Paraphilia is defined as a variant of sexual practice involving deviant and maladaptive rituals and objects that are deemed necessary to achieve sexual gratification. This definition of paraphilia assumes many important points about the nature of mental disorder. First, this paraphilia definition recognizes the existence of different variations of sexual activities. These variations may occur as a result of cultural differences, religious commitments, and personal values. Thus, any other sexual activities that may be considered deviant by one person may not be a paraphilia at all. Deviancy is only an indicator of possibility, but not a sufficient character of paraphilia, and for that matter, any other types of mental disorders. Second, the paraphilia definition above assumes that some forms of sexual practice are maladaptive, in a sense that the biological and emotional function of sex is inhibited. This is still a matter of debate for many psychologists because this criterion is concerned about the value sex brings. It has a moral tone to it. The biological function of sex refers to procreation; while the emotional function of sex indicates an act of "bonding" or the strengthening of relationships. Anyone can have a different take on this "maladaptive" criterion because it is commonly known nowadays that many people practice sex “just for the sake of it.” Consider the prevalence of prostitution. Hiring a prostitute neither satisfies any of these goals, but it remains to be a persistent global problem. For other types of mental disorders, the concept of "maladaptiveness" is not difficult to grasp because they mostly refer to the extent in which the individual's immediate survival is at stake. For example, depression can sometimes lead to suicide. Thus, depression can be maladaptive. This way of thinking has also been applied in conceptualizing the maladaptiveness of paraphilia without referring to any biological or emotional goal. Psychologists nowadays avoid using the biological and emotional functions of sex to explain the maladaptiveness of paraphilia. Instead, they highlight the negative effects of paraphilia on the people besides the paraphilic. For example, breaching other people's privacy and a paraphilic rape committed without or against the partner's consent. Thus, in a sense, paraphilia may be "adaptive" or useful to the paraphilic, but not to its victims. Personal distress is also sometimes attached to the meaning of maladaptiveness. Some paraphilics do report personal distress and a feeling of helplessness over their paraphilia, but not all of them do. Third and last, the definition paraphilia mentioned above recognizes the necessitating factor of rituals and objects in paraphilia. Considering the wide range of sexual variations in the world, it follows that sexually active people across the globe engage in various forms of rituals and use different kinds of objects in sex. However, unlike paraphilics, normal people are flexible and can achieve sexual gratification even without these rituals and objects. This is the most important criterion for a person to be diagnosed with paraphilia. As you can see, how modern psychologists define paraphilia reflects a combination of criteria that are being used for proper diagnosis. It is almost impossible to separate the concept of paraphilia from its medical background.
There are many types of paraphilias, and most of them were listed in Wikipedia. But it is important to know that the Diagnostic Statistical Manual of Mental Disorders (DSM), the official medical reference of the American Psychiatric Association and the American Psychological Association on mental disorders, only recognizes nine categories of paraphilias. The list of paraphilias below only highlights the main or most common types of paraphilias (DSM). These common paraphilia disorders are exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, transvestic fetishism, voyeurism, and paraphilia NOS (not otherwise specified). The paraphilias' symptoms are different for each type of paraphilia, so we will briefly discuss each type of paraphilia and their corresponding main symptoms to conceptually identify them from each other. Note that these differences still reflect the definition of paraphilia mentioned above. Exhibitionism is a type of paraphilia wherein the paraphilic (or exhibitionist) achieves sexual gratification only upon exposing and/or manipulating own genitals to the nonconsenting public in inappropriate circumstances. These circumstances are often fairly constant for each exhibitionist, and so with the victims, which are mostly young, middle-aged females (for male exhibitionists). The intent of the exhibitionist is to surprise and upset its victims. The more upset the victims are, the more intense the feeling of sexual gratification is to the exhibitionist. Because exhibitionism violates the concepts of "private parts" and the "right to privacy", it is considered a criminal offense under the legal term "indecent exposure." Fetishism is a type of paraphilia wherein the paraphilic (or fetishist) achieves sexual gratification only by using inanimate object/s. "Using" could mean fondling, kissing, smelling, or tasting the object/s of desire. These activities are also often done while masturbating. Fetishistic objects commonly include ears, hair, hands, legs, perfume, shoes, and undergarments. These objects usually are associated with the opposite sex. Frotteurism is a relatively new type of paraphilia so there's not much research literature on the subject. The DSM defines frotteurism as a type of paraphilia wherein the paraphilic (or frotteur) achieves sexual gratification only by rubbing one's self, particularly one's genitals, on a nonconsenting person. This is almost similar to exhibitionism. While exhibitionism is concerned about genital exposure, frotteurism is concerned about genital contact. Both paraphilias enjoy intruding other people's privacy, and both take delight in seeing their victims get shocked and scared. Pedophilia is a type of paraphilia wherein the paraphilic (pedophile) achieves sexual gratification only by having sexual intercourse with a prepubescent child (i.e., has not yet reached puberty), whether the child is a male or a female. Unlike the sadists, hurting the child is not the main goal; in fact, most pedophiles think that their victims will benefit from the act. Still, a painful physical and emotional experience is the unfortunate by-product of the sexual contact. The extent in which the victim agrees to be molested by the pedophile is not well-researched, but the current social consensus is that nobody is allowed to have sexual activities with children who have not yet reached puberty, even if the child or the primary caregiver gives consent. Pedophilia is therefore legally addressed as the problem of child sexual abuse. Masochism is popularly known as the practice of achieving happiness by giving in to other people's demands in spite of one's needs, while sadism is by getting one's wants despite other people's needs. Because the concepts of masochism and sadism are being applied in different contexts (e.g., a masochist student and a sadistic professor, a masochist priest and a sadistic soldier, and eastern masochism and western sadism), the DSM specifically added the word "sexual" to these paraphilias in order to clarify the sexual component of the disorders. Sexual masochism is a type of paraphilia wherein the paraphilic (sexual masochist) achieves sexual gratification only by being inflicted with pain and degradation from the sexual partner. This is done when the partner beats, humiliates and binds the masochist. Contrary to popular beliefs, masochists do not entirely want to have sex with sadists. Masochists look for partners who are willing to inflict them with pain and degradation within certain limits, something that cannot be achieved with sadists. Sexual sadism, on the other hand, is a type of paraphilia wherein the paraphilic (sexual sadist) achieves sexual gratification only by inflicting pain and degradation to the sexual partner. This is done when the sadist hits, spanks, or ties up the partner. Sadists enjoy when the partner screams and begs for help. Transvestic fetishism (or autogynephilia) is a type of paraphilia wherein the paraphilic (transvestite) achieves sexual gratification only by engaging in sexual activities while thinking of being a female. They may masturbate or have sex with their wives while wearing female clothing. They like to cross-dress in private, hence the term transvestic "fetishism", and they somewhat erratically change their attitudes and personalities in a more feminine way. Voyeurism is a type of paraphilia wherein the paraphilic (voyeur) achieves sexual gratification only by masturbating while looking or peeping into other people's naked bodies or while they engage in sexual activities. Sex-themed pictures and movies, although now widely distributed across different media, do not, however, provide sufficient substitutes for voyeurs on seeing the real thing. Lastly, paraphilia NOS (not otherwise specified) is a type of paraphilia that is, well, cannot be categorized using the other types of paraphilias just mentioned. They also include those types of weird paraphilias that are rarely observed (and studied) in the clinical setting, such as coprophilia, necrophilia, and telephone scatologia. Coprophilics achieve sexual gratification only with the presence of feces; necrophilics on sexual activities with dead people; and, telephone scatologics with having sex-themed telephone conversations.
The treatment for paraphilias remains controversial because not only do research studies produce conflicting and largely varying results, treatment of paraphilias that have no legal restrictions (and thus considered victimless) also are rarely sought and studied. However, because of the legal offenses attached to some forms of paraphilias like exhibitionism, pedophilia, sadism and voyeurism, and in some cases, theft associated with fetishism, psychological and surgical treatment for paraphilia have sprung up, although, as already mentioned above, they but only widened the room for improvement. Psychological paraphilias treatment includes aversion therapy, relapse prevention, cognitive restructuring, and social-skills training. They aim to develop appropriate sexual practice by modifying and altering the pattern of sexual arousal and the cognitions associated with the paraphilia, and by improving social skills needed in the appropriate practice of sex. Aversion therapy alters the pattern of sexual arousal in paraphilia by conditioning the paraphilic stimulus with the experience of an aversive event; for example, being forced to inhale or smell foul odors, getting electrocuted, or through a guided visual imagery of anything the paraphilic can consider repugnant. Relapse prevention alters the pattern of sexual arousal in paraphilia by identifying the antecedents of the paraphilic act. For example, a pedophile may avoid playgrounds and getting out in the daytime just to prevent seeing children. Cognitive restructing modifies cognitions associated with the paraphilia by challenging the reality of formed distortions; for example, victims of pedophiles generally say "no" to the sexual encounter, but because pedophiles often think that the act will benefit the child and because they play the dominant role and believe that the child is not in the position to decide for him/herself, they go on with it. In cognitive restructuring, the pedophile will be taught to accept the fact that the child will not benefit from the sexual encounter, and that the pedophile is never in the position to decide when, where, and with whom a child can practice sex. Social skills training improves the ability of the paraphilic to accurately interpret the partner's sexual signals. For example, some sadists think that women who struggle in sex are just playing hard to get, although this is not the real case. Because of the modest effect of psychotherapy on the treatment of paraphilia, some states enforced some forms of biological and surgical treatment paraphilia. Chemical and surgical castration are generally observed to be more effective than the psychotherapeutic techniques, and much more with the latter (because the former is subject to high relapse rate upon chemical withdrawal). Chemical castration involves the lowering of testosterone through inhibited production, while surgical castration is the literal cutting off of the penis or the scrotum. Many people believe that castration, especially surgical castration, is inhumane; however, this belief is currently being challenged as some paraphilics and even rapists request castration to permanently control their sexual urges.
Some cases of paraphilia may not be by nature coercive. Non-coercive paraphilia include fetishism, transvestic fetishism and voyeurism. This is because they do not force people to do something against their will in sex. However, it may be otherwise. Paraphilias, no matter how non-enforcing they may be, can manifest in a coercive manner especially when provoked or prohibited. An exhibitionist may force a stranger to look at him/her while masturbating. A fetishist may forcibly require the sexual partner to wear the fetish during sex. A frotteur may prevent the victim from running away while he/she reaches orgasm with rubbing his/her genitals. A pedophile usually forces a child to have sex. A masochist may require the sexual partner to hurt him/her despite the partner's will. A sadist utilizes force to inflict pain and degradation to his/her sexual partner. A transvestic fetishist may insist on putting on women's clothing while having sex with his wife even if the wife vehemently disagrees. And a voyeur may force his/her partner to unwillingly engage in sex with other people just to be able to watch a live sexual act. These coercive manifestations of paraphilia highlights the negative effects of the disorders on their victims and their loved ones.
The causes of paraphilia differ for each type of paraphilia. The research history of paraphilia dwells a lot on speculations of the etiology of the disorders and their moral implications. However, extensive controlled research studies on these cases are still a rarity. Paraphilias' causes generally point to the male's over-reliance on visual sexual imagery, making them more vulnerable to associating sexual arousal with inappropriate rituals and objects. Cognitive behaviorists believe that this tendency is markedly reinforced with consequent orgasm through conditioning. Despite this general agreement on the masculinity of paraphilia, there is still significant differences in the specific causal and developmental factors of paraphilias. This means that the causes of paraphilias are still considered qualitatively different for each type of paraphilia (but we will not dwell on this). In spite of this difference, however, it must be noted that most explanations on paraphilia psychology center on the role of conditioning in the development and maintenance of the disorder. Yet, it must also be remembered that reverse conditioning is also not much effective in reducing and permanently treating paraphilias.
Statistical data on paraphilia abound, and most address the prevalence of each type of paraphilia. But take heed. Some statistics on paraphilia listed below may conflict with each other. Data may also not contain numbers to reduce further errors in thinking, and to encourage a more layman understanding of the subject. Some statistical information on paraphilia are: (1) Paraphilias in men significantly outnumber paraphilias in women. Thus, research literature on paraphilia refers to paraphilics as males (using male pronouns). (2) A review of the research literature on fetishism highlights the role of classical conditioning and social learning in the development of the paraphilia. (3) Victims of male exhibitionists are mostly young or middle-aged female strangers, although some male exhibitionists also target children and adolescents, whether male or female. (4) Exhibitionism usually begins in adolescence or young adulthood. (5) Exhibitionism is the most common sexual offense (about one-third of all sexual offenses) reported to the police in the United States, Canada, and Europe. (6) Around 20 percent of women have been victimized either by an exhibitionist or a voyeur. (7) A significant minority of exhibitionists also qualifies for diagnosis of antisocial personality disorder. (8) Around 10 percent of both men and women engage in sadomasochistic activities. Despite this huge number, sexual sadism and masochism are rarely observed. (9) Sexual sadism and masochism occur mostly in heterosexual men. (10) Serial killers have high tendency to be sexual sadists. (11) Serial killers who are also sexual sadists tend to keep a record (e.g., videotape) of their sadistic acts. (12) The profile of sadistic serial killers is a white male in his late twenties or thirties. Sadistic serial killers follow a consistent system of attacking their victims, and some even report feeling like God in controlling the life and death of their victims. (13) Some sadistic serial killers also qualify for diagnosis of fetishism and exhibitionism. (14) 85 percent of sadistic serial killers report consistent violent sexual fantasies, and around 75 percent actually collect violent-themed sexual materials. (15) There is much higher prevalence of masochism than sadism; and the number of female masochists significantly outnumber female sadists. (16) Around 620 accidental deaths due to autoerotic asphyxia (a kind of masochism in which the masochist strangulates one's self to the point of oxygen deprivation) annually occur in the United States. (17) Paraphilias in women is so rare that they appear only as case reports in the research literature of paraphilia. (18) Most paraphilics qualify for more than one type of paraphilia. (19) Around 29 percent of people who died due to autoerotic asphyxia were partially or fully cross-dressed, and thus may also qualify for transvestic fetishism. (20) Not all cases of child sexual abuse concerns pedophilia because the "child" legally includes adolescents and hence are not restricted to pre-pubescent children - the victims of pedophiles. (21) Almost all pedophiles are males. (22) Around two-thirds of pedophile victims are girls between the ages eight and 11. (23) Many pedophiles do not distinguish between male or female children so long as they are pre-pubescent. (24) Some pedophiles were found to respond more sexually to pictures of nude or partially nude girls than to adult women. (25) Most pedophiles believe that their victims will benefit from the sexual act; and that the victims were the ones who initiated sex. (26) At least 400 priests committed sexual abuse of children and adolescents in the 1980s. (27) Paraphilics are more likely to reoffend than non-paraphilic sexual offenders. (28) The rate of recidivism (or their tendency to reoffend) for paraphilics declines only after the age of 50. (29) Aversion therapy showed modest effect in the laboratory, but whether paraphilics generalize the results to the outside world is not yet well-established. (30) Recidivism rate for castrated paraphilics is around three percent, compared to 50 percent in noncastrated paraphilics.