Most of us at some point in our sexual lives will have experienced what we may consider to be an atypical sexual thought or behavior. But does atypical necessarily mean pathological?
Today, most sex scientists and therapists believe that only a small portion of atypical sexuality needs to be cordoned off as pathological. In most cases, variant sexual interests are at worst harmless oddities, and at best the spice of life for a relationship.
But how do we distinguish between the two?
What are “normal” versus “atypical” sexual thoughts?
According to the Diagnostic Statistical Manual of Mental Disorders Fifth Ed. (DSM V, i.e. the psychiatrist’s bible), sexual interests fall into two categories, those that are normal (normophilic) and those that are anomalous (paraphilic).
Paraphilias are defined as intense and persistent sexual interests, outside of foreplay and genital stimulation with consenting adults. While the definition is broad enough to include hundreds of specific paraphilias, the DSM labels only eight, and they include: voyeuristic, exhibitionistic, sexual masochism, sexual sadism, fetishistic, and transvestic.
A paraphilic disorder requires the presence of intense and persistent paraphilic urges accompanied by distress, dysfunction, and/or executing one’s urges. However, paraphilic urges which involve potentially criminal behavior, such as voyeurism, exhibitionism, frotteurism, sexual sadism, and pedophilia can be diagnosed even if the individual denies experiencing distress or dysfunction as a result of the paraphilic urges.
What is Fetishism?
On the other hand, fetishism can often be egosyntonic, meaning that an individual’s behaviors, values or feelings are in harmony with the goals of their ego, and therefore normal. For instance, let’s say that a sex therapist works with a client named Mr. X who is occasionally aroused by having his consenting partner’s underwear in his mouth. Mr. X has a fulfilled sex life and isn’t experiencing any distress from his fetish; a diagnosis of fetishistic disorder would therefore not be warranted.
If you get the chills thinking about how medical the DSM makes paraphilias sound, you aren’t alone. Did you know that homosexuality was actually considered a mental illness from the beginnings of our manual in 1952, all the way up until 1973? Homosexuality was first diagnosed as a “sociopathic personality disturbance” in DSM-I (1952) and reclassified as a “sexual deviation” in DSM-II (1968). So, if you’re feeling particularly argumentative after reading this post, you now know how confusing diagnosing sexual disorders can be for us. Nonetheless, let’s cover the major eight paraphilias covered by the DSM.
Sexual gratification derived from seeing other people perform private activities such as undressing, being naked and/or seeing people performing a sexual act. Typically, a voyeur will carry out these activities in a discreet way, such as observing from their bedroom window while masturbating. As such, voyeurs may not come to the attention of the individual that they are observing.
Sexual gratification is derived from exposing one’s genitals to other people (typically strangers caught off guard). An exhibitionist often misinterprets their victim’s reactions as reciprocal sexual interest. As a result of this cognitive distortion, the individual’s behavior is rewarded and therefore reinforced.
These individuals openly acknowledge intense sexual arousal from the act of being humiliated, bound, beaten or otherwise made to suffer, as manifested by fantasies, urges, or behaviors. This may also include asphyxiophilia whereby which the individual achieves sexual arousal through the restriction of breathing.
Sexual arousal by the physical or psychological suffering of another person, manifested through one’s fantasies, urges or behaviors.
Involves sexual arousal derived from either the use of nonliving objects or a highly specific focus on non-genital body part(s). Common objects of fetishistic desire include shoes, lingerie, and jockstraps; certain materials such as leather, rubber, silk and fur may also be included in this category. One of the most common non-genital body parts to be fetishized are the feet, called podophilia, also known as foot fetishism.
Sexual excitement derived from the thought or act of cross-dressing, which is to dress in the clothing which is typical of the opposite sex. These thoughts or behaviors must be accompanied by emotional distress and/or impairment to one’s social or interpersonal functioning in order to be considered pathological.
Obscene phone calls (telephone scatologia)
Human breast milk (galactophilia)
And the list goes on and on…
What’s most important is not the list of peculiar thoughts or behaviors, but rather that after you read this article, you know that a paraphilia is not a mental disorder but rather a sexual preference for non-normophilic behavior. It’s only when a paraphilia leads to distress or involves a non-consenting individual that they become pathological.
On that note, let me leave you with some simple expert advice. Stay open and non-judgmental, because paraphilias are more common than you may think. Who knows, you may find something that you really enjoy but never even thought of trying.
Stay tuned for chapter 2 of “The Curious World of Paraphilias”, where we’ll look at their biopsychological origins, and explore the arguments for nature versus nurture.
Daniel Michaels holds a Bachelor’s of Science in Psychology and is currently a PhD candidate in Neuropsychiatry. His expertise as a scientist includes not only his work on sexual trauma, but also all things to do with sex and the brain. He has collaborated and trained with some of the leading scientists in the field of sex neuroscience. Daniel is also a regular contributor to PornHub’s Sexual Health and Wellness website. He is passionate about psychoeducation and has spoken at various academic and public events.