Chapter 8: Paraphilic Disorders


Paraphilic disorders are a category of disorders that include “unusual or bizarre fantasies” as a requirement for sexual arousal (American Psychological Association, 2022). This group of disorders causes harm or distress to another person. (Mayo Clinic, 2022). Watch the video below to learn more about paraphilic disorders.


Criteria to Diagnose: Fetishism is when inanimate objects are required for sexual arousal. Typically, the objects are unusual, not vibrators, but items like rubber items, shoes, undergarments and others. Individuals may go so far as to obtain items by stealing or ask partner to wear them during sex (Davey, 2021). The fetish must cause significant distress in the individual in order to be diagnosed (Conger, 2022).

Typical Demographics: This disorder is most common in males and may interfere with normal sexual experiences with a partner (American Psychological Association, 2022). This often presents in adolescence, brought on by sexual experiences from childhood.

Treatment, Medications, and Therapies: Therapy with a certified therapist who specializes in paraphilias is the best way to treat this disorder. The therapist may use strategies like sex therapy, CBT, and medication (Conger, 2022).

Case Studies to Review:

Transvestic Disorder

Review the slides and videos below to learn more about transvestic disorder.


"The forced surprise face" by Henry Söderlund is licensed under CC BY 2.0.
The forced surprise face” by Henry Söderlund is licensed under CC BY 2.0.

Criteria to Diagnose: This disorder is the behavior of showing a stranger genitals as a means for sexual arousal. There is no further interaction with the stranger (American Psychological Association, 2022). It is required that this causes distress or impaired functioning (Brown, 2021) for at least six months.

Typical Demographics: Up to 4% of men have this disorder; there is a lower prevalence in women. Brown (2021) estimates that 30% of sex offenders are exhibitionists and up to 50% relapse after treatment.

Treatment, Medication, and Therapy: Psychotherapy, support groups, and SSRIs are common treatments for this disorder. Drugs are not effective when this disorder is severe.


Select each of the four hot spots below to learn more about this disorder.


"Tokyo subway at rush hour" by transitpeople is licensed under CC BY 2.0.
Tokyo subway at rush hour” by transitpeople is licensed under CC BY 2.0.

Criteria to Diagnose: This disorder is characterized by individuals experiencing arousal by rubbing against other people. It will appear accidental, like in lines or crowded public spaces (American Psychological Association, 2022).

Typical Demographics: Generally, the individuals are men with any age group. It does seem to occur slightly more often in men who are “shy” or “withdrawn” and either older or within 15-25 years of age. It is estimated that 10-14 percent males have been diagnosed with this disorder (Psychology Today, 2022)

Treatment, Medications, and Therapies: This individuals do not usually receive treatment unless it is court mandated. When it is required, psychotherapy and medication are usually used to better control sexual desires. There is also proven success with behavioral therapy and relaxation training to manage urges (Psychology Today, 2022).

Case Study to Review:


Review each type below, flipping the card to see more details by selecting “Turn”. After reviewing a card, select the right pointing arrow to move to the next card. There are three cards to review.



Case Studies to Review:


Sexual Sadism and Sexual Masochism Disorders

Move the middle bar to the right to view and compare these disorders.


Case Studies to Review:


American Psychological Association (2022). Fetishism. APA.

American Psychological Association (2022). Paraphilia. APA.

American Psychological Association (2022). Exhibitionism. APA.

American Psychological Association (2022). Voyeurism. APA.

American Psychological Association (2022). Frotteurism. APA.

American Psychological Association (2022). Pedophilia. APA.

American Psychological Association (2022). Sexual sadism. APA.

American Psychological Association (2022). Sexual masochism. APA.

Anzani, A., Lindley, L., Tognasso, G. et al. (2021). “Being Talked to Like I Was a Sex Toy, Like Being Transgender Was Simply for the Enjoyment of Someone Else”: Fetishization and Sexualization of Transgender and Nonbinary Individuals. Arch Sex Behav 50, 897–911

Bennett, T. A (2021). Fine Line Between Pleasure and Pain: Would Decriminalising BDSM Permit Nonconsensual Abuse?. Liverpool Law Rev 42, 161–183

Brown, G. (2021). Transvestic disorder. Merck Manual. Retrieved on August 24, 2022 from

Brown, G. (2021). Exhibitionistic disorder. Merck Manual. Retrieved on August 24, 2022 from

Brown, G. (2021). Pedophilic disorder. Merck Manual. Retrieved on August 24, 2022 from

Brown, G. (2021). Sexual sadism disorder. Merck Manual. Retrieved on August 24, 2022 from

Clinical ORS (2022, June 23). Paraphilic disorders [Video]. YouTube.

Conger, I. (2022). Fetishistic disorder: Causes and treatment options. Choosing Therapy.

Conger, I. (2022). Sexual sadism disorder. Choosing Therapy. http://Move the middle bar to the right to view an image of coca leaves; move the middle bar to the left to view cocaine.

Davey, G. (2021). Psychopathology : research, assessment and treatment in clinical psychology (Third, Ser. Bps textbooks in psychology). Wiley-Blackwell.

Fuss, J., Briken, P. & Klein, V. (2018). Gender bias in clinicians’ pathologization of atypical sexuality: a randomized controlled trial with mental health professionals. Sci Rep 8, 3715

Harper, C.A., Lievesley, R., Blagden, N.J. et al. Humanizing Pedophilia as Stigma Reduction: A Large-Scale Intervention Study. Arch Sex Behav 51, 945–960 (2022).

Knox, B. (2020). Transvestic disorder – Sexual disorder series [Video]. YouTube.

Mayo Clinic (2022). Mental illness. Diagnosis and treatment. Retrieved on August 24, 2022 from

Psychology Today (2022). Frotteuristic disorder. Retrieved on August 24, 2022 from

Psychology Today (2022). Transvestic disorder. Retrieved on August 24, 2022 from

Putri, A. N., & Soetjipto, S. (2020). Frotteuristic Disorders. Jurnal Psikiatri Surabaya, 9(2), 46–51.

Qasim, S., McKeown, M., Kunda, C., Wainwright, J. P., & Khan, R. (2020). Plant Fetish: A Creative Challenge to Mental Health Stigma. Genealogy, 4(2), 40. MDPI AG. Retrieved from

Reale, K., Chopin, J., Gauthier, A., & Beauregard, E. (2022). Manifestations of sexual sadism in child sexual assault and the associated victim, offender, and offense characteristics: A latent class analysis  . CrimRxiv.

Selby, C. (2016, April 8). Transvestic disorder [Video]. YouTube. http://”10080026″ by moodboardphotography is licensed under CC BY 2.0.

Sowersby C-J, Erskine-Shaw M and Willmott D (2022) Masochist or Murderer? A Discourse Analytic Study Exploring Social Constructions of Sexually Violent Male Perpetrators, Female Victims-Survivors and the Rough Sex Defense on Twitter. Front. Psychol. 13:867991. doi: 10.3389/fpsyg.2022.867991

Stelzmann D, Jahnke S, Kuhle LF. Media Coverage of Pedophilia and Its Impact on Help-Seeking Persons with Pedophilia in Germany—A Focus Group Study. International Journal of Environmental Research and Public Health. 2022; 19(15):9356.

Thomas, A.G., Stone, B., Bennett, P. et al. (2021). Sex Differences in Voyeuristic and Exhibitionistic Interests: Exploring the Mediating Roles of Sociosexuality and Sexual Compulsivity from an Evolutionary Perspective. Arch Sex Behav 50, 2151–2162


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Psychopathology by Andrea Bearman and Jackie Delagrange is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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