Philosophical issues in the paraphilias

Review of cases, case series and prevalence studies of zoophilia in the general population

BACKGROUND

Information about the frequency of zoophilic behaviour in the general population is scarce.

OBJECTIVE

To review cases, case series and prevalence studies of zoophilia in adults in the general population.

METHODS

A review of publications was carried out in MEDLINE via PubMed, Scopus and the Biblioteca Virtual en Salud [Virtual Health Library] ranging from January 2000 to December 2017.

RESULTS

Thirteen papers were reviewed (ten case reports, two case series and one cross-sectional study). Twelve patients were described, the case series totalled 1,556 people and the cross-sectional study included 1,015 participants and reported a prevalence of zoophilic behaviour of 2%.

CONCLUSIONS

Information on the prevalence of zoophilic behaviour in the general population is limited. The Internet will probably be a valuable tool for further investigating these behaviours in coming years.

Exploring the relationship between paraphilic interests, sex, and sexual and life satisfaction in non-clinical samples

Limited research has indicated that paraphilic interests and behaviours do not necessarily decrease sexual and life satisfaction; some research suggests such interests may actually enhance satisfaction. The present study assessed how paraphilic-associated interests and behaviours were related to sexual and life satisfaction in a sample of 173 men and 356 women. Paraphilic interest rates were similar to existing population-based studies. Men reported significantly higher levels of most paraphilic interests than women, apart from masochism. Those with paraphilic interests rarely felt negatively affected. However, those interested in criminal paraphilic interests or both criminal and legally feasible paraphilic interests had lower levels of sexual satisfaction when they did not engage in paraphilia-associated sexual behaviour. The sexual satisfaction of those interested only in legally feasible paraphilic interests was not impacted whether or not they engaged in paraphilia-associated sexual behaviour. Further analyses indicated that those without a paraphilic interest and those who have a paraphilic interest and have disclosed to their partner have higher levels of sexual satisfaction than those who have not disclosed to their partner or who do not have a stable partner. Additionally, among those who had disclosed to a partner, sexual satisfaction was not affected whether the individual engaged in the paraphilic interest with or without their partner. These results suggest a multifaceted relationship that warrants further consideration and examination.

Paraphilias

PURPOSE OF REVIEW

The concept of paraphilia still carries an 'unwanted burden' of sexual norms because the pathologization of some sexual practices as paraphilic disorders is still based on the assumption that normal sexuality should be genitally organized with the aim of reproduction. The aim of this review is to give an impression of the ongoing discussion about the changes introduced with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the results of recent research in this area.

RECENT FINDINGS

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. According to DSM-5 diagnostic criteria, paedophilic disorder is the only paraphilic disorder without an 'in remission' and an 'in a controlled environment' specifier. Today, antiandrogen treatment is offered to sex offenders in many countries as an additional treatment strategy alongside psychotherapy.

SUMMARY

The introduction of DSM-5 offers the possibility to distinguish between paraphilia and paraphilic disorders. The aetiology of paraphilias is still unknown. Paraphilias are much more common in men than in women, but the reasons for this difference remain unknown. So far there is no clear consent on the best therapeutic approach for a paraphilic disorder.

[Richard Freiherr v. Krafft-Ebing and Sigmund Freud--discourse on the "normality" and "perversion" of human sexuality at the close of the 19th century and the beginning of the 20th century]

Sexuality has been defined a central feature of personal identity since the epoch of enlightenment and has gradually become a decisive issue also in societal and political terms. A major transfer from religion and religious institutions to medicine and medical experts and later on to neuropsychiatrists has to be underlined in the primary position to assess "normal" and "deviant" manifestations of sexuality. Richard Freiherr von Krafft-Ebing and Sigmund Freund play an eminent role in this "discourse on sexuality" (M. Foucault) during the nineteenth and beginning twentieth century on the way to modern sexology. Within this overarching context Krafft-Ebing's and Freud's theoretical conceptualizations of sexuality and perversion will be sketched and basic clinical and societal implications there out will be discussed.

Commentary: Problems with the sexual disorders sections of DSM-5

There are a number of problems with the sexual disorders sections of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. These problems must be understood in a historical context, namely the evolution of criteria for psychosexual disorders from DSM-II (1968) to DSM-5 (2013). There are many inconsistencies in the DSM-5 criteria for different sexual disorders. Given these inconsistencies--and the history of diagnostic criteria for homosexuality and gender identity disorder from DSM-II to DSM-5--it is possible that, like homosexuality, DSM-5 gender dysphoria could disappear from future editions of the manual. Even if that does not happen, there are numerous problems with the DSM-5 sexual disorders that require attention.