The introduction of DSM-5 offers the possibility to distinguish between paraphilia and paraphilic disorders. Nevertheless, discussion on what exactly constitutes sexual aberration continues. Critics of DSM-5 emphasize that there is still a tendency to devalue sexual practices that are not genitally organized with the aim of reproduction.
The aetiology of paraphilias is still unknown. Just as little we know why paraphilias in general are less common in women in spite of the fact that research revealed prevalence of paraphilic sexual fantasies in female samples. Because there is some evidence of a correlation of sex drive and paraphilic interest, the difference in sex drive between men and women may be one explanation for the observable gender difference. Focusing on forensic samples, there is evidence of a correlation between paraphilia and aggression. For medical staff, it is important to realize that paraphilias sometimes emerge in neurodegenerative disorders such as Parkinson's disease, in some cases as a side-effect of treatment. Although the coincidence of neurodegenerative disorders and paraphilias seems to suggest a correlation between cerebral pathology and paraphilia, functional neuroimaging has yet to reveal a sound theory about the underlying cerebral process.
So far there is no clear consent on the best therapeutic approach for a paraphilic disorder. In forensic samples, the best treatment responses have been achieved by the combination of psychotherapy and chemical castration. But because we do not yet know enough about the frequency of paraphilia in nonforensic samples, there is a possibility that even coercive paraphilic sexual fantasies may exist in individuals who never act them out. In this field, further research is urgently needed.
Curr Opin Psychiatry. 2015;28(6):440-444. © 2015 Lippincott Williams & Wilkins