Usually providers of mental-health care help make the diagnosis of paraphilias, including licensed mental-health therapists, psychiatrists, psychologists, psychiatric nurses, and social workers. Treatment of paraphilias usually involves the combination of psychotherapy and medication. Many people with one of these disorders suffer in secret or silence out of shame, and some are engaging in sexual offending behaviors and so are invested in not reporting their paraphilia. The unusual or forbidden nature of a paraphilia often causes symptoms of guilt and fear of punishment. Specifically, people with a paraphilia tend to become aroused by the stimulant to the exclusion or near exclusion of more common sources of sexual arousal, like an attractive person of similar age. While the desired sexual stimulant for the paraphilia sufferer depends on the specific paraphilia, the characteristics of the illness are often very similar. The patterns of what one finds sexually arousing tend to become formed by adolescence.
Paraphilias have been found to be quite chronic, such that a minimum of two years of treatment is recommended for even the mildest paraphilia. In order to qualify for the diagnosis of a paraphilia, the individual has to experience recurrent, significant sexual arousal by the object of their attraction; act on that attraction in urges, fantasies, or actions; and experience the symptoms for at least six months to the point that the individual suffers significant levels of distress or interference with his or her work, social function, or other important aspects of life. As part of this examination, the sufferer may be asked a series of questions from a standardized questionnaire or self-test to help assess the presence of paraphilic symptoms. Others believe paraphilias are the result of the sufferer associating something with sexual arousal or by having unusual early life sexual experiences reinforced by having an orgasm. The intensity of the attraction can be overwhelming enough to cause distress. Thorough exploration for any history or presence of all mental-health symptoms will be conducted such that paraphilia can be distinguished from other types of mental disorders. Specifically, people with a paraphilia tend to become aroused by the stimulant to the exclusion or near exclusion of more common sources of sexual arousal, like an attractive person of similar age. There are thought to be biological, psychological, and social risk factors for developing paraphilias. Except for masochism, which is 20 times more common in women than men, paraphilias are almost exclusively diagnosed in men. What is a paraphilia? Male pedophiles have been found to have lower IQ scores on psychological testing compared to men who are not pedophiles. While the desired sexual stimulant for the paraphilia sufferer depends on the specific paraphilia, the characteristics of the illness are often very similar. More than half engage in three or four such kinds of behaviors rather than just one. Treatment of paraphilias usually involves the combination of psychotherapy and medication. Usually providers of mental-health care help make the diagnosis of paraphilias, including licensed mental-health therapists, psychiatrists, psychologists, psychiatric nurses, and social workers. Prevention for the development of any paraphilic behavior usually involves alleviating the psychosocial risk factors for its development. There are a number of psychological theories about how paraphilias develop. Another theory about paraphilia risk factors is that they are linked to stages of childhood psychological development like temperament, early relationship formation, trauma repetition, and disrupted development of sexuality, as follows: To ensure that the paraphilic individual does not suffer from a medical condition that could complicate the assessment or treatment of their mental-health condition, routine laboratory tests are often performed during the initial evaluation. Such sexual offending is therefore not considered to be a paraphilia. Except for masochism, paraphilias are almost exclusively diagnosed in men. Some view these disorders as a manifestation of arrested psychosexual development, with the paraphilic behaviors defending the person's psyche against anxiety defense mechanisms. How do health professionals diagnose paraphilias? What are the different types of paraphilias? People who are abused, especially if it occurs during childhood, may identify with the abuser such that they act out what was inflicted on them by victimizing others in some way. For example, about one-third of pedophiles also have another paraphilia.
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