Fast Five Quiz: Sexual Interest Disorders (Paraphilias)

Steve Soreff, MD


December 19, 2022

In an act of frotteurism (frottage), the offender typically rubs the genital area against a victim's thighs or buttocks or fondles a victim's genitalia. While committing the act, the frotteur often fantasizes about an exclusive, caring relationship with the victim. The frottage typically takes place in crowded places (eg, public transportation vehicles and busy sidewalks). Most acts are perpetrated by people aged 15-25 years; after age 25 years, frequency gradually declines.

Exhibitionists may present to physicians out of a sense of guilt about their behavior and alarm about their inability to control it. Sometimes the behavior is revealed as the result of a criminal offense. More serious underlying pathology is suggested when preferred scenes include defecation or small children. The onset of exhibitionistic disorder is usually before age 18 years but may occur later.

The term voyeurism refers to the fairly common desire to view nudity and acts of coition. Differentiating innocent enjoyment of nudity from behavior that is similar but deviant in other circumstances can be difficult. When voyeuristic disorder is severe, peeping is the exclusive form of sexual activity. Onset is usually before age 15 years, and the disorder tends to be chronic. The wide extent of voyeuristic tendencies in the general population is evidenced by the common desire to indulge in exploitative activities such as live sex shows and pornography.

Sadistic fantasies or acts may involve activities such as dominance, restraint, blindfolding, beating, pinching, burning, electrical shock, rape, cutting, stabbing, strangulation, torture, mutilation, and killing. Sadistic sexual fantasies are likely to be present in these individuals in childhood. Onset of sadistic activities commonly occurs by early adulthood, and the sadistic behavior tends to be chronic. Advancing age is believed to have the same reducing effect as observed with other paraphilic disorders.

Learn more about the clinical presentation of paraphilias.


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