Paraphilia: A Critique of a Confused Concept

This chapter is more than a critique of the “paraphilia” construct. Ii is an attempt to unify several disparate serological and psychiatric concepts. Will review the history of the concept of paraphilia, its use in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA), and the distinctive uses of the same term in both psychiatry’ and sexology. I also will present an alternative DSM classification and criteria.

For present purposes, a sexual interest is defined as the focus of an individual s sexual fantasies, urges, desires, and behaviors. Explanations of the origins of sexual interests have emphasized behaviors or urges that our society has deemed peculiar. Correspondingly, there has been little attempt to develop a theory to explain “normal” sexual interests. The resulting gap will be addressed and critiqued in this chapter.

Sexual Interests

Neither sexology nor other disciplines have been able to explain how humans develop any or even particular sexual interests. The possibility (and probability) that different developmental processes can result in the same The proposed “В” criterion has been added because sexual interests can be the resuh. albeit rarely, of other medical disorders (e.g.. brain damage or seizure). Treatment of the underlying medical disorder may ameliorate the distressing or dysfunctional sexual interest. Additionally, some psychiatric syndromes (e.g., drug intoxication) may affect sexual interests. Treatment of these syndromes can result In cessation of the problematic sexual interest.

As mentioned above, the singling out of specific sexual behaviors must be avoided. In the SID category, naming of the specific sexual interest would be eliminated for three reasons:

1. First, it is a theoretical flaw to pathologize behavior. A behavior by itself is not necessarily evidence of psychopathology. People hallucinate without being psychotic, show vegetative signs without being depressed, use excess substances without quali¬fying for a drug abuse diagnosis, and so on. So, the sexual interest per se is not the issue, but whether or not it is the cause of distress or dysfunction in the individual’s life. Therefore specifying the behavior can only confuse the clinician and draw the focus of the evaluation away from the individual’s level of the distress or dysfunction. Avoiding the naming of the behavior and focusing on the psychological deficits the ehavior engenders is an important aspeci of any proposed diagnostic consideration.

2. Second, the therapist’s own socialization is likely to be thrust into the evaluation. The proposed alternative requires the individual diagnosing the client to justify the diagnosis on the basis of distress and dysfunction. rather than confounding the evaluation with the therapist’s personal reaction to atypical sexual behavior. It is not uncommon to hear mental health professionals make derisive comments on a patient’s behavior rather than focusing on the distress or dysfunction exhibited by the patient. For example, “How could being humiliated be healthy?” or “Cross-dressing must be compulsive why else would anyone do it?” These and similar remarks demonstrate that the therapist’s own socialization is the basis of the determination of psychopathology, rather than more objective criteria.

3. Third, the aci of specifying particular sexual behaviors as pathological has led to discrimination against all practitioners of that behavior, even when its expression is appropriate and benign. Specifying the behavior brings additional stigma to individuals who appropriately find their sexuality to be a source of enjoyment and satisfaction in their lives. Individuals have lost jobs, security clearances, custody of children, and other rights as the result of being so labeled. It is important to note that the diagnostic criteria do not specify “treat-ments.” It may be appropriate to reassure the client, to have the client attempt to cease the behavior and fantasies, to help the client with other underlying problems (e.g., depression), to problem-solve solutions to the client’s dilemmas, among other scenarios. If an individual’s sexual interest causes distress or dysfunction, the therapeutic options include the elimination of the interest or learning to express the interest in a “healthier” manner. Elimination of the interest is the parsimonious approach, as attempts to merely control the behavior require constant moni¬toring; transforming the interest is also possible but rarely attempted.

Comments are closed.