transformation into
Sandy was that it reminded Mike of his secret pastime during his teenage years: He’d
secretly “borrow” some of his older sister’s clothes from her room, dress up as a girl,
and admire himself in front of the mirror. He’d found this extremely erotic, but also
terrifying. He worried that he’d get caught and felt that it somehow wasn’t “right.”
Throughout his adulthood, Mike struggled to overcome his urge to dress in women’s
clothes, usually successfully. During most of his marriage to Laura, he’d managed to
keep this urge at bay, and he never told his wife about it. However, once he heard
about Sam, his urge became stronger—which affected his relationship with Laura
because he thought it best to avoid sexual relations with her until he felt more in
control of himself. He’d felt alone in his worries and concerns until he frequented
online chat rooms. Now he’s spending a lot of time “chatting” with other men who
like to cross-dress; he bought some women’s clothes (which he kept hidden) and puts
them on and masturbates when Laura is out. What’s going on with Mike? To fi nd
out, we need to consider another category of sexual disorders, called paraphilias.What Are Paraphilias?
Gender identity disorder focuses on the mismatch between an individual’s gender
identity and biological sex. In contrast, the DSM-IV-TR set of paraphilias (from
the Greek para-, meaning “beside” or “beyond,” and philos, meaning “fondness”
or “love”) focuses on “deviant” fantasies, objects, or behaviors that play a role in
sexual arousal. Specifi cally, a paraphilia is characterized by intense recurrent sexual
fantasies or urges related to:- nonconsenting partners or children,
- nonhuman objects (such as women’s shoes), or
- suffering or humiliating oneself or one’s partner; the diagnosis of a paraphilia
would apply only when such experiences are not part of sexual role-playing.
These fantasies, urges, or behaviors together form a predictable pattern of arousal
that is consistent for an individual (referred to as an arousal pattern). To be con-
sidered more than a normal variation in sexual fantasies, urges, or behaviors, this
arousal pattern must:- interfere with the ability for mutual sexual activity involving affection,
- impair functioning in some other way,
•ocause signifi cant distress, r- involve a person who did not consent (as when exhibitionists “fl ash” unsuspect-
ing strangers).
In addition, the diagnostic criteria for all paraphilias require that the arousal pattern
has been present for at least 6 months (American Psychiatric Association, 2000).
However, the arousal pattern doesn’t necessarily affect all areas of functioning—
people with a paraphilia may not be impaired at work or even necessarily in their
family life.
Sexuality—both normal and abnormal—is best thought of as being represented
by a continuum, but DSM-IV-TR uses a categorical approach, which means drawing
a line to separate “normal” from “abnormal.” For some paraphilias, DSM-IV-TR
draws the line at the point where the sexual arousal pattern causes signifi cant distress
or impairs functioning. Someone who becomes aroused in response to pornography
or in response to particular items of clothing, for instance, would not be diagnosed
as having a paraphilia unless this arousal pattern caused signifi cant distress or im-
paired functioning.
The specifi c arousal patterns of the types of paraphilias are listed in Table 11.3,
along with their DSM-IV-TR diagnostic criteria. Paraphilic disorders are often
classifi ed into two groups: those that involve nonconsenting individuals, and thoseParaphilia
A sexual disorder characterized by deviant
fantasies, objects, or behaviors that play a
role in sexual arousal.