Blog o6: "Not Every Fantasy Is a Disorder": Distinguishing Paraphilic Desires from Paraphilic Disorders

​Fabiola Ngamaleu Teumeni

​Fabiola (she/her) is a second-year undergraduate student in psychology at the University of Montreal. Since February 2023, she has been a research assistant in Dr. Bőthe's Sexuality, Technology, and Addictions Laboratory. She wishes to pursue her doctoral studies in clinical psychology, and her main research interests focus on the intersectional perspective of compulsive sexual behaviors in adults and seniors.

Sexual fantasies play a profound role in shaping our understanding of human sexuality (Joyal et al., 2015). These imagined scenarios, forged by past experiences, influence self-perception and may inform us of future sexual behaviors (Nese et al., 2021). Among theses fantasies, some are categorized as paraphilic sexual fantasies (PSFs) due to their atypical nature (Wilson, 1998). While PSFs might be unconventional, they are not inherently pathological—a critical distinction from paraphilic disorders (American Psychiatric Association, 2015; World Health Organization, 2021a).

​PSFs refer to strong and recurring sexual interests that involve imagining atypical objects, scenarios, or behaviors (World Health Organization, 2021a). By "atypical," we mean interests that fall outside societal norms. This includes interests involving individuals, such as children, who cannot provide consent, objects like using a plastic bag to induce asphyxiation, or scenarios such as engaging in sexual acts with animals (American Psychiatric Association, 2015; World Health Organization, 2021a). The spectrum of PSFs includes exhibitionistic fantasies, voyeuristic fantasies, pedophilic interest, coercive fantasies, frotteuristic fantasies, and other paraphilic interests involving non-consenting individuals, as well as those involving consenting adults or solitary behaviors (World Health Organization, 2021a).

Under certain conditions, PSFs can develop into disorders, as outlined by the World Health Organization (2021a). In most cases, for a paraphilic disorder to be identified, the individual must either act on the arousal or experience significant distress from it (American Psychiatric Association, 2015; World Health Organization, 2021a). However, in cases involving consenting adults or solitary behaviors, the diagnosis of a paraphilic disorder requires that the distress be specifically linked to the nature of the arousal pattern—distress that is not merely due to rejection or fear of rejection—or that the behavior poses a substantial risk of injury or death (World Health Organization, 2021h).
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To illustrate the distinction between fantasy and disorder, consider this example: an individual might privately have voyeuristic fantasies—such as imagining watching others having sex without their consent—without acting on them or causing harm. However, if these fantasies lead to significant emotional distress or result in harmful actions, like violating someone’s privacy, they could be classified as having a disorder.

​Paraphilic fantasies span a wide range of scenarios:
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• Exhibitionism involves exposing one’s genitals to an unsuspecting person, often in public (American Psychiatric Association, 2015; World Health Organization, 2021b).
• Voyeurism centers on watching others engage in private acts without their consent (World Health Organization, 2021). This might include observing individuals undressing or engaging in sexual activities (Ahlers et al., 2011; World Health Organization, 2021c).
• Pedophilic interests involve sexual attraction toward prepubescent children (World Health Organization, 2021d). For further details, refer to this blog post titled Clarifying Pedophilic Disorder.
• Coercive fantasies encompass desires to inflict suffering or exert dominance over non-consenting individuals (World Health Organization, 2021e). These fantasies can encompass a range of actions, including manipulation, aggression, blackmail, scratching, hitting, intimidation, insults, and harassment (Malamuth et al., 2005). It is essential to distinguish sexual coercion from consensual practices like bondage and discipline, domination and submission, and sadomasochism (BDSM), which prioritize mutual agreement and safety (Pitagora, 2013).
• Frotteuristic fantasies involve touching or rubbing up against a non-consenting person (World Health Organization, 2021f). These fantasies typically involve an unsuspecting victim who is unknown to the perpetrator (Patra et al., 2013).
• Other non-consensual fantasies, such as necrophilia and zoophilia, illustrate the extremes of paraphilic fantasies (World Health Organization, 2021g). Necrophilic fantasies involve sexual arousal from interactions with corpses (Kumar et al., 2019). Zoophilic fantasies, on the other hand, center on sexual attraction to animals (Aggrawal, 2011).
• Solitary and consenting acts, such as asphyxiophilia, involve self-induced oxygen deprivation to heighten sexual arousal (World Health Organization, 2021h). Methods can include self-strangulation or the use of devices designed to restrict airflow (Ueno et al., 2003). This high-risk behavior is practiced alone or with a consenting partner and reflects the interplay between danger and pleasure (Uva, 1995).

Stigma surrounding PSFs can prevent individuals from seeking help, reinforcing cycles of shame and isolation (Lehman, Schmidt et Jahnke, 2021; Joyal, 2021). Organizations like Ça suffit work tirelessly to combat this stigma by providing resources and support for those grappling with these issues (https://casuffit.info/). Recognizing that not all fantasies equate to disorders is a crucial step in fostering understanding and compassion. Indeed, by distinguishing between PSFs and paraphilic disorders, we create space for nuanced conversations about human sexuality—ones that validate diverse experiences while addressing potential harm. In doing so, we pave the way for a more empathetic and informed approach to mental and sexual well-being.


References
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World Health Organization. (2019h). 6D36 Paraphilic disorder involving solitary behaviour or consenting individuals. In International Statistical Classification of Diseases and Related Health Problems (11th ed.)

Text edited by Vanessa Beaulieu and Beáta Bőthe