Cognitive Behavioral Therapy for Paraphilia

Cognitive Behavioral Therapy for Paraphilia

Treatment for paraphilia involves a combination of psychotherapy and medications. The purpose is to promote compliance with medication, correct any attitudinal problems, and teach cognitive skills for resisting and managing sexual fantasies or urges.

Paraphilia is diagnosed when there is a pattern of intense sexual arousal to an atypical focus that persists for at least 6 months and manifests as sexual fantasies, urges or behaviors. Patients typically struggle to explain why they engage in these behavior patterns and do not believe their behavior to be abnormal.

Paraphilia, also known as parasexual disorder, is a deviant sexual preference that disrupts normal romantic relationships and/or involves coercive sexual activity. Examples of paraphilic disorders include pedophilia, leather fetishism, and sexual sadism.

Paraphiliac disorder can manifest as persistent sexual fantasies that become so distressing or intrusive that they interfere with daily activities. They may also have a detrimental effect on one’s relationships with others, causing significant interpersonal and family strain.

Many individuals with atypical sexual interests struggle to control their impulses and emotions, which may require counseling for discussion. Unfortunately, some may be reluctant to seek counseling because of embarrassment or fear of disclosing problematic sexual thoughts and behaviors to a psychiatrist.

For these patients, an extensive history of their atypical sexual interests and behaviors can be useful in assessing the level of risk for harm as well as whether these behaviors are causing significant issues in their life. Collateral sources such as prior treatment records or police reports may also provide insight into the severity of atypical sexual interests.

Computer programs can also be utilized to evaluate certain forms of atypical sexual interests and behaviors. For instance, visual receptivity theory (VRT) allows patients’ visual recognition of images that are sexually appealing and thus helps assess VRT (visual receptivity theory) responses.

There are non-psychological measures that can help assess atypical sexual interests and behaviors. For instance, a penile pulsation gauge measures the change in volume and circumference in response to potentially provocative stimuli.

Recurring, intense and pervasive atypical sexual interests and fantasies can often indicate that professional help is necessary. The intrusiveness of these behaviors may have become so great that they are interfering with social, academic, vocational or avocational activities of the patient.

Behavior rehearsal of paraphilic scenes is an integral component of treating these conditions. This type of therapy utilizes mental imagery to help individuals visualize sexual scenes with different outcomes than they usually anticipate, or simply make them feel satiated while masturbating with a fetishistic object.

Other treatments for paraphilias include behavior modification and deconditioning. These techniques aim to make the patient’s sexual arousal more flexible, thus decreasing the chance of relapse.

For many patients with paraphilia disorders, medication and psychotherapy is the most successful treatment plan. Medication can often help alleviate symptoms like anxiety, depression or obsessionality while improving interpersonal functioning. Furthermore, psychotherapy helps manage sexual cravings and fantasies so they do not cause harm to themselves or others.

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