Where do paraphilias come from?

Paraphilias — a tangled but human type of sexuality

You may have heard about them at parties, in office gossip, or in late-night conversations with friends. “He’s got this weird fetish.” “I don’t understand why anyone would be into that.” These people, equal parts baffled and judgemental, are referring to the particularly interesting phenomenon of paraphilias.

In every society there are lines dividing sexual desires into “acceptable” and “abnormal”. Sexual desire that falls outside the realm of acceptable is termed “paraphilia”, from the Greek root para meaning “beside” or “apart from”, and philia meaning “love”.

A paraphilia is defined as sexual arousal in response to abnormal objects, situations, behaviors, fantasies, or individuals. “Abnormal” means the arousal is not shared by a majority of people, but many paraphilias are extremely widespread. What causes paraphilias? What kinds of things are paraphiles attracted to? How can some specific categories of paraphilias be so common?

What types of paraphilias are there?

It’s impossible to establish a definitive list of paraphilias. It seems that the spectrum of human attraction spans just about anything one could imagine.

A Billion Wicked Thoughts, by neurologist Ogi Ogas bills itself as the “world’s largest experiment on human desire”. Instead of interviewing subjects on their deep, dark fantasies, the study described in the book used software to crawl millions of porn site search contents. The study lists the following top online pornography search categories for men and women:

While that is certainly a varied list, that only covers the top most common searches. Venturing deeper into the internet reveals even wilder fantasies.

In an attempt to document the vast expanse of sexual attraction, a rich tradition of naming paraphilias arose in the twentieth century, bestowing them with very clinical-sounding Greek and Latin roots.

These named paraphilias (Aggrawal, 2009) include:

Sadism — inflicting pain on others

Masochism — having pain inflicted

Podophilia — feet

Dacryphilia — tears

Raptophilia — rape / non-consenting sex

Emetophilia — vomit

Exhibitionism — exposing oneself to others

Voyeurism — watching others

Paraphilic infantilism — dressing and acting like an infant

Feederism — eating and weight gain

Forniphilia — using humans as furniture

Macrophilia — growth, size difference

Objectophilia — specific inanimate objects

Many documented paraphilias relate to some negative aspect of life. Maybe it’s some inexplicable connection between sex and suffering. More likely, negative emotions are considered more abnormal to be aroused by, and therefore are more likely to be called a paraphilia.

There are, interestingly, common themes across the spectrum. These categories can be described as:

• Pain and humiliation focused (a subset of BDSM)
• Body part focused
• Inanimate object focused
• Danger focused
• Taboo focused

How do they work?

Paraphilias are different from general kinks in that they are involuntary. No one chooses what they are attracted to. They discover the nature of their sexuality as they mature. Therefore, paraphilias can be considered a type of sexual orientation. “Kinky” sexual activities such as roleplay and BDSM are not as much of a psychiatric phenomenon as paraphilias, putting paraphilias closer to the realm of psychological disorders.

Paraphilia intensity can range from optional, preferred for sexual arousal, or completely necessary for sexual arousal (American Psychiatric Association, 2000, p. 570). Unfortunately, the exact ratio of each is not officially known.

What does society think about paraphilias?

Throughout history, what was considered abnormal has changed. In the Middle Ages, all non-reproductive sexual acts were considered vices (Amaral & Mota, 2016). Homosexuality and bisexuality used to be considered paraphilic, and now they are considered normal variations of the sexual orientation spectrum. For recent history, there is one official source that best reflects society’s view:

The Diagnostic and Statistical Manual of Mental Disorders

Commonly known as the DSM, the Diagnostic and Statistical Manual of Mental Disorders is the standard, comprehensive catalogue of mental disorders published by the American Psychiatric Association (Yes, the namesake of the famous APA academic format!). Over time, different revisions of the DSM have treated paraphilias differently. The DSM-I in 1952 listed sexual deviations as a sociopathic personality disorder. The DSM-III created the “sexual disorder” subcategory.

The DSM-5 draws a distinction between harmless, ordinary paraphilias and paraphilic disorders. To be a paraphilic disorder, it must “cause distress to the subject or cause harm to non-consenting persons around them” (American Psychiatric Publishing. 2013. p. 685.)

What causes paraphilias, according to science?

Scientific research is unclear on how paraphilias develop. Little research has been done on the topic, since consensual, private paraphilias pose no threat to society. The one exception is research on convicted pedophiles and sex offenders; although the scientific journals are mostly on effective chemical castration methods and not the psychology behind the paraphilia.

Phenomenological Theories

Albert Eulenburg, a German neurologist, in his 1914 book Ueber sexualle Perversionen, theorized that all forms of sexual perversion are “hyperbolic intensifications” of normal sexual desires. That is, paraphilias are atypical exaggerations of typical sexual desire, or of specific areas of typical desire. This theory does explain paraphilias oriented towards human behavior or human body parts, such as capnolagia (smoking fetishism), dacryphilia (crying), and partialism (specific body part fetishes), because they are a derivation of some part of typical attraction. In American society, breasts are considered too sexual to display in public, while in other societies, that sexualization can extend to shoulders, and legs. Partialism could be an extreme extension of this very normal appreciation of body parts. But this theory does not explain the more unique fetishes out there such as dendrophilia (trees) and objectophilia (specific inanimate objects).

Behavioral Theories

The cognitive-behavioral approach is a common theory regarding the origin of paraphilias. Some theorists claim that exposure to certain stimuli in early childhood result in fetishes developing later in life (Bradford & Ahmed, 2014). However, this does not explain why some paraphilias like foot fetishes, macrophilia, or latex fetishes are so specific, yet so common. Early childhood stimuli across a wide population are too different to create such commonalities. However, behavioral reinforcement through masturbation or sexual activity in life may strengthen the intensity of the innate attraction by creating an association to pleasure.

Neurological Theories

Like many aspects of psychology, biology plays an important role in paraphilias. There is no one specific region of the brain dedicated to sexual attraction, but certain case studies have shown that sexual deviance can be affected by neurological causes. In one case, a patient with multiple sclerosis (a disease that affects the brain and central nervous system), lesions that developed on his hypothalamus and mesencephalon caused him to develop a paraphilia for inappropriate groping, and lowered his self-control abilities (Frohman, Frohman & Moreault, 2002). The hypothalamus is responsible for many core bodily functions, including hormones, appetite, and sexual behavior. Although the link between the brain and sexual desires is mysterious, one can draw the logical conclusion that his regulation of sexual behavior was changed due to the physical lesions.

Another study links dopaminomimetic agents, used to simulate dopamine and treat Parkinson’s disease, with hypersexual behavior and the development of paraphilias (Solla, Bortolato, Cannas, Mulas, & Marrosu, 2015). In such a case, the paraphilias were not innate, but caused by drugs which affected some aspect of the brain.

Perhaps the most astounding neurological case report involves a 40-year old man who was sentenced to prison for child molestation and child pornography, whose criminal behavior closely corresponded with the growth of an orbitofrontal tumor (Burns & Swerdlow, 2003). Following removal of the tumor and additional psychiatric treatment, he was released successfully. It is unknown exactly how much pedophilic behavior he demonstrated before the tumor’s growth. The frontal lobe is the center of high-level cognition, problem-solving, judgement, and sexual behavior. The damage to that part of the subject’s brain may have been the cause for altered sexual desire, poor impulse control, and lack of empathy.

These discoveries shake up previously known information about paraphilias. Providing a neurological basis for “odd” fetishes may demystify them and remove some of their stigma.

So what about those “weird” fetishes?

Even though progressive societies are growing more accepting of sexual diversity, “weird” fetishes are still a subject of derision and bewilderment. The amount of times I hear the phrase “I don’t understand why anyone would be into that” demonstrates the general public’s lack of knowledge. The best place to start is by understanding that paraphilias are not a choice. There is no answer to the question “Why would anyone be attracted to that?”, short of “Because it’s a paraphilia and it’s how the brain works”. Greater understanding would not just lead to more empathy towards consensual, private activities. Understanding paraphilias as a psychological phenomenon would result in helpful attitudes towards individuals with criminal and disordered paraphilias. Instead of being seen as inherently “sick, deranged freaks”, a more empathetic attitude would encourage research for their treatment and improve the field of psychology as a whole.

REFERENCES

1. Ogas, O., & Gaddam, S. (2011). A Billion Wicked Thoughts: what the world’s largest experiment reveals about human desire. New York: Dutton.
2. Aggrawal, A. (2009). Forensic and medico-legal aspects of sexual crimes and unusual sexual practices. Boca Raton: Taylor & Francis.
3. Amaral, A., Ferraz, I., & Mota, M. (2016). A journey across perversions history — from Middle Age to DSM. European Psychiatry, 33. doi: 10.1016/j.eurpsy.2016.01.2186
4. “Paraphilic Disorders”. Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Philadelphia, Pennsylvania: American Psychiatric Publishing. 2013. p. 685.
5. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). pp. 569–570, 572, 574, Washington, DC: Author.
6. Eulenburg (1914). Ueber sexualle Perversionen. Ztschr. f. Sexualwissenschaft, Vol. I, №8. translated in Stekel, Wilhelm. (1940). Sexual aberrations: The phenomena of fetishism in relation to sex. New York: Liveright, p. 4. OCLC 795528
7. Burns, J. M., & Swerdlow, R. H. (2003). Right Orbitofrontal Tumor With Pedophilia Symptom and Constructional Apraxia Sign. Archives of Neurology, 60(3), 437. doi: 10.1001/archneur.60.3.437
8. Frohman, E. M., Frohman, T. C., & Moreault, A. M. (2002). Acquired Sexual Paraphilia in Patients With Multiple Sclerosis. Archives of Neurology, 59(6), 1006. doi: 10.1001/archneur.59.6.1006
9. Solla, P., Bortolato, M., Cannas, A., Mulas, C. S., & Marrosu, F. (2015). Paraphilias and paraphilic disorders in Parkinson’s disease: A systematic review of the literature. Movement Disorders, 30(5), 604–613. doi: 10.1002/mds.26157