There are a wide variety of paraphilias, distinguished from one another by the focus of sexual desire or arousal. Patients with paraphilias often have more than one type. Paraphilias often involve one of the following:

• Involuntary partners, including children
• Inanimate objects or animals
• Suffering and humiliation

Some paraphilias may be seen in clinical settings more than other paraphilias because they involve illegal behavior and the possibility of arrest. Patients with paraphilias may only come to the attention of mental health professionals once they have been arrested. The most commonly diagnosed paraphilias are:

• Pedophilia. Sexual arousal associated with children who have not yet reached puberty (generally 13 years old and younger). People with pedophilia often report being attracted to children of a particular age group. They may focus on children within their own family or on strangers. Pedophilia may involve girls, boys or both. Some people with pedophilia may be attracted adults and children, whereas others are only attracted to children. Sexual activity may include undressing or looking at the nude child, masturbation in the presence of the child, fondling, oral sex or sexual penetration. Like all paraphilias, pedophilia usually begins in adolescence, although it may sometimes begin for the first time in mid-life. Sexual involvement with minors is a crime, although the age a person can consent to activity varies in different jurisdictions.
  
  
• Sexual exhibitionism. Also known as “flashing,” achieving  sexual excitement by exposing one’s own genitals to others without their consent. This may include masturbation during exposure (or fantasizing about exposure), but generally does not include any attempt at sexual activity with another person.
  
  
• Voyeurism. Also known as “peeping,” sexual  pleasure derived from witnessing the naked bodies or sexual activity of others without their consent. Masturbation may occur while watching others, but rarely is contact ever made with the observed person.
  
  
• Frotteurism. Touching or rubbing one’s genitals against unsuspecting or unwilling person(s) in order to achieve sexual gratification. This usually occurs in crowded places, such as buses, subways and busy sidewalks. It may include the fondling of a stranger’s body with the hands.  

Additional paraphilias include:

• Fetishism. Sexual desire associated with inanimate objects, such as women’s undergarments or shoes. Frequently, people with fetishism will masturbate while handling the desired item or will request a partner wear the item during sexual activity. The desired item is usually required for sexual satisfaction – its absence may trigger sexual dysfunction (e.g., impotence).  Fetishism does not refer to objects specifically designed for genital stimulation.
  
  
• Sexual masochism. Sexual arousal associated with being humiliated or made to suffer. It may occur in fantasy, by oneself or with a partner. Methods may include being bound, beaten or subjected to verbal abuse and humiliation. When cross-dressing occurs as an element of this type of paraphilia, it is the humiliation of being forced to cross-dress that provides sexual stimulation. Hypoxyphilia, or autoerotic asphyxia, is a type of sexual masochism where sexual arousal is achieved by oxygen deprivation (e.g., via noose, plastic bag, chemicals). Mistakes can be made during this process and accidental death sometimes occurs.
  
  
• Sexual sadism. Gaining sexual gratification from inflicting pain and suffering on others. This may include psychological as well as physical harm. Sexual sadism can occur in fantasy, with a willing other (e.g., a person with sexual masochism) or may be imposed on an unwilling person. The tactics used to inflict pain or humiliation may vary greatly (and include killing), but in all cases it is the suffering of the other that is sexually arousing. Sadism is a crime when it involves nonconsenting participants, and is likely to be repeated until the person with sexual sadism is apprehended.
  
  
• Transvestic fetishism. The practice by heterosexual males of dressing in female clothing for sexual stimulation. It may involve a single item of clothing, but often progresses to complete cross-dressing. The act of cross-dressing provides sexual stimulation, not the clothing itself (as in fetishism). If cross-dressing occurs as part of an overall desire to become a member of the opposite sex, the behavior is associated with a gender identity disorder called transsexualism, not transvestic fetishism.

The above-listed paraphilias may be more common than currently reported. Even if reported, some mental health professionals may be hesitant to characterize as a mental disorder sexual behavior that involves willing adults or behavior that they perceive as not harmful to others. Thus, the above types of paraphilias (with the possible exception of sexual sadism) may be underdiagnosed.

Paraphilias encountered less frequently in clinical settings include, but are not limited to:

• Telephone scatalogia. Sexual arousal obtained by making obscene phone calls to unwilling people. In order to be considered a paraphilia, the sexually explicit language must be imposed on unwilling parties. 
   
• Zoophilia. Sexual arousal associated with animals. It may involve sexual activity or intercourse.