Symptoms of paraphilias include recurrent and intense sexual fantasies, urges or behaviors involving inappropriate objects of sexual desire. This may include unwilling participants, children, inanimate objects, animals or humiliation and suffering. The focus of sexual excitement may differ, depending on the type of paraphilia involved.

These thoughts or behaviors may occur periodically (e.g., during periods of stress) or at any time. They generally last a lifetime, although sexual fantasies and behavior tend to diminish with advanced age.

Many people with paraphilias experience distorted thoughts regarding their behavior. For example, they may believe nonconsenting strangers desire their attention or action (e.g., in cases of sexual exhibitionism or frotteurism) or that the behavior is for the good of the victim (e.g., pedophilia). They also commonly fantasize about sexual relations with others (e.g., voyeurism).