Certain sexual thoughts or behaviors that are considered abnormal, unusual or distasteful may indicate a complex mental disorder called paraphilia. Paraphilia literally means “abnormal or unnatural attraction.”

Paraphilias are a type of sexual disorder. They involve recurring and intense sexual fantasies, urges or behavior. Fantasies or thoughts often turn into sexual acts. For many patients with paraphilias, sexual excitement is achieved through the use of involuntary partners (including children), inanimate objects or animals, or pain and humiliation.

Many people may experience occasional sexual thoughts or behaviors that deviate from what is generally considered normal. These isolated instances are usually limited to fantasy during masturbation or occur during sexual activity with a willing partner. It is not considered a paraphilia when these thoughts or behaviors involve no illegal behavior, do not cause distress or impede development of healthy interpersonal relationships and are not required to achieve sexual gratification.

There are many different types of paraphilias, which may be distinguished from one another based on the focus of sexual desire or arousal. Patients with paraphilias often have more than one type.

Most sexual fantasies and behaviors, including those associated with paraphilias, begin during adolescence. They often continue throughout a person’s lifetime. Patients may engage in paraphilic activities with a consenting partner, use the service of prostitutes or impose their behavior upon unwilling others. 

People with paraphilias may engage in work or hobbies that bring them into contact with the focus of their paraphilia. For example, a man with a shoe fetish may choose to work in a store that sells women’s shoes, or a pedophile may spend his spare time engaging in activities that involve children. People with paraphilias may also rely on Internet images, films or other representations of the object of their arousal to achieve sexual gratification.

Almost all patients diagnosed with a paraphilia are male. Approximately 50 percent of patients in treatment for paraphilias are married, according to the American Psychiatric Association.

The exact number of people with some type of paraphilia is unknown. Although rarely diagnosed, paraphilias are believed to be more common than reported. This may be due to:

• Secrecy surrounding sexual behavior. It can be difficult to obtain information about sexual thoughts and activities since sexual behavior is usually considered a private, personal act. People are often not willing to share information about their sexual practices with others. Feelings of embarrassment or shame may cause a person to be unwilling to admit to certain sexual thoughts or behaviors. In addition, patients with paraphilias may believe their thoughts or behaviors cause no harm and they are rarely willing to seek help for their sexual thoughts or behavior.
  
  
• Reluctance to classify consensual sexual behavior as a disorder. Some mental health professionals may be unwilling to diagnose as a mental disorder those types of paraphilias that occur between consenting adults or are believed to cause no harm. Thus, even if these types of paraphilias are reported to a mental health professional or physician, they may go undiagnosed and unreported.
  
  
• Availability of paraphilic products and services. Many products and services are available (sometimes illegally) that appear to cater to various paraphilias. These include child pornography and sadistic or masochistic devices. This availability indicates that the prevalence of these disorders may be higher than currently reported.   

All paraphilias may eventually involve significant consequences. Those that involve children or unwilling participants are criminal acts. These consequences include:

• Arrest. Paraphilias that involve illegal behavior can lead to arrest. Being caught or accused of engaging in these behaviors is often the only way many paraphilias are discovered. Many people who are arrested for sex offenses commit acts such as pedophilia, sexual exhibitionism and voyeurism.
  
  
• Physical injury. People who engage in sexual masochism may suffer from physical wounds that can range from minor cuts and bruises to life-threatening injuries.
  
  
• Interpersonal difficulties. People with paraphilias often have difficulty maintaining healthy personal and sexual relationships. This may be due to the negative reaction of others to the paraphilia. It may also occur when the paraphilia becomes the center of a person’s life – to the exclusion of family, friends or loved ones.
  
  
• Feelings of shame or guilt. People with paraphilias may experience feelings of intense shame or guilt over their thoughts or behavior. They may have trouble reconciling their actions with what others consider amoral, indecent or socially unacceptable.
  
  
• Depression. Patients with paraphilias may experience depression as a result of their feelings concerning their abnormal sexual thoughts or behavior. Feelings of depression may, in turn, cause an increase in the frequency and intensity of the patient’s paraphilia.
  
  
• Sexual dysfunction. Problems with sexual functioning or level of sexual desire (e.g., impotence, frigidity) sometimes occur in patients with a paraphilia.
  
  
• Sexually transmitted diseases. People with paraphilias who engage in frequent, unprotected sex may contract and/or transmit sexually transmitted diseases.

Though not a consequence of paraphilias, other mental disorders sometimes occur in patients with paraphilias. For example, the emotions, thoughts and behavior patterns of people with paraphilias may sometimes meet criteria to be classified as a personality disorder.