Paraphilias, problematic sexual behaviours and personality disorder-To what extent are they linked?

Since DSM-III, mental disorders have been classified based on overt symptoms and behaviours rather than underlying psychological and personality processes.

This study examines the occurrence of personality dysfunction in individuals with paraphilic disorders and problematic sexual behaviours.

The Shedler-Westen Assessment Procedure (SWAP-200), a clinician-rated assessment measure of personality disorders, was administered in a sample of 303 patients referred to a specialist forensic psychotherapy clinic. Sixty-six percent (N = 200) of the sample were diagnosable with traits of one or more DSM-5 personality disorders, and 35% (N = 106) were diagnosable with categorical DSM-5 personality disorders. When an alternative set of empirically derived personality diagnoses was examined, 94% (N = 285) had significant traits of the personality syndromes, and 62% (N = 188) of the sample met criteria for categorical diagnoses.

Paraphilic fantasies and behaviours may be linked to underlying personality pathology, suggesting implications for assessment and treatment.