Organic disease and the differential diagnosis of paraphilias Mental retardation

Mental retardation causes serious limitations to patients not only because of their cognitive deficits, but also because of the unusual environment in which they live and develop. Families and institutions become frustrated with the mentally retarded individual's limitations and the subsequent economic, social, and emotional burden placed on others. The mentally retarded individual's sex education is dramatically different from that of non-retarded people. Families fear the consequences of involvement of their mentally retarded daughters or sons in any sexual activity and, as a consequence, the message to the mentally retarded is simply never to be sexual.

The mentally retarded person's intellectual limitations make it difficult to access those individuals identified as most attractive. However, because these individuals do nevertheless possess a biologically based sex drive, they find themselves having sexual desire but not having sexual outlets for their expression. Furthermore, intellectual limitations often lead the mentally retarded to spend more time with other retarded people or with children, where they feel more of an intellectual compatibility and hence find it easier to relate to these people. This may lead to sexual interaction with a child but does not necessarily lead to paedophilia, although it might if this interaction is repeated over time. In other cases, mentally retarded individuals may develop an interest in sexual behaviours which do not involve social interaction with a partner, such as fetishism, exhibitionism, or zoophilia.

Studies indicate that paraphilic recidivism for the mentally retarded is almost twice that of the non-retarded individual. (15 This may result from poor quality of treatment for the mentally retarded paraphiliac, limitations in learning resulting from the mental retardation, or the fact that mentally retarded individuals are easier to apprehend since their concealment skills are less effective than the non-retarded.

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