Paraphilias and paraphilic disorders in Attention-Deficit/Hyperactivity Disorder: an observational study

Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) are more likely than the general population to exhibit increased sexual desire and to engage in risky sexual behaviors. Emerging evidence also links ADHD to a heightened risk of sexual offenses and recidivism. While certain paraphilias and paraphilic disorders are known risk factors for sexual offending, it remains unclear whether they are more prevalent in individuals with ADHD than in the general population. This preliminary study investigated the prevalence of paraphilias and paraphilic disorders among 50 adults with ADHD and 136 control subjects. Paraphilic disorders tended to be more prevalent among individuals with ADHD than among control subjects. Although several differences did not reach statistical significance, voyeurism, voyeuristic disorder, exhibitionism, sadism, and pedophilic disorder were more frequently observed in the ADHD group than in controls. The pattern of increased prevalence of paraphilic disorders suggests greater psychological distress related to paraphilic interests among individuals with ADHD. The increased occurrence of voyeurism, sadism, and exhibitionism-particularly among men-raises concerns about a potential risk of sexual offending. Clinically, it is essential to distinguish between individuals with ADHD and paraphilic interests who present no risk of sexual offending and those who may pose such a risk. For the former, clinicians should be trained to evaluate and discuss paraphilic interests sensitively to promote sexual health; when paraphilias cause psychological distress, psychotherapeutic support should be provided. For the latter, when a non-negligible risk is identified, targeted psychotherapeutic and/or psychopharmacological interventions should be implemented.