Assessing and Treating Paraphilias
Although the majority of paraphiliacs do not seek treatment and are content with balancing the pleasure and guilt of their paraphilia, others find their paraphilia to be an unwanted disruption to their lives. Their sexual desires may get in the way of forming relationships, may get them into legal trouble, or may become such a preoccupation that
SEX in Real Life
ach term that follows refers to an object or practice that a person is compulsively responsive to and dependent on for sexual arousal and orgasm. Often these behaviors are addictively repetitious.
Acrotomophilia and apotemnophilia: Having either a partner who is an amputee, or imagining oneself being an amputee.
Asphyxiophilia or hypoxyphilia (also known as autoerotic asphyxiation): Decreasing the flow of oxygen to the brain. Many who engage in this practice use a rope or noose around their neck and try to hang themselves at the moment of orgasm. This is very dangerous, and one estimate is that 31% of adolescent suicides in a 10-year period were actually due to autoerotic asphyxiation that accidentally (or intentionally) went too far (Sheehan & Garfinkel, 1988).
Autonepiophilia: Impersonating a baby in diapers and being treated as one by partner.
Coprophilia and urophilia: Being smeared with or ingesting feces or urine.
Formicophilia: The sensations produced by insects, frogs, or snails creeping or crawling on the genitals.
Gerontophilia: Having a partner who is elderly.
Hyphephilia: The feel of a certain type of texture, such as skin, hair, fur, or leather.
Klismaphilia: Receiving an enema.
Mysophilia: Self-degradation by smelling, chewing, or utilizing sweaty or soiled clothes or menstrual items, such as used tampons.
Narratophilia: Using erotic or obscene talk, such as the pay-sex phone lines.
Olfactophilia: The smells of certain body parts, especially sexual and hairy areas.
Stigmatophilia: Being with a partner who is pierced or tattooed.
Source: Adapted from Holmes, 1991; Money, 1984.
they dominate their lives. For these people, a number of therapeutic solutions have been tried, with varying success.
The first step in treating a person with a paraphilia of some sort is to assess the nature and scope of the problem. This can be done through self-report, through behavioral observation, or by physiological tests or personality inventories (Seligman & Hardenburg, 2000). Self-reports may not be reliable, however; individuals under court order to receive treatment for pedophilia may be highly motivated to report that the behavior has ceased. Also, people are not necessarily the best judge of their own desires and behavior; some may truly believe they have overcome their sexual desires when in fact they have not. The second technique, behavioral observation, is limited by the fact that it cannot assess fantasies and desires; also, most people can suppress these behaviors for periods of time.
Physiological tests may be a bit more reliable. The most reliable technique for men is probably penile plethysmography, which is often used with male sex offenders. For example, a pedophile can be shown films of nude children and the plethysmograph can record his penile blood volume. If he becomes excited at the pictures, then he is probably still having pedophilic desires and fantasies. A similar test is also available to test the sexual response of female offenders. However, both of these physiological tests have been found to be of limited use in this population (Seligman & Hardenburg, 2000).
Personality inventories, such as the Minnesota Multiphasic Personality Inventory (MMPI), can help establish personality patterns and determine whether there are additional psychological disorders (Seligman & Hardenburg, 2000). Other psychological inventories for depression and anxiety are often also used.