What are Sexual Compulsivity and Paraphilias?
Paraphilia Related Disorders (PRD), also referred to as sexual compulsivity, are not well recognized even though they have been present for some time. These disorders include socially accepted forms of sexual expression that become intrusive or excessive for the patient and are accompanied by personal distress and significant impairment. Paraphilias are socially deviant, persistent, highly arousing, sexual fantasies and urges, which cause personal distress and/or social difficulties. This can revolve around a particular object (children, feet, rubber) or act (exposing oneself, being physically injured). In order for a person to be a paraphilia they need to be preoccupied with the object or behavior and require it for sexual gratification. These urges may be described as compulsions by therapists and patients. Usually, sexual activities that do not involve the paraphilic behaviors are not arousing to the person and at times they have to fantasize about the behavior during sexual activity. Parahilias are more common in men than in women and they are not the same as unwanted sexual obsessions, which cause anxiety rather than arousal.
Common PRD’s include compulsive masturbation, promiscuity, pornography dependence, and phone sex or cyber sex dependence. Different arguments have been made as to what the cause for these disorders may be. Some may say it is an impulse-control disorder, others say it is an addiction, and some argue that it is an obsessive compulsive disorder. PRD’s often meet criteria for an impulse disorder because these behaviors represent a failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or others. Those who make the argument of addiction state like with substance abuse the individual forms a pathological relationship with a mood altering experience. Paraphilias and PRD’s can be difficult to treat because people with these disorders often conceal them, experience guilt and shame and are not cooperative with medical professionals. These behaviors can lead to many problems such as: low self-esteem, shame, guilt, legal consequences, STD’s, unwanted pregnancy, financial problems, relationship problems, divorce, child abuse, and even suicide. It is not surprising that 70% of people with these disorders also have a depressive or anxiety disorder as well.
In the past surgical castration was advocated as treatment for these disorders. It was abandoned and is illegal in many countries. Although there is no clear treatment for this it has been found that certain medications which reduce testosterone controls the symptoms. Testosterone increases deviant sexual fantasies, urges, and behaviors. Depo-Provera (Antiandrogenic) has been widely used to decrease sex drive in men with these disorders. SSRI’s, Tricyclic antidepressants, Lithium, Anxiolytics, and Psycho-stimulants have reported reduced sexual compulsive behavior and obsessive sexual thoughts. Although there is no cure for these disorders the above medications combined with therapy can be helpful and provide hope to our patients.