How Common are Kinks, Fetishes, and Paraphilic Disorders?
According to a recent study, paraphilic attractions (kinks and fetishes) are more common than most people might think.[i] The study surveyed 387 adult males about the presence and impact of paraphilic attractions and behaviors in their lives, with the following results:
- 62.4% of survey participants reported some degree of paraphilic arousal.
- 58.6% said paraphilic arousal was most frequent while fantasizing.
- 47.7% used paraphilic arousal during masturbatory fantasies.
- 44.4% said they’d engaged in some form of real-world paraphilic sexual activity.
The most common paraphilic arousal patterns were:
- Voyeurism (38.7%)
- Fetish (35.7%)
- Sadism (24.8%)
- Masochism (18.5%)
- Frotteurism (15.0%)
- Pedophilic (10.4%)
- Cross-Dressing (7.4%)
- Exhibitionism (4.1%)
Notably, paraphilic arousal patterns are not, per se, pathological. Criteria beyond paraphilic attraction must be met for a kink/fetish to qualify as pathology. For a paraphilic attraction or behavior to be diagnosed as a paraphilic disorder (a pathological condition), it must cause significant distress to the individual or harm (or risk of harm) to self or others. Thus, paraphilic arousal patterns are a necessary but not sufficient condition for diagnosing a paraphilic disorder.
Moreover, the potential paraphilic disorders examined in the study (which are also the potential paraphilic disorders specifically listed in the DSM-5) are hardly an exhaustive catalog. About this, the DSM-5 states:
The eight listed disorders do not exhaust the list of possible paraphilic disorders. Many dozens of distinct paraphilias have been identified and named, and almost any of them could, by virtue of its negative consequences for the individual or others, rise to the level of a paraphilic disorder.[ii]
So, a whole lot of sexual attractions potentially qualify as pathological behavior. But how often do those attractions cross the line (by causing distress or harm to self or others)? The percentage may not be as high as one might think. For starters, only 1.7% of the men in the study who reported a paraphilic attraction said they were distressed by it. From the standpoint of causing harm (or potential harm) to self or others, the numbers are a bit higher.
- 18.0% admitted to voyeuristic behaviors.
- 6.5% admitted to frotteuristic behaviors.
- 3.8% admitted to pedophilic behaviors. (The study did not distinguish between “hands-on” offending and viewing illegal pornography.)
- 2.2% admitted to exhibitionistic behaviors.
Assuming no cross-over, the overall percentage here is 30.5%. Most likely, there is cross-over (possibly considerable crossover) and the actual percentage of is lower.
Either way, based on the results of this study, it would appear that a whole lot of people have some sort of paraphilic attraction, and for the most part those attractions do not rise to the level of pathology. In other words, most paraphilic attractions are good old-fashioned kinks and fetishes. And if you’re wondering, kinks and fetishes are pretty much the same thing. That said, they can be divided into two categories – non-dedicated and dedicated.
- Non-dedicated kinks and fetishes are nontraditional sexual behaviors used to spice things up. People with a non-dedicated kink or fetish can take it or leave it. It’s fun and exciting, but not necessary for sexual arousal.
- Dedicated kinks and fetishes are nontraditional sexual behaviors that are integral (often necessary) for sexual arousal. Individuals with a dedicated kink or fetish both want and need that element to enjoy sex.
To reiterate, kinks and fetishes are not, in and of themselves, pathological. They only rise to the level of a paraphilic disorder when they cause significant internal distress or harm (or potential harm) to the individual or others.
What’s a Therapist to Do?
First and foremost, as therapists we must ask basic questions about sex. Every therapist is told, early in the clinical training process, “If you don’t ask, you will never find out.” This is especially true with sexual issues. Non-threatening, highly enlightening questions to ask include:
- Do you have any concerns about your past or current sexual attractions or behaviors?
- Has anyone ever expressed concern about your past or current sexual attractions or behaviors?
- Is there anything about your sexual attractions or behaviors that feels shameful to you or that you work to keep secret?
Asking a few straightforward questions about sexual attractions and sexual behaviors allows clients to share about sexual concerns (that may underlie more obvious issues like anxiety and depression) without fear of judgment. Opening the door to honest communication about sexual desires and activity gives otherwise reticent clients permission to talk about their sexual thoughts and life and how that might be impacting them (and possibly the people around them). If a client has a sexual issue that he or she needs or wants to talk about, this is an open invitation to do so.
Next, it is important for therapists to understand that paraphilic attractions (kinks and fetishes) are part of a person’s arousal template, the same as sexual orientation. And like sexual orientation, these elements of the person’s arousal template are relatively fixed and immutable. People can add to their arousal template but subtracting from it borders on the impossible. No amount of talk therapy, aversion therapy, prayer, or any other tactic will dislodge a deeply rooted arousal trigger.
Thus, it is not the job of any therapist to judge or attempt to change a client’s paraphilic attraction. If that attraction is legal and not harmful to others, the therapist’s job is to reduce and hopefully eliminate personal distress the client may be having. The proper course of action with such a client is to help the client accept what he or she desires sexually as a natural and healthy part of his or her arousal template. If the client eventually chooses to incorporate that attraction into his or her sexual life, therapeutic guidance may be needed. Assistance may also be needed when informing a spouse or partner about the client’s desire to engage in a kink or fetish behavior.
If a client’s sexual attraction or behavior is illegal or harms (or could potentially harm) the client or others, deeper clinical intervention is needed. This work is best handled by a specialist – most often a clinician trained and certified in one or more of the following disciplines:
- Human Sexology
- Sexual and Behavioral Addictions
- Gender Identity/Sexual Orientation
The best referral sources for sexual issues of all types are listed below. Many of these organizations also provide trainings and certifications to therapists who wish to learn more.
- AASECT: The American Association of Sexuality Educators, Counselors, and Therapists. This organization provides referrals for counselors who can help with non-addiction, non-offending sexual issues, along with training and certification for treatment of non-addiction, non-offending sexual issues.
- ATSA: The Association for the Treatment of Sexual Abusers. ATSA promotes evidence-based practice, public policy, and community strategies that lead to the effective assessment, treatment, and management of individuals who have sexually abused/offended or are at risk to do so. ATSA provides referrals to qualified therapists.
- IITAP: The International Institute for Trauma and Addiction Professionals. IITAP trains and certifies therapists to deal with the full gamut of sexual issues, including sexual addiction. They are a great referral source.
- Safer Society Foundation: The Safer Society Foundation is dedicated to ending sexual abuse and offending through effective prevention and best-practice treatment for sexual abusers/offenders and their victims. The foundation provides a great deal of useful information on its website.
- SASH: The Society for the Advancement of Sexual Health. SASH is dedicated to sexual health and overcoming problem sexual behaviors, including sexual addiction. SASH offers both training and referrals.
- SSSS: The Society for the Scientific Study of Sexuality. SSSS is dedicated to the study of human sexuality. This is a great organization to contact if you’ve got a client who is ego dystonic about non-pathological sex-related issues (such as sexual orientation, non-harming fetishes, and the like).
- WPATH: World Professional Association for Transgender Health. WPATH is a professional organization dedicated to transgender health. The organization promotes evidenced-based care, education, research, advocacy, public policy, and respect.
[i] Ahlers, C. J., Schaefer, G. A., Mundt, I. A., Roll, S., Englert, H., Willich, S. N., & Beier, K. M. (2011). How unusual are the contents of paraphilias? Paraphilia‐associated sexual arousal patterns in a community‐based sample of men. The journal of sexual medicine, 8(5), 1362-1370.
[ii] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.