[Deviant sexual behaviors, paraphilias, perversions]

To know the new concept of paraphilias, their clinical presentation and their link with a personality disorder as perversion, the French legislation concerning them and the different therapeutic options.

Review of guidelines published on this subject in the Medline database and a reflexion from our own clinical experience, especially in the judicial expertise.

Deviant sexual behavior is, in current classifications, known as paraphilia. This clinical entity corresponds to any sexual behavior considered "abnormal" compared with sexual acts in the society where the person lives. It means precisely, firstly, suffering caused by this disorder or deterioration of social, professional, or family life. Paraphilia such as pedophilia have strict age limits. The victim must be aged below 16 years, with an age difference of at least 5 years with the author of the act. Sexual acts which are illegal are crimes or offences according to the degree, and are sanctioned by the law. In ordinary terms, they are known as perverts, committing perversions. This concept is different from that of paraphilia, a pervert can have, or not have, paraphiliac behavior. In order to diagnose a personality disorder such as perversion, all the criteria must be included: narcissism, use of a person as an object for pleasure, with, primarily, mechanisms of denial and a split personality which removes any feeling of guilt from the perpetrator.

Medical treatment of paraphilia alone is not satisfactory for the denial mechanism is such that only the sex drive is affected with a high risk of recurrence. Only psychotherapy can modify the pathological element of a perverted personality.