出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2019/09/15 09:50:50」(JST)
| 「パラフィリア」はこの項目へ転送されています。佐藤まさきの漫画については「パラフィリア 〜人間椅子奇譚〜」をご覧ください。 |
出典は列挙するだけでなく、脚注などを用いてどの記述の情報源であるかを明記してください。記事の信頼性向上にご協力をお願いいたします。（2011年11月） |
この項目には性的な表現や記述が含まれます。免責事項もお読みください。 |
この記事には暴力的または猟奇的な記述・表現が含まれています。免責事項もお読みください。 |
| 性的倒錯 | |
|---|---|
| 分類および外部参照情報 | |
| 診療科・ 学術分野 | 精神医学, 心理学 |
| ICD-10 | F65 |
| MeSH | D010262 |
| テンプレートを表示 | |
性的倒錯（せいてきとうさく）、性的嗜好障害（せいてきしこうしょうがい）[1]、あるいは性嗜好異常（せいしこういじょう）は、英語でパラフィリア（英語: Paraphilia）と言い、人間の性に関連する行動において、精神医学における病理的な精神疾患と診断される症状（性的嗜好）を指す。なお2013年に出版されたDSM-5の日本語版では、パラフィリア障害群という用語を採用し、それ以前のDSM-IVでは性嗜好異常である。
広義には、常識的な性道徳や社会通念から逸脱した性的嗜好を指す。ただし、性道徳や社会通念は抽象的な概念であることから、その基準や境界線は時代や文化、個人の価値観によって多様な解釈や定義が存在している。また、それらの多様な解釈や定義が偏見や差別の原因となる場合がある。
この記事にて主として解説するのは、精神医学において、パラフィリア障害群としてまとめられている精神障害の一分類である。従ってその診断には、そのような行動によって著しい苦痛や、日常生活への障害、また同時に、その社会的に容認され難い行動を制御できないという診断基準を満たしていることが必要である。しかし、どこからが異常であるかという基準や境界線は厳密ではなく、文化や時代によっても変化するため、以下で述べる症例が、必ずしも精神疾患に該当するということにはならない。また、あらゆる精神的、または心理的な病理と同様に、古くから存在が確認されている症例もあれば、プライベート性が高く第三者に認識されにくい症例、時代や文化の変化と共に新しく誕生する（発見される）症例などもある。
従って、何れも医療機関の専門家による具体的な診察や長期的な観察などが重要になる。
現在、各国で通用する英単語のパラフィリア （Paraphilia）の語源は、ギリシア語の前置詞で「横」や「脇」を意味するパラ （ギリシア語:παρά 、英:para）と、古代ギリシア語の名詞で「愛」を意味する フィリア （古代ギリシア語:φιλíα、英:philia）を合わせた単語で、直訳すると「横に逸れた愛」といった意味を持つ。病理学的な専門用語として客観的かつ中立的に表現し、偏見や差別を防止する目的で使用されるようになった造語である。
日本の精神医学界では、昭和時代の初期頃まで一部で変態性欲 （英：Sexual perversion）などと呼ばれていたが、異常性が強調されてしまう言葉であることから、客観性や中立性を表現できる病理学的な専門用語が求められるようになり、英語圏で普及していたパラフィリアを意訳した性的倒錯 （せいてきとうさく）という言葉が大正時代頃から次第に普及するようになった。
しかし、「変態」や「異常」という言葉はもちろんのこと、「倒錯」や「逸脱」といった言葉でも一般的には誤解を招きやすく、客観性や中立性に欠ける表現になりかねないとの配慮から、アメリカ精神医学会（APA）や世界保健機関（WHO）などで使用されている、障害であることを積極的に意味する精神障害や、前述したパラフィリアなどの専門用語を積極的に使用する方が望ましいとの意見もある。
ドーパミン受容体パーシャルアゴニスト作用を有する抗精神病薬のアリピプラゾール（エビリファイ）を服薬することによって異常性欲や性的倒錯を発症することがある。患者は通常、罪悪感のためにこれらに言及するのは困難とされる[2][3]。アメリカ食品医薬品局（FDA）は添付文書で黒枠警告をしている[4]。
ここより、精神疾患としての性的倒錯を述べる。この概念は、精神医学または臨床精神医学などにおいて、精神障害の一分類であるパラフィリア障害群として認識されている。以下で示す診断基準などは記述精神医学に則っており、表出する症状に着目しており、その内面性にはあまり比重を置いていない。
精神医学的に正常な性的嗜好やフェティシズムの定義や分類と重複したり混同する場合が多い。例として、サディズム（加虐性愛）やマゾヒズム（被虐性愛）などの用語は、パラフィリアともなりうるものとして存在するが、同時に正常な性的嗜好や性風俗などの用語としても用いられており、境界線はない。
精神医学的には、正常な性嗜好を逸脱している場合には、性嗜好障害（せいしこうしょうがい）や性嗜好異常（せいしこういじょう）である。
各国の医療機関で準拠することの多い、アメリカ精神医学会（APA）による『精神障害の診断と統計マニュアル』第4版改定版（DSM-IV-TR）では、「性嗜好異常（Paraphilia）」である。性嗜好異常の項目では、すべての性嗜好異常に共通する第一段階における診断規準が記述されている。精神疾患であると診断する為の条件として、少なくとも以下の2点を同時に満たすことが必要と定義されている。なお2013年に出版されたDSM-5の日本語版では、「パラフィリア障害群」という用語を採用している。
（1）当人が自分の性的嗜好によって、心的な葛藤や苦痛を持ち、健康な生活を送ることが困難であること。
（2）当人の人生における困難に加えて、その周囲の人々、交際相手や、所属する地域社会などにおいて、他の人々の健全な生活に対し問題を引き起こし、社会的に受け入れがたい行動等を抑制できないこと。
従って、これらを同時に満たしていない場合は、精神疾患としての性的倒錯とは診断されない。
例として、当人が自身の性的嗜好に葛藤や苦痛を持たず、日常生活に支障がなければ、（1）の条件を満たしていないのでパラフィリアとは診断されない。また、当人が葛藤や苦痛を持っていても、第三者や社会秩序にとって脅威や問題がない場合は、（2）の条件を満たしていないのでパラフィリアとは診断されない。
さらに、当人が何らかの性的嗜好を持っていたとしても葛藤や苦痛がなく、第三者や社会秩序にとっても具体的な問題が生じていない場合は（1）と（2）の両方を満たしていないので、精神医学的にも社会的にも許容範囲の性的嗜好とみなされ、つまり医学的には正常な性嗜好である。
以下、各国の医療機関で準拠することの多いアメリカ精神医学会（APA）と世界保健機関（WHO）が定義した、精神疾患としてのパラフィリアの分類を挙げる。各症例については後述「パラフィリアの類型」を参照のこと。
なお、非常に稀な症例や少数の報告例しかない場合は、何れの医療機関も総合的な「性的倒錯」や単に「その他」などの分類に含めて割愛されることが多い。ただし、症例や報告例の数の多い少ないが、病理的な意味や重篤さの程度を示す指標にはならないので注意が必要である。
アメリカ精神医学会（APA）が定める『精神障害の診断と統計マニュアル』第4版改定版（DSM-IV-TR）では、「11章 性障害および性同一性障害（Sexual and Gender Identity Disorders）」において以下の性的嗜好が分類として定義されている。
DSM は、1952年に第1版（DSM-I）が発行されて以降、改訂されており、最新版は2013年に発行されている。基本的にICD-10と同期しているが、発売時期が異なるため、完全には同期していない。
国連の世界保健機関（WHO）が定める『疾病及び関連保健問題の国際統計分類』（ICD）の第10版の、精神障害のものである『ICD-10 第5章:精神と行動の障害』では、「F60-F69 成人のパーソナリティおよび行動の障害」の「F65. 性嗜好の障害」において、以下の性的嗜好が分類として定義されている。なお、ICDは1900年に発行されてから約10年ごとに改訂されており、現在は1990年に発行されて2007年に改訂の入ったICD-10が利用されている。
パラフィリアの主な類型を挙げる。
最終目標が性交（セックス）ではなく、何らかの嗜好や倒錯した行為が認められる症状が「性目標倒錯（せいもくひょうとうさく）」である。後述の「性対象倒錯」と併発している場合も多く、厳密な区分は困難である。
最終目標は性交（セックス）にあるが、その相手や対象、状況などに何らかの嗜好や倒錯の認められる症状が「性対象倒錯（せいたいしょうとうさく）」である。前述の「性目標倒錯」と併発している場合も多く、厳密な区分は困難である。便宜的に「人物」「年齢」「物体」「状況」「その他」の5つに分類して挙げる。
主に人物、または身体の部位や状態に関連する性的嗜好を挙げる。一般的な総称としては「フェティシズム（英語：Sexual fetishism）」や「フェティッシュ（英語：Fetish）」という言葉が広く知られており、日本では俗語的な略称「フェチ」なども同義である。なお、身体の特定の部位（パーツ、英語：Parts）への性的嗜好は、広義に「パーシャリズム（英語：Partialism）」と言う。
主に年齢に関連する性的嗜好を挙げる。なお、特定の年齢の人物に対する性的嗜好の場合もあれば、年齢差そのものへの性的嗜好の場合もある。また、年齢や性別の定義は医療機関によって多少の差異が存在する。
主に物体に関連する性的嗜好を挙げる。それらの物体を伴う（例えば着用しているような）人物に対する性行為の場合もあれば、物体そのものに対する性行為の場合もある。なお、物体そのものへの性的嗜好は、広義に「オブジェクト・セクシャリティー（対物性愛）英語：Object sexuality」と言う。
主に状況や環境に関連する性的嗜好を挙げる。なお、それらの状況に遭遇した人物に対する性行為の場合もあれば、状況そのものに対する性行為の場合もある。:
パラフィリアは人間の性に関わる精神疾患であるが、時代や文化と共に定義や分類が変化し続けている。例として、かつて同性愛は性的倒錯であるとみなされていた。しかし、1973年にはアメリカ精神医学会（APA）の『精神障害の診断と統計マニュアル』第2版（DSM-II）改訂7版から、同性愛が削除され、1990年には世界保健機関（WHO）の『疾病及び関連保健問題の国際統計分類』第10版（ICD-10）では「同性愛は治療対象にならない」として削除されている。これを受け、1994年には日本においても厚生省（現厚生労働省）が準拠を表明している。
従って、今後も時代や文化の変化と共に、旧来の症例がパラフィリアとしては該当しなくなる場合や、一方で、新しく追加される症例がパラフィリアとして定義される可能性がある。
| |||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paraphilia | |
|---|---|
| Specialty | Psychiatry |
| Causes | Sexual attraction |
Paraphilia (previously known as sexual perversion and sexual deviation) is the experience of intense sexual arousal to atypical objects, situations, fantasies, behaviors, or individuals.[1][2] Such attraction may be labeled sexual fetishism.
No consensus has been found for any precise border between unusual sexual interests and paraphilic ones.[3][4] There is debate over which, if any, of the paraphilias should be listed in diagnostic manuals, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD).
The number and taxonomy of paraphilia is under debate; one source lists as many as 549 types of paraphilia.[5] The DSM-5 has specific listings for eight paraphilic disorders.[1] Several sub-classifications of the paraphilias have been proposed, and some argue that a fully dimensional, spectrum or complaint-oriented approach would better reflect the evidence.[6][7]
Many terms have been used to describe atypical sexual interests, and there remains debate regarding technical accuracy and perceptions of stigma. Sexologist John Money popularized the term paraphilia as a non-pejorative designation for unusual sexual interests.[8][9][10][11] Money described paraphilia as "a sexuoerotic embellishment of, or alternative to the official, ideological norm."[12] Psychiatrist Glen Gabbard writes that despite efforts by Stekel and Money, "the term paraphilia remains pejorative in most circumstances."[13]
Coinage of the term paraphilia (paraphilie) has been credited to Friedrich Salomon Krauss in 1903, and it entered the English language in 1913, in reference to Krauss by urologist William J. Robinson.[14] It was used with some regularity by Wilhelm Stekel in the 1920s.[15] The term comes from the Greek παρά (para) "beside" and φιλία (-philia) "friendship, love".
In the late 19th century, psychologists and psychiatrists started to categorize various paraphilias as they wanted a more descriptive system than the legal and religious constructs of sodomy[16] and perversion.[17] Before the introduction of the term paraphilia in the DSM-III (1980), the term sexual deviation was used to refer to paraphilias in the first two editions of the manual.[18] In 1981, an article published in American Journal of Psychiatry described paraphilia as "recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving:[19]
Homosexuality, now widely accepted to be a normal variant of human sexuality, was at one time discussed as a sexual deviation.[20] Sigmund Freud and subsequent psychoanalytic thinkers considered homosexuality and paraphilias to result from psychosexual non-normative relations to the Oedipal complex.[21] As such, the term sexual perversion or the epithet pervert have historically referred to gay men, as well as other non-heterosexuals (people who fall out of the perceived norms of sexual orientation).[20][21][22][23]
By the mid-20th century, mental health practitioners began formalizing "deviant sexuality" classifications into categories. Originally coded as 000-x63, homosexuality was the top of the classification list (Code 302.0) until the American Psychiatric Association removed homosexuality from the DSM in 1973. Martin Kafka writes, "Sexual disorders once considered paraphilias (e.g., homosexuality) are now regarded as variants of normal sexuality."[22]
A 2012 literature study by clinical psychologist James Cantor, when comparing homosexuality with paraphilias, found that both share "the features of onset and course (both homosexuality and paraphilia being life-long), but they appear to differ on sex ratio, fraternal birth order, handedness, IQ and cognitive profile, and neuroanatomy". The research then concluded that the data seemed to suggest paraphilias and homosexuality as two distinct categories, but regarded the conclusion as "quite tentative" given the current limited understanding of paraphilias.[23]
The causes of paraphilic sexual preferences in people are unclear, although a growing body of research points to a possible prenatal neurodevelopmental correlation. A 2008 study analyzing the sexual fantasies of 200 heterosexual men by using the Wilson Sex Fantasy Questionnaire exam, determined that males with a pronounced degree of fetish interest had a greater number of older brothers, a high 2D:4D digit ratio (which would indicate excessive prenatal estrogen exposure), and an elevated probability of being left-handed, suggesting that disturbed hemispheric brain lateralization may play a role in deviant attractions.[24]
Behavioral explanations propose that paraphilias are conditioned early in life, during an experience that pairs the paraphilic stimulus with intense sexual arousal.[25] Susan Nolen-Hoeksema suggests that, once established, masturbatory fantasies about the stimulus reinforce and broaden the paraphilic arousal.[25]
There is scientific and political controversy regarding the continued inclusion of sex-related diagnoses such as the paraphilias in the DSM, due to the stigma of being classified as a mental illness.[26]
Some groups, seeking greater understanding and acceptance of sexual diversity, have lobbied for changes to the legal and medical status of unusual sexual interests and practices. Charles Allen Moser, a physician and advocate for sexual minorities, has argued that the diagnoses should be eliminated from diagnostic manuals.[27]
Albert Eulenburg (1914) noted a commonality across the paraphilias, using the terminology of his time, "All the forms of sexual perversion...have one thing in common: their roots reach down into the matrix of natural and normal sex life; there they are somehow closely connected with the feelings and expressions of our physiological erotism. They are...hyperbolic intensifications, distortions, monstrous fruits of certain partial and secondary expressions of this erotism which is considered 'normal' or at least within the limits of healthy sex feeling."[28]
The clinical literature contains reports of many paraphilias, only some of which receive their own entries in the diagnostic taxonomies of the American Psychiatric Association or the World Health Organization.[29][30] There is disagreement regarding which sexual interests should be deemed paraphilic disorders versus normal variants of sexual interest. For example, as of May 2000, per DSM-IV-TR, "Because some cases of Sexual Sadism may not involve harm to a victim (e.g., inflicting humiliation on a consenting partner), the wording for sexual sadism involves a hybrid of the DSM-III-R and DSM-IV wording (i.e., "the person has acted on these urges with a non-consenting person, or the urges, sexual fantasies, or behaviors cause marked distress or interpersonal difficulty").[31]
The DSM-IV-TR also acknowledges that the diagnosis and classification of paraphilias across cultures or religions "is complicated by the fact that what is considered deviant in one cultural setting may be more acceptable in another setting”.[32] Some argue that cultural relativism is important to consider when discussing paraphilias, because there is wide variance concerning what is sexually acceptable across cultures.[33]
Consensual adult activities and adult entertainment involving sexual roleplay, novel, superficial, or trivial aspects of sexual fetishism, or incorporating the use of sex toys are not necessarily paraphilic.[32] Paraphilial psychopathology is not the same as psychologically normative adult human sexual behaviors, sexual fantasy, and sex play.[34]
Clinicians distinguish between optional, preferred and exclusive paraphilias,[35] though the terminology is not completely standardized. An "optional" paraphilia is an alternative route to sexual arousal. In preferred paraphilias, a person prefers the paraphilia to conventional sexual activities, but also engages in conventional sexual activities.
The literature includes single-case studies of exceedingly rare and idiosyncratic paraphilias. These include an adolescent male who had a strong fetishistic interest in the exhaust pipes of cars, a young man with a similar interest in a specific type of car, and a man who had a paraphilic interest in sneezing (both his own and the sneezing of others).[36][37]
In American psychiatry, prior to the publication of the DSM-I, paraphilias were classified as cases of "psychopathic personality with pathologic sexuality". The DSM-I (1952) included sexual deviation as a personality disorder of sociopathic subtype. The only diagnostic guidance was that sexual deviation should have been "reserved for deviant sexuality which [was] not symptomatic of more extensive syndromes, such as schizophrenic or obsessional reactions". The specifics of the disorder were to be provided by the clinician as a "supplementary term" to the sexual deviation diagnosis; there were no restrictions in the DSM-I on what this supplementary term could be.[38] Researcher Anil Aggrawal writes that the now-obsolete DSM-I listed examples of supplementary terms for pathological behavior to include "homosexuality, transvestism, pedophilia, fetishism, and sexual sadism, including rape, sexual assault, mutilation."[39]
The DSM-II (1968) continued to use the term sexual deviations, but no longer ascribed them under personality disorders, but rather alongside them in a broad category titled "personality disorders and certain other nonpsychotic mental disorders". The types of sexual deviations listed in the DSM-II were: sexual orientation disturbance (homosexuality), fetishism, pedophilia, transvestitism (sic), exhibitionism, voyeurism, sadism, masochism, and "other sexual deviation". No definition or examples were provided for "other sexual deviation", but the general category of sexual deviation was meant to describe the sexual preference of individuals that was "directed primarily toward objects other than people of opposite sex, toward sexual acts not usually associated with coitus, or toward coitus performed under bizarre circumstances, as in necrophilia, pedophilia, sexual sadism, and fetishism."[40] Except for the removal of homosexuality from the DSM-III onwards, this definition provided a general standard that has guided specific definitions of paraphilias in subsequent DSM editions, up to DSM-IV-TR.[41]
The term paraphilia was introduced in the DSM-III (1980) as a subset of the new category of "psychosexual disorders."
The DSM-III-R (1987) renamed the broad category to sexual disorders, renamed atypical paraphilia to paraphilia NOS (not otherwise specified), renamed transvestism as transvestic fetishism, added frotteurism, and moved zoophilia to the NOS category. It also provided seven nonexhaustive examples of NOS paraphilias, which besides zoophilia included telephone scatologia, necrophilia, partialism, coprophilia, klismaphilia, and urophilia.[42]
The DSM-IV (1994) retained the sexual disorders classification for paraphilias, but added an even broader category, "sexual and gender identity disorders," which includes them. The DSM-IV retained the same types of paraphilias listed in DSM-III-R, including the NOS examples, but introduced some changes to the definitions of some specific types.[41]
The DSM-IV-TR describes paraphilias as "recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving nonhuman objects, the suffering or humiliation of oneself or one's partner, or children or other nonconsenting persons that occur over a period of six months" (criterion A), which "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" (criterion B). DSM-IV-TR names eight specific paraphilic disorders (exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, voyeurism, and transvestic fetishism, plus a residual category, paraphilia—not otherwise specified).[43] Criterion B differs for exhibitionism, frotteurism, and pedophilia to include acting on these urges, and for sadism, acting on these urges with a nonconsenting person.[35] Sexual arousal in association with objects that were designed for sexual purposes is not diagnosable.[35]
Some paraphilias may interfere with the capacity for sexual activity with consenting adult partners.[35]
In the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a paraphilia is not diagnosable as a psychiatric disorder unless it causes distress to the individual or harm to others.[2]
The DSM-5 adds a distinction between paraphilias and paraphilic disorders, stating that paraphilias do not require or justify psychiatric treatment in themselves, and defining paraphilic disorder as "a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others".[1]
The DSM-5 Paraphilias Subworkgroup reached a "consensus that paraphilias are not ipso facto psychiatric disorders", and proposed "that the DSM-V make a distinction between paraphilias and paraphilic disorders. [...] One would ascertain a paraphilia (according to the nature of the urges, fantasies, or behaviors) but diagnose a paraphilic disorder (on the basis of distress and impairment). In this conception, having a paraphilia would be a necessary but not a sufficient condition for having a paraphilic disorder." The 'Rationale' page of any paraphilia in the electronic DSM-5 draft continues: "This approach leaves intact the distinction between normative and non-normative sexual behavior, which could be important to researchers, but without automatically labeling non-normative sexual behavior as psychopathological. It also eliminates certain logical absurdities in the DSM-IV-TR. In that version, for example, a man cannot be classified as a transvestite—however much he cross-dresses and however sexually exciting that is to him—unless he is unhappy about this activity or impaired by it. This change in viewpoint would be reflected in the diagnostic criteria sets by the addition of the word "Disorder" to all the paraphilias. Thus, Sexual Sadism would become Sexual Sadism Disorder; Sexual Masochism would become Sexual Masochism Disorder, and so on."[44]
Bioethics professor Alice Dreger interpreted these changes as "a subtle way of saying sexual kinks are basically okay – so okay, the sub-work group doesn’t actually bother to define paraphilia. But a paraphilic disorder is defined: that’s when an atypical sexual interest causes distress or impairment to the individual or harm to others." Interviewed by Dreger, Ray Blanchard, the Chair of the Paraphilias Sub-Work Group, explained: "We tried to go as far as we could in depathologizing mild and harmless paraphilias, while recognizing that severe paraphilias that distress or impair people or cause them to do harm to others are validly regarded as disorders."[45]
Charles Allen Moser pointed out that this change is not really substantive as DSM-IV already acknowledged a difference between paraphilias and non-pathological but unusual sexual interests, a distinction that is virtually identical to what is being proposed for DSM-5, and it is a distinction that, in practice, has often been ignored.[46] Linguist Andrew Clinton Hinderliter argued that "Including some sexual interests—but not others—in the DSM creates a fundamental asymmetry and communicates a negative value judgment against the sexual interests included," and leaves the paraphilias in a situation similar to ego-dystonic homosexuality, which was removed from the DSM because it was realized not to be a mental disorder.[47]
The DSM-5 acknowledges that many dozens of paraphilias exist, but only has specific listings for eight that are forensically important and relatively common. These are voyeuristic disorder, exhibitionistic disorder, frotteuristic disorder, sexual masochism disorder, sexual sadism disorder, pedophilic disorder, fetishistic disorder, and transvestic disorder.[1] Other paraphilias can be diagnosed under the Other Specified Paraphilic Disorder or Unspecified Paraphilic Disorder listings, if accompanied by distress or impairment.[48]
Most clinicians and researchers believe that paraphilic sexual interests cannot be altered,[49] although evidence is needed to support this.[49] Instead, the goal of therapy is normally to reduce the person's discomfort with their paraphilia and limit any criminal behavior.[49] Both psychotherapeutic and pharmacological methods are available to these ends.[49]
Cognitive behavioral therapy, at times, can help people with paraphilias develop strategies to avoid acting on their interests.[49] Patients are taught to identify and cope with factors that make acting on their interests more likely, such as stress.[49] It is currently the only form of psychotherapy for paraphilias supported by randomized double-blind trials, as opposed to case studies and consensus of expert opinion.[50]
Pharmacological treatments can help people control their sexual behaviors, but do not change the content of the paraphilia.[50] They are typically combined with cognitive behavioral therapy for best effect.[51]
Selective serotonin reuptake inhibitors (SSRIs) are used, especially with exhibitionists, non-offending pedophiles, and compulsive masturbators. They are proposed to work by reducing sexual arousal, compulsivity, and depressive symptoms.[51] They have been well received and are considered an important pharmacological treatment of paraphilia.[52]
Antiandrogens are used in more severe cases.[51] Similar to physical castration, they work by reducing androgen levels, and have thus been described as chemical castration.[51] The antiandrogen cyproterone acetate has been shown to substantially reduce sexual fantasies and offending behaviors.[51] Medroxyprogesterone acetate and gonadotropin-releasing hormone agonists (such as leuprorelin) have also been used to lower sex drive.[51] Due to the side effects, the World Federation of Societies of Biological Psychiatry recommends that hormonal treatments only be used when there is a serious risk of sexual violence, or when other methods have failed.[50] Surgical castration has largely been abandoned because these pharmacological alternatives are similarly effective and less invasive.[53]
Research has shown that paraphilias are rarely observed in women.[54][55] However, there have been some studies on females with paraphilias.[56] Sexual masochism has been found to be the most commonly observed paraphilia in women, with approximately 1 in 20 cases of sexual masochism being female.[35][55]
Many acknowledge the scarcity of research on female paraphilias.[57] The majority of paraphilia studies are conducted on people who have been convicted of sex crimes.[58] Since the number of male convicted sex offenders far exceeds the number of female convicted sex offenders, research on paraphilic behavior in women is consequently lacking.[58] Some researchers argue that an underrepresentation exists concerning pedophilia in females.[59] Due to the low number of women in studies on pedophilia, most studies are based from "exclusively male samples".[59] This likely underrepresentation may also be attributable to a "societal tendency to dismiss the negative impact of sexual relationships between young boys and adult women".[59] Michele Elliott has done extensive research on child sexual abuse committed by females, publishing the book Female Sexual Abuse of Children: The Last Taboo in an attempt to challenge the gender-biased discourse surrounding sex crimes.[60] John Hunsley states that physiological limitations in the study of female sexuality must also be acknowledged when considering research on paraphilias. He states that while a man's sexual arousal can be directly measured from his erection (see penile plethysmograph), a woman's sexual arousal cannot be measured as clearly (see vaginal photoplethysmograph), and therefore research concerning female sexuality is rarely as conclusive as research on men.[57]
In the United States, since 1990 a significant number of states have passed Sexually violent predator laws.[61] Following a series of landmark cases in the Supreme Court of the United States, persons diagnosed with paraphilias, particularly pedophilia (Kansas v. Hendricks, 1997) and exhibitionism (Kansas v. Crane, 2002), with a history of anti-social behavior and related criminal history, can be held indefinitely in civil confinement under various state legislation generically known as sexually violent predator laws[62][63] and the federal Adam Walsh Act (United States v. Comstock, 2010).[64][65]
|deadurl= (help)
|dead-url= (help)
|deadurl= (help)CS1 maint: archived copy as title (link)
| Classification | D
|
|---|
| Look up paraphilia in Wiktionary, the free dictionary. |
| Wikimedia Commons has media related to Paraphilias. |
Paraphilias | |||||
|---|---|---|---|---|---|
List | |||||
| |||||
| |||||
|
Human sexuality and sexology | |
|---|---|
Sexual relationship phenomena |
|
| Sexual dynamics |
|
| See also |
|
Outline of human sexuality | |
|---|---|
| Physiology and biology |
|
| Health and education |
|
| Identity and diversity |
|
| Law |
|
| History |
|
| Relationships and society |
|
| By country |
|
| Sexual activities |
|
| Sex industry |
|
| Religion and sexuality |
|
| |
全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.
| リンク元 | 「服装倒錯フェティシズム」「性嗜好異常」「フェチシズム」「窃視症」「窃触症」 |