Following on from the previous post, I was curious to find out how prevalent paraphilias are amongst the general adult population. Not surprisingly, there is scant evidence on this although conservative estimates range from 10% to 15%. There is no evidence on the percentage of men compared to women who have a paraphilia. Anecdotally, it seems that men are more likely to have paraphilic tendencies than women, but this could be due to the greater prominence of men in kinky subcultures, and in sexual activities that have criminal consequences (such as paedophilia). Women with paraphilic behaviours may be more likely to keep them as solo fantasies, but of course this is just speculation.
The American Psychiatric Association estimates that 50% of participants in paraphilic activities are married. A cynic would say this is because it helps alleviate the boredom of married life. Another view is that people in stable, long-term relationships may be more willing to share their unusual sexual practices with their partner. An unanswered question is whether the percentage of people engaging in paraphilic activities has increased in modern times, as evidenced by the huge array of material on the internet, or whether it is just that paraphilias that were previously kept secret have now become more visible, less taboo, and easier to engage in with the internet.
The answers to these questions also depend on what definition of ‘paraphilia’ is used. For example, according to the current edition of the Diagnostic and Statistical Manual of Mental Disorders (‘DSM’ 2000, published by the American Psychiatric Association), a paraphilia is a condition “characterised by recurrent, intense sexual urges, fantasies, or behaviours that involve unusual objects, activities or situations”. More common ones include voyeurism, exhibitionism, paedophilia, sadism, masochism, fetishism (sexual arousal from inanimate objects such as women’s shoes), transvestic fetishism (fantasies involving cross-dressing), and frotteurism (touching and rubbing a non-consenting person, often in crowded public places).
One could query how ‘unusual’ some of these activities really are. Given the ready availability of internet porn and the phenomenal popularity of books such as E.L. James’ 2011 best-seller Fifty Shades of Grey, perhaps some of these paraphilias have become more mainstream and no longer warrant their classification as such. Indeed, it wasn’t until 1986 that homosexuality was removed from the list of recognised paraphilias in the DSM, which shows that cultural perspectives of what is ‘unusual’ can change over time.
The ancient Greeks, for example, not only tolerated but also encouraged the love of adolescent boys by older men. Today this would be considered paedophilia. In ancient Buddhist literature, there are references to paraphilic practices including bestiality (sexual contact with animals), necrophilia (sexual interest in corpses) and fetishism among the monastic community over two-and-a-half thousand years ago. Sexual sadism and masochism have also existed for many centuries, long before the graphic novels of the Marquis de Sade (Donatien Alphonse Francois, 1740-1814) and Leopold von Sacher-Masoch (1836-1895) after whom sadism and masochism are respectively named (both men were infamously committed to asylums for significant periods of their lives as a result of their sexual activities and publications).
In the clinical literature, paraphilias were being discussed extensively by the second half of the 19th century. In Richard von Krafft-Ebing’s 1887 Psychopathia Sexualis, the neuro-psychiatrist detailed numerous sexual case studies involving fetishism, flagellation, sadism, lust-murder, necrophilia, masochism, exhibitionism, bondage, paedophilia, sodomy, bestiality, and incest. Indeed, in Victorian London there was a flourishing network of brothels that specialised in flagellation for those wishing to give or receive punishment, and Victorian pornography was full of images depicting sadism and masochism.
One of Krafft-Ebing’s case studies concerned a man who, since the age of 12, had a fetish for women’s handkerchiefs and would orgasm at the sight of one. Another case involved a 20 year-old man who was caught having intercourse with a hen. The village hens had been dying one after another, and the man causing the mysterious deaths had been wanted by local authorities for some time. When asked by the judge as to the reason for such an act, the man said that his genitals were so small that intercourse with a woman was impossible!
In 1947 a psychologist reported an adolescent male who had a strong fetishistic interest in car exhaust pipes, while a man who had a fetish for sneezing has also been the subject of a psychological study. It seems that pretty much any object or activity one can think of has been the subject of a fetish for at least one individual. In 1990 a psychologist at John Hopkins University and Hospital reported a case study involving a 42 year-old married woman who had the amputee paraphilia (acrotomophilia) since childhood. The woman experienced great sexual excitement in seeing the stump of an amputated limb, to the extent that she considered becoming an amputee herself.
However, there is an important distinction between paraphilias on the one hand, and the non-pathological use of fantasies and objects to stimulate sexual excitement, on the other. A paraphilia is considered pathological when it becomes the sole focus of sex, is the only way a person can experience sexual arousal, and when the person’s behaviour causes problems with normal functioning in daily life. Some people with paraphilias – and particularly the more obscure ones, like the woman with the amputee fetish – often experience it as a burden and have feelings of isolation, depression and guilt. Sometimes it prevents them from ever having a satisfying sexual relationship, especially with a partner.
There are several contesting theories about the causes of paraphilias. One study found that amongst heterosexual males, those with high paraphilic tendencies had a significantly greater number of older brothers and were more likely to be left-handed – two established correlates of male homosexuality related to the hormones involved in prenatal neuro-development. The authors of this study suggest that the development of paraphilias may involve an in utero biological component.
Others dispute this finding and claim that there is no obvious neural or biological basis for paraphilic behaviour. Rather, the causes are thought to be more psychological than biological, although individual physiological differences may help reinforce paraphilic activities through the creation of neural pathways. Most paraphilias seem to be established before puberty, while learned behaviour is still flexible and before neural synapses have completed their last major step of maturation.
Psychoanalysts such as Robert Stoller theorise that a paraphilia is the result of a traumatic childhood event that is relieved and overcome by achieving orgasm. According to Stoller, “the fantasy picks out the moment of greatest trauma for what is now its moment of greatest thrill”. For example, in another case study reported by John Hopkins University, a woman had experienced sexual arousal by physically handicapped men (abasiophilia) since she was 12 years old. She believed her paraphilia was directly attributal to childhood events – a period when both she and her father were incapacitated on crutches, with her father dying of a heart attack shortly afterwards. The ‘trauma in childhood’ theory has a degree of explanatory power, although it made me wonder why a traumatic childhood event manifests itself as a paraphilia for one person but not for another? No one seems to know the answer to this question.
Other psychoanalysts have suggested that some paraphilias such as feederism and masochism may be explained by the ‘Escape from Self Theory’. According to Baumeister’s ‘Escape from Self Theory’, the emphasis in Western culture on the autonomous self can sometimes be a burden, resulting in a desire to escape from the oppressive aspects of self. Baumeister argued that this could be achieved through sexual masochism because such acts involve a complete loss of power and control, which are inconsistent with the maintenance of normal modern identity and responsibility. Therefore some sexual practices may represent an appealing form of freedom and escape from the pressures of daily life.
Personally, I like the observation by Dr Fred Berlin, a leader in the study and treatment of sexual disorders, that “people don’t decide the nature of their sexual desires, they discover them.” If you’re interested in delving deeper into this subject, Daniel Bergner’s book The Other Side of Desire could be the way to go. I think that this inner space, the nature of desire, is far more fascinating than exploring outer space. The dark and secret terrain of the human mind is a universe unto itself.
 G Brame, Come Hither: A commonsense guide to kinky sex, (2000), New York, Simon & Schuster.
 John Money, Paraphilia in Females, Journal of Psychology and Human Sexuality, (1991), 3:2, 165-172.
 Qazi Rahman, Deano Symeonides, ‘Neurodevelopmental Correlates of Paraphilic Sexual Interests in Men, Archive of Sexual Behaviour, (2008) 37:166-172.
 Robert Stoller, Perversion: the Erotic Form of Hatred, 1975, Pantheon Books, New York.
 Lesley Terry, Paul Vasey, Feedersim in a Woman, Archive of Sexual Behaviour, (2011), 40:639-645.
 Roy Baumeister, Masochism as escape from self, Journal of Sex Research, (1988), 25, 28-59.