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The Relation Between the Paraphilias and Anxiety in Men: A Case–Control Study

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Abstract

Despite a multitude of theoretical views, it is still unclear how individuals develop and sustain paraphilic interests (e.g., sexual attraction to children, interest in non-consensual violence). It is also not clear from these views why many paraphilic interests, and especially many paraphilias and paraphilic disorders, are much more common in men than in women. One possible factor affecting male's higher rate of paraphilias is anxiety, because anxiety can potentiate sexual arousal in men. We speculated that paraphilic interests could develop when feelings of anxiety are recurrently generated by atypical sexual stimuli, and when that anxiety repeatedly potentiates sexual arousal, reinforcing sexual response to atypical stimuli. It follows that men with paraphilic interests are susceptible to anxiety disorders, because an anxiety disorder would facilitate the hypothesized developmental process. We conducted a retrospective file review of 1048 consecutive patients (944 male patients retained for analysis) referred to an outpatient sexual behavior clinic at a psychiatric hospital to investigate the link between paraphilias and anxiety. Male patients with a paraphilia had 1.64 greater odds than male patients without a paraphilia of having been diagnosed with an anxiety disorder, but they also had elevated rates of many other types of disorders. Therefore, there does not seem to be a specific link between paraphilias and anxiety in this sample. The discovery of a general link between the paraphilias and psychological disorders in men opens new avenues for studying the developmental origins and consequences of male paraphilic interests.

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Notes

  1. We thank a reviewer for this tip.

  2. Cohen considered values of 0.21 and 0.40 as fair, 0.41–0.60 as moderate, 0.61–0.80 as substantial, and 0.81–1.00 as almost perfect agreement (McHugh, 2012).

  3. Given that the data spanned 1999–2009 and that in some cases diagnoses were provided before this date, diagnoses from the DSM-III, DSM-IV, or DSM-IV-TR were used.

  4. Given the conceptual differences between personality disorders and other psychological disorders, two “any categories” were created: one including personality disorders and one excluding them.

  5. We thank a reviewer for this astute observation.

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Funding

Funding for this study was provided by the University of Ottawa Medical Research Fund awarded to M. L. Lalumière, A. R. Ashbaugh, S. Curry, M. H. Renaud (Fox), E. Levaque, J. P. Fedoroff, J. M. Bradford, and M. C. Seto. Thanks to Dawn Hunter for her expert copy-editing.

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Author notes

  1. Mélanie H. Fox

    Present address: Correctional Service of Canada, Ottawa, ON, Canada

  2. Nabhan Refaie

    Present address: Gordon S. Lang School of Business and Economics, The University of Guelph, Guelph, ON, Canada

  3. Sofija Lavrinsek

    Present address: Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada

  4. Victoria Hall

    Present address: The Royal’s Institute of Mental Health Research, Ottawa, ON, Canada

  5. John M. Bradford

    Present address: St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada

Authors and Affiliations

  1. School of Psychology, University of Ottawa, Ottawa, ON, Canada

    Mélanie H. Fox, Michael C. Seto, Nabhan Refaie, Sofija Lavrinsek, Victoria Hall, Andrea R. Ashbaugh, Enya Levaque & Martin L. Lalumière

  2. University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, ON, K1Z 7K4, Canada

    Michael C. Seto, Susan Curry, J. Paul Fedoroff, John M. Bradford & Martin L. Lalumière

  3. The Royal Ottawa Health Care Group, Brockville, ON, Canada

    J. Paul Fedoroff

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Fox, M.H., Seto, M.C., Refaie, N. et al. The Relation Between the Paraphilias and Anxiety in Men: A Case–Control Study. Arch Sex Behav 51, 4063–4084 (2022). https://doi.org/10.1007/s10508-022-02346-z

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