The cause of paraphilias is poorly understood. Most sexual fantasies and behaviors, including those associated with paraphilias, begin during adolescence. What triggers a focus on inappropriate objects of sexual desire is not clear.

Problems maintaining healthy interpersonal and sexual relationships may reinforce paraphilic thoughts or behavior. Periods of stress, the existence of an accompanying mental disorder (e.g., depression), and opportunity may all increase the frequency of a particular paraphilia. 

Several factors appear to increase the likelihood of paraphilias. These include:

• Gender. Almost all patients diagnosed with a paraphilia are male. Although most paraphilias may occur in either gender (except transvestic fetishism), they are almost exclusively diagnosed in men. However, it is believed  that female pedophilia may be a much more common disorder than previously thought. Sexual masochism is one paraphilia in particular that includes a measurable percentage of women – an estimated one female for every 20 males, according to the American Psychiatric Association (APA).
  
  
• Age. Younger people may be at greater risk of certain paraphilias than older adults. Sexual thoughts and behaviors (including paraphilias) generally appear during the teen years. Also, sexual fantasies and behavior tend to diminish with age.
  
  
• Childhood sexual abuse. In some studies, patients with paraphilias had significantly higher rates of childhood sexual abuse than patients without paraphilias.
  
  
• Early exposure to deviant sexual behavior. Through imitation and conditioned learning, people exposed to abnormal sexual behaviors (including paraphilias) during their childhood may be more likely to develop paraphilias.