Norbert Konrad; Justus Welke; Annette Opitz-Welke


Curr Opin Psychiatry. 2015;28(6):440-444. 

In This Article

Diagnostic Approach

The release of DSM-5 in the spring of 2013 introduced a distinction between paraphilias and paraphilic disorders, implying a destigmatization of consenting adults engaging in unusual sexual behaviour.[11] The rejection of paraphilic coercive disorder from the main body of the DSM was approved by Agalaryan and Rouleau,[12] who pointed out that the proposed criteria still lack precision. Turner et al.[9] argued that although hypersexual disorder was not included in DSM-5, the construct of hypersexuality can be validly assessed, and there is a valid screening test available for hypersexual behaviours in patients with neurodegenerative disorders. DSM-5 defines paraphilic interests as 'nonnormophilic' or 'anomalous' sexual interests, but the definition of atypical sexual interest remains a point of discussion. A survey of sexual fantasies among college students revealed that only a minority of sexual fantasies could be considered typical.[13] The authors recommend focusing less on the content of fantasies than on the effect, and Agalaryan and Rouleau[12] pointed out that coercive sexual fantasies can be experienced without individuals ever acting them out. On the contrary, Chan and Beauregard[14] revealed that a higher percentage of homicidal sexual offenders showed paraphilic interests when compared with nonhomicidal sexual offenders. The homicidal sexual offenders also exhibited a higher percentage of maladaptive personality traits.[14]

Paraphilias are much more common in men than in women, but the reasons for this difference remain unknown. Various factors have been discussed. Dawson et al.[15] examined a nonclinical sample of men and women for the prevalence of paraphilic interests. Their findings suggested a correlation of sex drive and paraphilic interests that provided the best explanation for the observable gender difference in paraphilic interests. They also found comorbidity of different paraphilic interests.[15] Recent results of a systematic review by Solla et al.[16] of paraphilias and paraphilic disorders in Parkinson's disease patients revealed that both could emerge as a rare iatrogenic consequence in Parkinson's disease treatment. Typically, any paraphilias or paraphilic disorders appear during treatment with dopaminomimetic medication. Aberrant sexual behaviour observed included exhibitionism, frotteurism, paedophilia, sexual masochism, and transvestism. Because hypersexuality is often described as a neuropsychiatric complication of Parkinson's disease, this leads to the assumption that hypersexuality and paraphilias may be the phenotypical expressions of different degrees of a common pathophysiological process.[16]