DSM-IV paraphilia: Descriptions, demographics and treatment interventions

An overview and demographic description of each of the current DSM-IV-TR paraphilias (i.e., Pedophilia, Transvestic Fetishism, Exhibitionism, Fetishism, Voyeurism, Sexual Masochism, Frotteurism, Paraphilia Not Otherwise Specified) are provided. Most of these are medical descriptions of sexual offenses. Discussion is provided regarding a paraphilic description of rape (i.e., Paraphilic Coercive Disorder) that may appear in DSM-5. The effectiveness of current treatments (behavioral, cognitive–behavioral therapy, chemical/physical castration; and the use of selective serotonin re-uptake inhibitors) for each of these paraphilias is examined. It was found that there are too few well-designed studies to provide support for evidence-based practice with any of the paraphilias, based on Chambless and Hollon (1998) criteria (i.e., evidence should be based on: two + well conducted studies/two + independent researchers, three + small experiments reporting data from at least nine participants). It is suggested that more high quality research studies need to be conducted into the treatment of paraphilias. This work is contrasted with the growing body of evidence for the effectiveness of sex offender treatment for child molesters and exhibitionists (typically without a paraphilic diagnosis); current evidence is equivocal regarding the efficacy of treatment for rapists.