As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.

Note: There is a lot of stigma around sex and sexuality. When you work with a therapist in a confidential environment, you can be sure that they will be understanding of your personal desires and wishes to improve your life and assist you in adopting a healthier relationship with your sexuality.

Paraphilias are colloquially understood as “odd” or “unusual” sexual desires. Historically, the term fetish has been used and has harbored a lot of judgement and negativity. This has been the case in both social and mental health settings. However, as our attitudes and understanding of human sexuality evolve, sexual desires that are considered “outside the norm” are becoming more commonplace and accepted in the psychological community, as long as they are among consenting adults and do not have an negative impact on a person’s life.

For some, their sexual desires can cause quite a bit of disturbance in their day-to-day lives and relationships. Some clients seek out therapy to help sort through sexual-desire-related issues, commonly referred to in the psychological community as paraphilias.

Currently, the Diagnostic and Statistical Manual of Mental Health Disorders lists a variety of so called “sexual disorders.” There is still a lot of controversy surrounding these diagnoses among branches of the psychology and therapy community, however, the Diagnostic and Statistical Manual of Mental Health Disorders remains the gold standard for understanding and categorizing desire-related disruptions.

There are a variety of paraphilias that exist, but the common basis lies in the diagnosis of Fetishistic Disorder.

Fetishistic Disorder is characterized predominantly by:

  • “Recurrent and intense” arousal from inanimate or nonliving objects (i.e. Not people) or non-genital body parts
  • This desire and arousal can manifest via fantasies, urges, behaviors, or a combination of the three
  • These desires must cause distress for the individual and/or cause disruption in an individual’s life such as in work, social, or other important areas of functioning
  • These desires are not related to clothing used in cross-dressing or in objects specifically designed for genital stimulation (such as vibrators or other masturbation aides)
  • These symptoms must be experienced for a period of at least 6 months

There are a wide variety of paraphilias that an individual might experience, each with their own diagnostic criteria and presentation. Examples include:

  • Voyeuristic Disorder: This involves deriving sexual attraction from watching an unsuspecting person who is naked, in the process of disrobing, or engaged in sexual activity. Like Fetishistic Disorder, this may be experienced in the form of fantasies, urges, or behaviors.
  • Exhibitionist Disorder: Similar to Voyeuristic Disorder, Exhibitionist Disorder manifests by an individual being aroused by being the one exposing themselves to unsuspecting people. This may manifest in urges, fantasies, or behaviors.
  • Frotteuristic Disorder: This condition is characterized by a person deriving sexual arousal from rubbing against or touching a nonconsenting person. This desire and arousal may be manifested by urgent, fantasies, or behaviors.
  • Sexual Masochism Disorder: Sexual Masochism Disorder is experienced by those who achieve sexual arousal by being bound, physically beaten, emotionally humiliated, or otherwise made to suffer. This arousal may manifest in urges, fantasies, or behaviors.
  • Sexual Sadism Disorder: This disorder is characterized by intense, and current, arousal from the emotional, psychological, or physical suffering of someone else. This can be manifested in the form of urges, fantasies, or behaviors. The individual with the desires may have acted upon these urges or, if they haven’t, may experience disruption in their lives due to the desires themselves.
  • Pedophilic Disorder: Pedophilic Disorder is a condition characterized by arousing fantasies, behaviors or urges which involve sexual activity with prepubescent children (generally 13 years of age or younger). The individual must also be 16 years of age and at least 5 years older than the prepubescent child. This condition, however, does not include an individual in late adolescence who is in a sexual relationship with a 12 or 13 year old. The person with the disorder may have acted on these urges, but may also experience the condition without enacting their behaviors or fantasies.
  • Transvestic Disorder: This condition is manifested by an individual experiencing sexual arousal from cross-dressing. This may occur in the scope of urges, fantasies, or behaviors.

Many people who participate in non-normative sexualities may engage in practices, for example pain play, between consenting adults. However, it should be noted that any behaviors such as, but not limited to, frotteurism, exhibitionism, pedophilia are illegal in most jurisdictions and punishable by law. While sexual attitudes or desires may not be controllable, physically enacting fantasies on non-consenting or underage parties is never acceptable behavior.


Treatment

Sexual desire disorders, otherwise known as paraphilias, are typically treated with cognitive behavior therapy. In some cases, pharmacotherapy is recommended as medication can be very helpful in improving mood and reducing urges overall. These can be critical interventions, especially when safety is a primary concern.

Medication

There is some research that indicates that medications can be helpful in the treatment of sexual desire disorders. In particular, research has indicated that antidepressants may be helpful with limited effectiveness. Popular antidepressants such as Sertraline, Fluoxetine, and Citalopram present options for many.

Medications to lower sex drive, known as antiandrogens, may be helpful adjuncts to individual therapy strategies and techniques to manage urges. However, other medications known as gonadotropin-releasing hormones provide chemical “castration” are used in those most at-risk for enacting their fantasies with nonconsenting or underage persons. These medications have demonstrated great effect in the treatment of disorders which include harm to others (such as exhibitionism, sexual sadism, frotteurism, and pedophilia). Examples of said medications include: leuprolide acetate and triptorelin.

Psychotherapy

There are a wide range of approaches and interventions that a therapist may include in the treatment of paraphilias.

Working with a Certified Sex Therapist can be very helpful for those living with any of the paraphilias listed above. Treatment will typically involve a combination of psychoeducation, cognitive strategies, and behavioral therapy to assist in minimizing harm on the individual seeking out therapy and, in some instances, reduce the risk to other community members potentially impacted or put at risk, depending on the nature of the disorder.

Additionally, a therapist may implement social skills training in the treatment of sexual desire disorders, as there is some thought that those living with these conditions may experience isolation due to an inability to interact in a manner that fosters meaningful social connections.

Other behavioral strategies may include: assertiveness training, masturbatory training or orgasm reconditioning, relapse prevention, and accountability or surveillance options (such as involving others in watching for warning signs or other concerning behavior, as applicable).

Group Therapy

Support in the form of group therapy can be very powerful for those living with Fetishistic Disorder and other sexual desire disorders. Due to the highly secretive nature and shame associated with these conditions, it can be difficult for many to engage in and access treatment, particularly group treatment. However, the benefits of group support can be profound to counteract the isolating impact of these mental health concerns.

In group therapy, individuals will learn coping skills to deal with their urges and share in a supportive environment with like-minded individuals.


Therapeutic Note

Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.


Questions for my therapist:

  • How do I know if what I like is a disorder or just something I like?
  • Does this have anything to do with porn addiction?
  • I’ve tried to make myself not enjoy the things I do...how can therapy actually help?
  • My desires have really changed my romantic and social relationships, can you help with that?
  • Are there any gender differences among these conditions?


Sources:

American Psychiatric Association. Paraphilic Disorders. Desk Reference to the Diagnostic Criteria From DSM-5®. Washington: American Psychiatric Publishing, 2014. 333-339.

Brannon, G. E., et al. (2017, May 02). Paraphilic Disorders Treatment & Management. Retrieved July 19, 2017, from http://emedicine.medscape.com/article/291419-treatment#d10

Mcmanus, M. A., Hargreaves, P., & Alison, L. J. (2013). Paraphilias: definition, diagnosis and treatment. F1000Prime Reports,5. doi:10.12703/p5-36