Epidemiology

The paraphilias are predominantly disorders of males, but do occasionally occur in females. The estimate is that the male-to-female ratio is approximately 30 to 1. The higher prevalence of paraphilias in males probably results from the higher testosterone levels in males compared with females, leading to greater sexual drive at an earlier age.

Estimating the incidence and prevalence of paraphilic behaviour is problematic for various reasons. First, it is difficult to obtain a representative sample of paraphiliacs upon which to base such estimates. Second, it is difficult to determine if information such as frequency of paraphilic behaviour would be more accurate if gathered from samples obtained from clinical populations or from the general population. Both groups present challenges in attempts to elucidate epidemiological characteristics of the paraphilias. For example, in clinical populations it is common to see paraphiliacs who engage in a variety of paraphilic behaviours, even if they restrict those behaviours to one type of paraphilic diagnostic classification. To compound this problem, most paraphiliacs seen within the clinical environment do not fully divulge the extent of their paraphilic activities because they are afraid of criminal recourse. In the general population the accurate reporting of paraphilic interests and behaviours is influenced by the fact that paraphilias are socially undesirable and therefore are under-reported. Furthermore, most paraphiliacs fear arrest and prosecution by the criminal justice system; therefore, whether they are being assessed in a clinical environment or are being questioned as part of a survey sample, paraphiliacs are extremely adept at hiding the nature of their paraphilic interests. (!°>

Despite the problems indicated above, several studies have described and clarified some of the epidemiological characteristics of the paraphilias. A study of 561 subjects voluntarily seeking assessment and/or treatment of their sexual interests within a psychiatric setting found that the average number of paraphilic crimes and victims was substantial/20» Participants had been involved in 291 737 paraphilic incidents with 195 408 victims. Additionally, each of the 560 participants were diagnosed following assessment and evaluation. Categories of paraphilic diagnoses are as follows: 19 per cent were diagnosed as paedophiles interested in extrafamilial girls; 13 per cent were diagnosed as paedophiles interested in extrafamilial boys; 13 per cent were diagnosed as incestuous paedophiles with an interest in girls; 4 per cent were diagnosed as incestuous paedophiles with an interest in boys; 11 per cent were diagnosed as rapists of adult females; 12 per cent were diagnosed as exhibitionists; 5 per cent were diagnosed as voyeurs; 5 per cent were diagnosed as frotteurs; 3 per cent were diagnosed as transsexuals; 3 per cent were diagnosed as transvestites; 2 per cent were diagnosed as sadists; 2 per cent were diagnosed as egodystonic homosexuals; the few remaining participants had carried out minor paraphilic behaviours.

Utilizing data gathered from samples selected from general populations, three studies have provided information on the incidence and frequency of paraphilic behaviour. One study was conducted to assess the frequency of men's erotic fantasies during masturbation and intercourse. (21) Of the 94 males in this study who reported sexual fantasies, 62 per cent fantasized about sexual encounters with young girls, 33 per cent fantasized about raping adult females, 12 per cent fantasized about sadomasochistic encounters, 5 per cent fantasized about zoophilic encounters, and 3 per cent fantasized about sexual encounters with young boys. The other two studies were conducted with college students and were undertaken to investigate paraphilic sexual interests. One of these studies involved 193 male participants who were questioned regarding sexual interest in children. (22> Of these 193 participants, 21 per cent reported sexual attraction to children, 9 per cent fantasized about sexual encounters with a child, 5 per cent reported masturbation fantasies of sex with children, and 7 per cent responded that there was a likelihood of their becoming sexually involved with children if they could find a way to avoid criminal consequences for such activity. The second study involved 60 participants who were questioned about paraphilic interests, especially child molestation. (23> Of the 60 participants, a total of 65 per cent of this sample indicated involvement in a paraphilia; 3 per cent reported sexual encounters with girls under 12, 42 per cent reported voyeurism, 8 per cent indicated participation in telephone scatalogia, 35 per cent in frotteurism, 2 per cent in exhibitionism, and 5 per cent in coercive sexual encounters. These studies are limited because the samples are homogeneous and the participants were not questioned about every form of paraphilic interest. However, the three studies strongly indicate that males often fantasize about paraphilic behaviour and that these same males report engaging in paraphilic activities.

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