General Information: History, Etiology and Theory (e.g., Courtship), Diagnosis, Comorbidity and Prevalence

Abstract

The descriptions of what we call paraphilias or paraphilic behaviors appear in various texts and pictorial art since the ancient times. Some old cave paintings picture men having sex with animals. One of the oldest texts mentioning paraphilic behavior is the Bible, as pointed out by Aggrawal (J Forensic Leg Med 16: 109–114, 2009). We also know that some paraphilia, e.g., pedophilia and hebephilia, or what some would call pedohebephilia, were fairly benevolently practiced in Ancient Greece and Old Rome. What we now call paraphilias and paraphilic disorders were called by different names and terms by various societies, e.g., sexual deviation, perversion, bestiality, and others. Individual sexual deviations (now paraphilias/paraphilic disorders) have been described in different texts, starting with the Bible (here, e.g., voyeurism, bestiality, exhibitionism, necrophilia-1). A couple of the individual paraphilia names (sadism and masochism) came from the description in fiction literature. The term sadism originated with Marquis Donatien Alphonse Francois de Sade, a French nobleman and sexual libertine, who practiced and described in his novellas and other writings various “deviant” sexual practices, including what we call sadism or sadistic practices. Interestingly, de Sade was institutionalized in “lunatic asylums” several times and died in one, where he had what we would call a pedophilic relationship till his death. Masochism is called after an Austrian nobleman Baron Leopold von Sacher-Masoch who also practiced various what we would call paraphilic behaviors (including masochism) and described masochism in his story of Venus in Furs. Interestingly, von Sacher-Masoch was also under psychiatric care in his late life and some even claim that he died in an asylum (unconfirmed). The term masochism was introduced into medical terminology by Austrian psychiatrist/sexologist Richard Freiherr von Krafft-Ebing in his famous book Psychopathia Sexualis (first published in 1886).

Medicine, psychiatry, and psychoanalysis have gradually become more interested in sexual deviations and, over the last century or so, have attempted to explain their origins and find treatment. Psychoanalysts, starting with Sigmund Freud, have presented many interesting cases and their psychoanalytic interpretations, but unfortunately have not been successful either in improving our understanding of sexual deviations or in finding effective treatments. The attention has gradually shifted to attempts to identify biological causes and treatments. The entertained underlying causes of sexual deviances have ranged from poor impulse control to obsessive compulsive spectrum disorders and personality disorders. The main change has been the conceptualization of sexual deviance or paraphilia as a medical condition rather than a matter of choice or lifestyle.