The paraphilias ( Greek παραφιλία from pará , 'apart', 'next to', and philía , 'friendship', 'love') denote sexual inclinations that deviate significantly from the empirical norm. These include, in particular, pronounced and recurring sexual fantasies, needs or behaviors that relate to inanimate objects ( sexual fetishism ), pain , humiliation , persons unable to consent such as children or animals .
For a long time, paraphilias were predominantly regarded as pathological. With the publication of the DSM-5 in 2013, they are no longer generally assigned a disease value, but only if they are associated with psychological stress in the person concerned or are not socially acceptable, i.e. harm society. Today a distinction is made between non-pathological paraphilia (paraphilia) and pathological paraphilic disorder ( paraphilic disorder ) .
Changes in the concept
The term was coined by Friedrich Salomo Krauss after the Hungarian doctor Heinrich Kaan had published a work under the title Psychopathia sexualis in 1843 in which he converted Christianity's notions of sin into medical diagnoses . Critics see Krauss in a corresponding line of tradition that corresponded to the moral world of his time.
Today, paraphilias are classified as mental disorders in the DSM-IV catalog and under the term “disorder of sexual preference ” (F65) in the International Classification of Diseases, 10th revision ( ICD-10 ) . The diagnosis of sexual preference as paraphilia is, however, controversial and is subject to continuous change historically and sociologically, which is reflected in an ongoing revision and discussion by the editors of both diagnostic manuals.
Delimitation of the term
Although overlaps are possible, the following technical terms must be distinguished from paraphilia:
- Deviance and perversion (the latter term is rarely used these days and is more likely to be derogatory or discriminatory)
- Dissexuality : a " social failure expressed in sexual terms " as a "failure to meet the (time and socio-culturally conditioned and thus changeable) average expectable partner interests"
- Sexual delinquency : a behavior primarily defined by the respective legislation and case law
Laypeople often refer to paraphilias (even in their subclinical form) as perversions, with both the WHO and the APA expressly speaking out against the discrimination and stigmatization of people with "unusual" sexual preferences .
Diagnoses according to ICD-10 and DSM-IV-TR
The German text edition of ICD-10, Chapter V (International Classification of Mental Disorders) published by the WHO in 1992 differs significantly from the online versions or diagnosis lists in that the diagnostic criteria of most diseases are formulated in detail here while they are online Expenses are often only briefly listed and are sometimes completely absent from the ICD-10 lists. Because of this, misdiagnoses often occur in this area (see below).
In its new edition of the DSM (DSM-IV-TR, 2000), the American Psychiatric Association has changed the diagnostic criteria for paraphilias, so that a diagnosis based on an outdated edition of the manual can also be incorrect.
For example, the diagnostic criteria for fetishism are not found in this chapter, only the type of sexual preference is described here. The clinical guidelines are superordinate to the paraphilias, which is why a clinician who looks up “fetishism” in the ICD-10 will only find a description of the sexual preference, which of course a non-clinical patient can also meet. If the diagnosis is correct, then the supercategory F65.x must first be diagnosed before the decision tree of the ICD-10 can proceed to diagnosis F65.0 ( sexual fetishism ).
The high number of misdiagnoses and the stigmatization of people with unusual preferences resulting from the layman's term leads to requests for the abolition of the entire F65 category from some experts and activists. However, since the APA explicitly emphasizes the difference between non-pathological sexual preferences and paraphilias, it does not provide for the diagnosis to be abolished. “ There are no plans or processes set up that would lead to the removal of the Paraphilias from their consideration as legitimate mental disorders. ”(Regier (APA), 2003).
I-syntony vs. Ego dystonia in paraphilias
In contrast to many mental disorders, the paraphilias are usually I-syntonic . In many cases, this leads to paraphiles not being recognized, as they usually do not perceive themselves to be sick. According to this, the pressure of suffering (if at all) arises late in the course of the disease and is mostly secondary, i.e. the patient does not suffer from his own symptoms, as in ego-dystonic diseases (e.g. phobias ), but he suffers from grievances that are secondary resulting from his illness. These often include legal consequences, social isolation, financial difficulties, job losses, medical disease factors, etc., caused by the appearance of sexual fantasies, needs or behaviors.
Paraphilias and Personality
The causes of paraphilias have not yet been clarified, although (as with most mental disorders) there are many, sometimes very divergent explanations. There is a connection between sexuality (in general) and personality that has been validated over decades of empirical research . According to common personality theories, human behavior, thought patterns, attitudes, etc. result to a large extent from the personality structure of each individual. This can also be applied empirically to sexual behavior.
Based on this consideration, some researchers establish connections between disturbed sexual behavior and personality disorders . However, this does not mean that every paraphilia is to be equated with a personality disorder, but rather that the disordered behavior, which many (not all) paraphiles exhibit, is strongly reminiscent of the conditions in personality disorders.
A personality disorder (F60.x) is defined by a clear deviation from the norm in a person's attitudes and behavior, whereby this deviation from the norm is permanent and constant, has a pronounced depth and breadth (regardless of specific situations) and begins in childhood and adolescence , manifests itself in early adulthood and is in most cases experienced as an ego synton .
These conditions are also found in a group of paraphils whose sexual behavior deviating from norms is extremely pronounced, permanent and dominant and becomes manifest in adulthood (usually becoming stronger). The paraphiles affected do not perceive themselves as sick, but rather regard their sexual needs as often more important than those of other people, so that there are often violations of the law (e.g. rape, sexual assault on children, theft, desecration of corpses, coercion, trespassing, etc. ). The concept of paraphilic personality disorder has been proposed for this condition, but it is still relatively unexplored and so far has largely relied on qualitative research and few empirical results. Overlaps can also be found in the concept of dissexuality by Klaus Michael Beier at the Institute for Sexology and Sexual Medicine at the Charité in Berlin.
“To characterize this central aspect in a morally neutral way as far as possible, the term 'dissexuality' is a 'social failure expressed in sexuality', which is understood as the failure of the (time- and socio-culturally conditioned and thus changeable) average expectable partner interests . "
Most of the best-known paraphilias are listed as separate classes in both diagnostic manuals, only some of the forms listed below are classified in the remaining categories. Since the DSM-IV does not provide its own diagnostic keys - the ones given there are only the old keys of the ICD-9 - only the codes according to ICD-10 are given here for the sake of simplicity.
Fetishism describes the sexual fixation on inanimate objects that serve as a substitute for the usual sexual act with a partner. Typical sexual fetishes are clothing. Aids expressly intended for sexual use, such as vibrators, are excluded from the diagnosis. The fixation on certain parts of the body, on the other hand, is called partialism , and arousal from body parts is called necrophilia .
According to ICD-10, fetishism may only be diagnosed if it is so pronounced that it represents the most important or even the only source of sexual arousal and makes sexual intercourse almost compulsive or excruciating for the person concerned. The inclusion of additional material in sexual intercourse, for example in role-playing games with disguise, is not considered sexual fetishism if the diagnosis of F65.x is not met. Nor is it fetishism if an object is used during masturbation in order to evoke the memory of the owner, for example a pair of panties worn by the partner.
F65.1 Fetishistic transvestism / transvestite fetishism (DSM)
In transvestite fetishism (the DSM designation leads to less confusion), sexual arousal is gained from just putting on clothes of the opposite sex. This can be clearly distinguished from both transsexuality and classic transvestism as well as the other behaviors of the transgender spectrum, in which wearing the clothing of the opposite sex is not linked to sexual stimulation. In contrast to transgender people, transvestite fetishists often report taking off clothing of the opposite sex after orgasm or after sexual arousal has subsided (ICD-10).
Exhibitionists achieve their sexual arousal by showing the genitals (often in combination with masturbation), whereby for them it is not important to induce sexual contact, but rather they usually perceive the reaction of their victims as arousing. The exhibitionist is typically not a rapist.
Voyeurs feel sexual arousal while observing others engaged in sexual or masturbatory acts, or when they are undressed. Because of their paraphilia, they often commit sexual coercion or trespassing . Viewing material produced specifically for sexual stimulation ( pornography ) is generally not classified as voyeurism.
In pedophilia , sexual and emotional interest is exclusively or predominantly directed towards children of pre- or early adolescence . In contrast to this, sexual arousal by post-pubescent children and adolescents is often referred to as ephebophilia (adult male tendency towards pubescent boys) or parthenophilia (adult male and female tendency towards pubertal girls).
According to ICD-10 and DSM-IV-TR, a one-time sexual act with a child does not justify a diagnosis of pedophilia.
The question of the medical-psychological classification or its requirements should not be confused with a criminal or ethical assessment. Sexual acts with persons under a certain age are criminal offenses under the law of practically all states.
- See on this (in particular also on criminological aspects such as the consequences for the victims) in the article Sexual abuse of children .
According to definition F65.5, sadomasochism is a contraction of the terms sexual sadism and sexual masochism and also includes consensual sexual behavior, which is often defined as BDSM . Both terms go back to books in which the respective variety was described excessively:
- The author of the book The 120 Days of Sodom , Donatien Alphonse François de Sade , inspired the naming of sadism as sexual arousal by torturing or humiliating others.
- The book Venus im Pelz by Leopold von Sacher-Masoch prompted the psychiatrist Richard von Krafft-Ebing to describe the sexual arousal from suffering pain and humiliation as masochism .
From this point of view, sadomasochism describes the infliction or the relish tolerance of pain, bondage, humiliation or infliction of others - usually perceived as stressful - (emotional) torments for sexual stimulation. Sadomasochism can therefore take on many different facets, which are not always about inflicting physical pain (compare pleasure pain ).
A special form of sexual masochism in the broadest sense is asphyxiophilia , in which sexual arousal is caused by a reduction in the blood supply to the brain (mostly through self- strangulation ). This form of stimulation can take place during sex with partner (s) as well as during masturbation.
Asphyxiophilia, however, cannot be clearly assigned to the paraphilias, as it is not clear whether it is really a deviation from the norm. There is evidence that reducing the level of oxygen in the blood is actually sexually arousing. One indication is the effect of amyl nitrite ( poppers ). The APA reports about two deaths per million people a year from sexual self-strangulation.
The definition of F65.5 contradicts that of the authors of the DSM-IV and led to international protests and the establishment of organizations that have set themselves the goal of abolishing what they consider to be a discriminatory definition.
F65.6 Multiple disorders of sexual preference
Paraphilias do not always occur in isolation, but can often be observed in patients in combination. The most common combinations consist of fetishism, transvestism, and masochism.
F65.8 Other disorders of sexual preference
Paraphilias in their entirety are very rare, which is why not each individual paraphiliac has its own diagnostic coding. Category F65.7 is therefore missing, and all other forms of paraphilia are subsumed under F65.8. These include, for example:
Also known as frottage . It gives the patient sexual satisfaction to rub his body (mostly in public) against those of other, unknown people, often in crowds (e.g. in public transport or in department stores). According to APA (1994), frotteurism usually subsides after the age of 25.
In the past, the term sodomy was often used to denote both sexual acts on animals and anal intercourse between men, thereby devaluing both. Therefore , when animals are objects of sexual arousal or satisfaction, it is now clearly referred to as zoophilia .
- Probably the most dangerous form of necrophilia is a predilection for fresh corpses. This results from the fact that it comes here in the truest sense of the word to drug- related crime , i.e. to murdering others in order to get to a fresh corpse. Often these necrophiles satisfy their victims to a certain degree of decay before they dispose of the corpses and murder again. On the basis of the case of Armin Meiwes , the German Federal Court of Justice decided in spring 2005 that killing a person with the aim of subsequently getting aroused either on the corpse or on the image and sound material of the killing is also the murderous characteristic of killing to satisfy the sexual instinct Fulfills.
- Another preference of necrophiles is partially decomposed corpses. The objects of sexual desire are therefore exhumed in cemeteries, similar to the last group. It turns out that many necrophiles in this direction often explicitly choose professions in which it is easier for them to get to corpses (e.g. undertakers )
- The members of the last group experience sexual satisfaction through acts on already skeletonized corpses, which are usually also exhumed in cemeteries.
Often necrophiles are satisfied with body parts, mostly due to the fact that the decomposition process has already progressed too far to “use” or transport the whole body.
There are a number of forums on the Internet in which necrophiles can exchange ideas, give tips and tricks or share their experiences with each other. Necrophilia also finds its place in many art forms, such as in films or music. A singer who often sings about necrophilia in titles like Cold Ethyl or I Love The Dead is Alice Cooper .
Acrotomophilia and apotemnophilia
Under Acrotomophilie refers to sexual arousal through sexual activity with people with amputated limbs, Apotemnophilie is a sexual pleasure by amputation. Both terms were coined in 1977 by the American psychologist John Money in the same article. Money described two cases of patients who each wanted to have their healthy limbs amputated, and explained this desire with sexual desires.
This argumentation is controversial, however, since in none of the cases (neither with Money nor with numerous subsequent ones) was really about an increase in sexual pleasure through the amputation. The classification of apotemnophilia among the paraphilias is therefore not tenable in the opinion of many experts. Today the term "BIID" ( Body Integrity Identity Disorder ) is used more often .
These forms of sexual preference are best known through the book A Leg To Stand On by Oliver Sacks , although neither state is explicitly described there.
- Amelotatism : sexual predilection for missing limbs
- Autassinophilia : sexual arousal from the threat of one's own killing or staging it
- Autonepiophilia : sexual preference for diapers and / or appropriate role play
- Feeding : sexual preference for feeding and being overweight
- Symphorophilia : sexual arousal from viewing an accident or catastrophe
- Coprophilia : sexual preference for feces
- Urophilia : sexual preference for urine
- Emetophilia : sexual predilection for vomit
- Pre-arephilia : sexual predilection for the thought of being devoured, devouring, or watching the process
- Volkmar Sigusch: Neosexualities. About the change of love and perversion. Campus Verlag, Frankfurt / New York 2005, ISBN 3-593-37724-1 .
- Volkmar Sigusch: On the benefit of the pervert. In: Süddeutsche Zeitung , April 8, 2008.
- Brigitte Vetter: Perverted, right? Sexual preference disorders. 100 questions, 100 answers. Causes - Symptoms - Treatment. Hans Huber, Bern 2009, ISBN 978-3-456-84672-9 .
- Erwin J. Haeberle: “Paraphilia” - a pre-scientific term. Notes on a current debate . In: Sexology . tape 18 , no. 3–4 , 2011, pp. 185–192 ( Unabridged version from sexarchive.info [accessed on January 21, 2015] Abridged version).
- DSM-IV-TR (text revision) (English)
- DSM-IV-TR and the Paraphilias: An Argument for Removal . (English)
- Raphael M. Bonelli : Pathology of Sexuality . Vienna Conference on Internet Sex Addiction Vienna, April 24, 2010 (lecture; video ).
- What The DSM-5 Means For The Diagnosis And Treatment Of Sexual Issues. Retrieved September 9, 2016 .
- DF Janssen: How to “Ascertain” Paraphilia? To Etymological Hint. In: Archives of Sexual Behavior. 2014. doi: 10.1007 / s10508-013-0251-5
- Hans-Ludwig Kröber, Dieter Dölling, Norbert Leygraf, Henning Sass (ed.): Manual of forensic psychiatry. Volume 2: Psychopathological foundations and practice of forensic psychiatry in criminal law. Springer, 2011, ISBN 978-3-7985-1447-8 , p. 483 from an excerpt from google-books .
- cf. The criticism of the AK Psychology and Sexual Science of the Federal Association of Sadomasochism , online under content work on the "ICD-10-GM". ( Memento of the original from June 14, 2007 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.