Perspectives and Paradigms

Abstract: Paraphilias are sexual interests that differ from “normal.” There is a widespread belief that paraphilias cannot be changed and therefore can be at best, managed, with no hope of successfully treatment. This chapter reviews how problematic sexual interests have been dealt with by clinicians and the courts. It introduces the concepts of genes, gender, orientation, drive, and interests. The chapter also presents reasons for the persistence of the unproven belief that paraphilic interests cannot change. It concludes with an alternative paradigm in which paraphilic interests are seen as variants of non-paraphilic interests and therefore equally modifiable. This means that paraphilic disorders can be effectively treated, and the establishment of persistent harmful sexual interests can be prevented.