Paraphilias are intense and abnormal sexual interests that involve recurrent sexual urges towards non-consensual objects, situations, or individuals. Paraphilias are complex conditions with no single cause. Researchers have proposed various psychological, biological, and sociocultural factors that may predispose individuals to developing paraphilic disorders.
What are paraphilias?
Paraphilias are defined in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) as intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners. The key features are that the interests are recurrent and intense, and cause distress or impairment to the individual or risk of harm to others.
Common paraphilias include voyeurism, exhibitionism, frotteurism, masochism, sadism, pedophilia, fetishism, and transvestic disorder. Most people with atypical sexual interests do not have a mental disorder. A paraphilic disorder is diagnosed only if the atypical sexual interests lead to distress, impairment or harm.
Psychological factors
Various psychological mechanisms have been proposed to explain the development and persistence of paraphilic disorders:
- Early childhood experiences – Traumatic or inappropriate sexual experiences in early childhood may lead to an attachment to the experience and a failure to develop age-appropriate sexual interests.
- Learning and conditioning – Paraphilic interests may develop through association of an atypical stimulus with sexual arousal and gratification. Reinforcing experiences strengthen the association.
- Cognitive distortions – Some individuals develop cognitive distortions that justify and reinforce their paraphilic interests, such as beliefs that minimize harm.
- Emotional regulation – Paraphilic fantasies or behaviors may provide a way to manage difficult emotions or psychological stress.
- Intimacy deficits – Problems with emotional intimacy, insecure attachment styles, and social rejection may contribute to seeking fulfillment through paraphilic rather than normative sexual interests.
Biological factors
Biological factors that may contribute to paraphilias include:
- Hormones – Increased testosterone exposure in utero has been associated with higher risk for developing paraphilias in adulthood.
- Genetics – Paraphilias appear to have some heritability, indicating genetic contributions. Specific genes increasing vulnerability have not been identified.
- Neurobiology – Differences in brain structure and function have been found in some paraphilias, suggesting a neurobiological basis. However, findings are mixed and more research is needed.
- Co-occurring mental illness – Paraphilias are more common in individuals with mental illnesses such as schizophrenia, bipolar disorder, and dementia. Shared genetic or neurobiological factors may underlie these associations.
Sociocultural factors
Social and cultural influences also affect the development and expression of paraphilias:
- Stigma and isolation – Social stigma, feelings of isolation, and lack of mental health treatment increase likelihood of developing maladaptive coping such as paraphilic interests.
- Normalization – Greater access to and normalization of deviant sexual materials online may reinforce and strengthen maladaptive sexuality.
- Childhood adversity – Abuse, neglect, poverty and other adverse childhood experiences disrupt healthy sexuality and increase risk of paraphilias.
- Cultural context – Social, cultural, and religious norms shape sexual values and development. Extreme restriction or permissiveness regarding sexuality may increase paraphilia risk.
Conclusion
In summary, the development of paraphilias is complex and multifactorial. The strongest evidence points to childhood adversity, learning and conditioning, and neurobiological factors as predisposing individuals to forming intense and maladaptive sexual interests. Psychological, biological, social and cultural influences likely interact in complex ways to produce vulnerabilities or resilience to developing paraphilic disorders. More research is needed to elucidate these complex causal pathways.