Essay on the diagnosis and nature of paraphilia

Increasing clinical experience has allowed the formulation of three psychodynamic viewpoints about the nature of the paraphilic disorder. Paraphilia is a disorder of sexual identity development, often solely of the intention component, that has three characteristics: a long-standing, highly arousing, unusual erotic preoccupation; a pressure to act upon the erotic fantasy; sexual dysfunction with a partner during conventional sexual behavior. Paraphilia is also a disorder of self-regulation characterized by a considerable gap between personal aspirations and behaviors. Finally, paraphilia is a dramatic impairment in the capacity to love. Two rarely recognized issues complicate the nosology of paraphilia: Many related sexual problems are often confused with paraphilia, and some paraphilias manifest themselves as variations in gender identity and object choice. The defensive functions of paraphilia are discussed and common terms used in conjunction with paraphilia are redefined.