Paraphilia

A paraphilia is an intense and persistent sexual attraction to something not inherently sexual, or to anything other than a consenting human partner. Such interests are considered uncommon and are often contrasted with what is seen as normophilic, or typical, sexuality—though what counts as normal remains debated.

The exact number and classification of paraphilias is disputed; one researcher has listed 549 types. Some argue for a dimensional or spectrum-based approach to better capture the diversity of human sexuality. While once thought rare, later research suggests that some degree of paraphilic interest is relatively common.

Etymology

The term paraphilia was coined in 1903 by Friedrich Salomon Krauss and used regularly by Wilhelm Stekel in the 1920s. It comes from Greek para (“other” or “outside of”) and philia (“loving”). John Money popularized it in the 1980s as a non-judgmental label for unusual sexual interests. It first appeared in the DSM in 1980.

History of paraphilic terminology

No broad scientific consensus defines the boundaries between unconventional sexual interests, kinks, fetishes, and paraphilias; these terms are often used loosely and interchangeably. Historically, many labels have been applied to atypical sexual interests, with ongoing debate about accuracy and stigma. Money described paraphilia as a “sexuoerotic embellishment of, or alternative to the official, ideological norm.” Psychiatrist Glen Gabbard notes that despite efforts by Stekel and Money, the term remains pejorative in most contexts.

In the late 19th century, psychologists and psychiatrists began categorizing paraphilias to create a more descriptive system than legal or religious terms like sodomy or perversion. In 1914, Albert Eulenburg observed that all forms of sexual perversion share roots in normal sex life, describing them as “hyperbolic intensifications, distortions, monstrous fruits” of normal eroticism. Before the term paraphilia appeared in DSM-III (1980), the first two editions used sexual deviation. A 1981 article in the American Journal of Psychiatry defined paraphilia as involving recurrent, intense fantasies, urges, or behaviors generally including non-human objects, suffering or humiliation of oneself or a partner, prepubescent children, or non-consenting individuals.

Criticism of common definitions

There is scientific and political controversy over including paraphilias in the DSM due to stigma. Some groups advocate for greater acceptance of sexual diversity and changes to legal and medical status. Physician Charles Allen Moser argues these diagnoses should be eliminated. Ray Blanchard contends that defining paraphilia by exclusion (anything not normophilic) is preferable to listing specific types.

Inclusion and subsequent exclusion of homosexuality

Homosexuality, now widely accepted as a normal variant of human sexuality, was once classified as a sexual deviation. Sigmund Freud and later psychoanalysts linked both homosexuality and paraphilias to psychosexual non-normative relations to the Oedipal complex, though earlier versions of his work considered paraphilias as stemming from original polymorphous perversity.

The term sexual perversion historically referred to gay men and other non-heterosexuals. By the mid-20th century, mental health practitioners formalized deviant sexuality classifications; homosexuality was coded 302.0 until the APA removed it from the DSM in 1973. Martin Kafka writes that sexual disorders once considered paraphilias, like homosexuality, are now regarded as normal variants.

A 2012 literature study by clinical psychologist James Cantor compared homosexuality and paraphilias, finding both share lifelong onset and course but differ in sex ratio, fraternal birth order, handedness, IQ, cognitive profile, and neuroanatomy. The research concluded the data suggested two distinct categories, but called this conclusion “quite tentative” given limited understanding.

Paraphilias typically arise in late adolescence or early adulthood.