Sexual perversions: causes, symptoms, diagnosis and treatment

By Cristiano Antonino On Jun 13, 2023

The once-used term ‘sexual perversion’ or ‘sexual deviation’ has been replaced by the scientific term ‘paraphilia’ from the Greek ‘filìa’ (attraction) and ‘para’ (deviation), i.e. attraction to abnormal or bizarre sexual behaviour

The basic characteristics of sexual perversions consist of recurrent and intense sexual urges and sexually arousing fantasies that relate to:

1) non-human objects;

2) receiving and/or inflicting genuine suffering or humiliation on oneself or one’s partner; or

3) children or other non-consenting persons.

One speaks of paraphilia (or sexual perversion) only when the behaviour tends to be repetitive and is almost exclusively the only way of experiencing sexuality.

This characteristic distinguishes sexual perversions from abnormal or bizarre but freely chosen and varied sexual behaviour; that is, behaviour that two sexual partners decide to engage in if they so wish.

Thus, the boundary of pathology, in sexuality, is related to the exclusivity of the paraphilic behaviour, the compulsiveness of the behaviour and the lack of consent on the part of the sexual partners.

Clinically, eight major forms of sexual perversions are recognised

exhibitionism (sexual arousal by exposure of one’s genitals, often during masturbatory activities, in front of a stranger who does not expect it);
fetishism (sexual arousal through the use of inanimate objects, such as, for example, women’s clothing; the subject often achieves sexual pleasure through onanistic practices, while wearing, rubbing and smelling the fetish. He may also ask his partner to use it during sexual encounters);
frotteurism (sexual arousal obtained by touching or rubbing against an unwilling person, an activity often carried out in crowded public places or on means of transport)
paedophilia (sexual urges and activities towards prepubescent children);
masochism (deriving sexual enjoyment from being subjected to physical and psychological suffering and humiliation by others)
sadism (sexual arousal resulting from real and unsimulated acts involving the infliction of humiliation, beatings or suffering on the partner)
cross-dressing fetishism (sexual urges caused by dressing up in clothes of the opposite sex; this category should not be confused with transsexualism, which is an outcome of gender identity disorder and is therefore not a paraphilia)
voyeurism (sexual pleasure derived from spying on unsuspecting people while they are naked, in intimacy, or during their sexual intercourse; this condition should be distinguished from troilism, which consists of deriving sexual arousal from openly observing other people having sex).

Among the many rarer sexual perversions (paraphilias) are

zoophilia (sexual practices with animals)
necrophilia (erotic investment in macabre scenes, with funeral rituals, sometimes going as far as sexual union with corpses)
coprolalia or telephone scatology (arousal obtained by uttering obscene phrases over the telephone);
partialism (sexual attention focused exclusively on one part of the body);
coprophilia (drawing sexual arousal from faeces);
urophilia or pissing (drawing sexual arousal from urine);
chlorismaphilia (using an enema in erotic activities).

It must be remembered that any sexual perversion must last for at least six months, must manifest itself as the subject’s exclusive or predominant form of sexuality, and must cause clinically significant distress or impairment in the social, work or other important areas of functioning.

Unfortunately, the treatment of sexual perversions (paraphilias) has been scarcely studied in depth, as sufferers very rarely decide to see a therapist, unless, after being caught in the act, they are forced to do so by a relative or by the law; but in any case, they are poorly motivated patients and their cooperation, if they come to therapy for judicial reasons, is purely for the purpose of alleviating their punishment.

Moreover, in general, perversion sufferers are very unlikely to choose a course of therapy spontaneously, sometimes out of shame, but much more often because they are unaware of their problem.

Before proceeding to any intervention, however, an initial diagnostic assessment is necessary, especially to exclude other psychopathological forms such as mental retardation, severe personality disorders (in particular borderline disorder, narcissistic disorder and obsessive-compulsive disorder) and other pathologies.

Once the patient’s global functioning has been assessed, it will be possible to orientate towards the appropriate form of treatment for each specific case of sexual perversion.

The optimal therapeutic approach will therefore have to be different depending on the type of perversion, the degree of invalidation of the person and their social dangerousness.

Depending on the severity of the case, appropriate pharmacological and psychotherapeutic combinations can be implemented.

In general, this disorder can be improved through a targeted cognitive-behavioural psychotherapeutic intervention.

If, on the other hand, the subject requires therapy because of difficulties in his relationship with his partner due to his paraphilic behaviour, couples psychotherapy seems to be the most suitable treatment.

Anorgasmia (Frigidity) – The Female Orgasm

Body Dysmorphophobia: Symptoms And Treatment Of Body Dysmorphism Disorder

Vaginismus: Causes, Symptoms, Diagnosis And Treatment

Premature Ejaculation: Causes, Symptoms, Diagnosis And Treatment

Sexual Disorders: An Overview Of Sexual Dysfunction

Sexually Transmitted Diseases: Here’s What They Are And How To Avoid Them

Sexual Addiction (Hypersexuality): Causes, Symptoms, Diagnosis And Treatment

Sexual Aversion Disorder: The Decline In Female And Male Sexual Desire

Erectile Dysfunction (Impotence): Causes, Symptoms, Diagnosis And Treatment

Mood Disorders: What They Are And What Problems They Cause

Dysmorphia: When The Body Is Not What You Want It To Be