Other Paraphilias and Treatment

Unspecified Paraphilias (Zoophilia, Necrophilia, etc.)

The DSM includes categories for "other specified" and "unspecified" paraphilic disorders to capture clinical pictures that cause impairment but do not fit into the main categories.

Behaviors such as zoophilia (sex with animals), necrophilia (attraction to dead bodies), coprophilia (use of feces), urophilia (urination), or clismaphilia (enemas) are grouped here.

Lesser known paraphilias such as somnophilia (sex with sleeping persons), acrotomophilia (attraction to amputations) or telephone scatology (obscene calls) are also included.

The common denominator for clinical diagnosis remains significant discomfort, risk to third parties or inability to function sexually without such stimulation.

Comprehensive therapeutic approach

The treatment of paraphilic disorders is complex and does not adhere to a single model. An integration of approaches is required.

The psychodynamic model is useful in exploring the genesis of the impulse, using techniques such as association to understand what the paraphilic object or act symbolizes in the patient's psyche.

Gestalt can work with the patient's internal polarities (the part that desires the paraphilia vs. the part that rejects it) using the empty chair technique.

It is essential to work on the awareness of illness, since many patients arrive in denial or minimization.

Treatment seeks to reduce compulsivity and risk, promoting impulse control and, in necessary cases, the restructuring of sexual arousal towards normative or consensual stimuli.

Use of cognitive-behavioral techniques and psychodrama

The cognitive-behavioral approach (CBT) is the one with the most evidence for the management of problematic sexual behaviors.

Cognitive restructuring techniques are used to modify the distortions that justify the act ("she wanted to"), and aversive or covert sensitization techniques are used to reduce arousal to deviant stimuli. Social skills and empathy towards the victim are also trained.

Psychodrama offers powerful tools such as role reversal, where the patient must act the role of his or her victim or affected partner, which fosters a visceral empathy that breaks down objectification.

The use of mirror techniques allows the patient to see himself "from the outside" while performing the behavior, confronting the reality of his actions in a way that rationaliza