Does the Paraphilia Scale Work for Everyone? Confirmatory Factor Analysis and Measurement Invariance Across Gender and Sexual Orientation Groups

We conducted three studies to examine the factor structure and measurement invariance of the Paraphilia Scale, a measure of paraphilic interests used in multiple studies. In the first study, we conducted a confirmatory factor analysis (CFA) testing different a priori models with a community sample of 1,040 adults previously reported by Seto et al. (2021), and found support for a hierarchical four-factor model: An agonistic continuum involving coercion or physical pain (biastophilia, sexual sadism, masochism), chronophilias (pedophilia, hebephilia), courtship disorders (voyeurism, exhibitionism, and frotteurism), and fetishism (object fetishism, transvestic fetishism, urophilia-coprophilia). This factor structure was replicated in a second study comprising a combined sample of 400 mTurk participants and 870 university students. The third study analyzed the community sample and found evidence of configural invariance but not scalar or metric invariance across gender (man or woman) and sexual orientation for gender (heterosexual or other sexual orientation). This indicates that the factor structure of the Paraphilia Scale is robust for gender and sexual orientation for gender, but factor loadings differ across these groups, as do the loadings of individual items on the four factors. Implications for research on gender and sexual orientation differences in paraphilic interests are discussed.

Factor Analysis With Unusual Sexual Interests: A Replication Study in a Representative Population Sample

A previous study found a variety of unusual sexual interests to cluster in a five-factor structure, namely submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism (Schippers et al., 2021). The current study was an empirical replication to examine whether these findings generalized to a representative population sample. An online, anonymous sample (N = 256) representative of the Dutch adult male population rated 32 unusual sexual interests on a scale from 1 (very unappealing) to 7 (very appealing). An exploratory factor analysis assessed whether similar factors would emerge as in the original study. A subsequent confirmatory factor analysis served to confirm the factor structure. Four slightly different factors of sexual interest were found: extreme, illegal and mysophilic sexual activities; light BDSM without real pain or suffering; heavy BDSM that may include pain or suffering; and illegal but lower-sentenced and fetishistic sexual activities. The model fit was acceptable. The representative replication sample was more sexually conservative and showed less sexual engagement than the original convenience sample. On a fundamental level, sexual interest in light BDSM activities and extreme, forbidden, and mysophilic activities seem to be relatively separate constructs.

Paraphilic fantasies and behavior in attention deficit/hyperactivity disorder and their association with hypersexuality

Previous research has found some peculiarities in sexual functioning of adults with attention deficit/hyperactivity disorder (ADHD). Using a set of questionnaires that had to be answered online, we assessed the prevalence of paraphilic fantasies and behaviors in a sample of 160 adults with ADHD in comparison to 75 adults without ADHD and evaluated the association between paraphilias and hypersexuality in the ADHD group. Both groups reported high rates of paraphilic fantasies and behaviors. ADHD individuals were more likely to report about very sexually arousing paraphilic fantasies (ADHD: 58.2% vs. non-ADHD: 40.5%; χ2 = 6.323, p = 0.01) and behaviors (ADHD: 44.9% vs. non-ADHD: 28.4%; χ2 = 5.774, p = 0.02). Furthermore, ADHD individuals reported on average about more very sexually arousing paraphilic behaviors compared to non-ADHD individuals (ADHD: M = 1.28, SD = 0.10 vs. non-ADHD: M = 0.81, SD = 0.09; T = 2.68, p < 0.01). Furthermore, in ADHD individuals both very sexually arousing paraphilic interests in masturbation fantasies (r(158) = 0.17, p = 0.03) and in sexual behaviors (r(158) =0.19, p = 0.02) showed a significant correlation with hypersexuality. In non-ADHD individuals no such significant correlation could be found. Altogether, it can be concluded that individuals with ADHD seem to be more prone to develop and act out paraphilic sexuality than those without ADHD, however, found differences were rather small. The results of the present study add to the current trend to depathologize paraphilic sexuality in the general as well as in clinical populations.

Psychopathic Personality as a Moderator of the Relationship Between Atypical Sexuality and Sexual Coercion Proclivity in the General Population

Being sexually coerced can have long-lasting psychological impacts on victims; with perpetration strongly predicted by elevated psychopathic traits. Owing to recent legislative developments in the United Kingdom that criminalize coercive control under the Domestic Abuse Act (2021), this study offers a timely investigation into the mechanisms of sexual coercion in domestic abuse across sexual abuse and coercive control. We used moderation analysis (n = 405) to investigate whether sexual coercion proclivity was predicted by facets of atypical sexuality (non-clinical elevated levels of sex drive, sexual sadism, and sexual masochism), and whether this relationship was moderated by psychopathic personality traits specifically the factor one components, which encompasses interpersonal and affective characteristics. Psychopathic personality traits significantly moderated the positive association between sex drive and sexual coercion proclivity, and between sexual sadism and sexual coercion proclivity in males (but not females), but psychopathic personality traits had no such moderating effect in the sexual masochism model. Results are discussed in terms of identifying risk factors of sexual coercion within a general population sample and international application. Open data and a preprint of this paper are available at [https://osf.io/xkcah/?view_only=134ff9c93ad24ba286515b348ce79c0c].

Youth sexual offending in Hong Kong: examining the role of self-control, risky sexual behaviors, and paraphilic interests

Introduction

Little is known about the nature and prevalence of sexual offending among youth in Hong Kong.

Methods

Testing self-control theory and sexual health risk factors (i.e., risky sexual behaviors [general and two subtypes] and paraphilic interests [general and 14 subtypes]), the prevalence of self-reported sexual offending behaviors (i.e., threat of sexual assault, penetrative sexual assault, and nonpenetrative sexual offense) was examined in a community-based sample of 863 young people (aged 17 to 20) in Hong Kong.

Results

In this study, men reported significantly higher levels of threat of sexual assault and of general and 12 subtypes of paraphilic interests than women; and women reported a significantly higher level of a specific paraphilic interest subtype (i.e., transvestic fetishism) than men. Logistic regressions found that, in general, a low level of self-control and high levels of risky sexual behaviors and paraphilic interests were important factors in the participants' likelihood of issuing threats of sexual assault and engaging in penetrative and nonpenetrative sexual assault.

Discussion

Important practical implications for reducing the tendency of young people to engage in sexual offending behavior can be derived from this study.

Psychological and Developmental Correlates of Paraphilic and Normophilic Sexual Interests

The classification of sexual fantasies and behaviors (here referred to as 'sexual interests') has historically been divided into 'paraphilic' and 'normophilic'. However, studies on paraphilic interests are often limited to clinical or forensic samples and normophilic interests are rarely assessed in tandem. Previous research has found mixed results for psychological and other correlates of sexual interests, potentially due to inconsistency in operationalism and measurement of fantasies and behaviors. The aim of the current study was to quantify correlates of sexual interests via the Sexual Fantasies and Behaviors Inventory, containing factors related to general fantasies/behaviors, normophilia, power dynamics, sadomasochism, and courtship paraphilias, using a large (N = 4280) non-clinical sample. Psychological, developmental, sexual, and demographic correlates were investigated via bivariate correlations, mean difference testing, and multiple regression. Sexual interest domains were largely unrelated to psychopathology and developmental factors. Sociosexuality and more accepting attitudes towards sadomasochism was generally related to more arousal to/engagement in normophilic and paraphilic domains. More autism spectrum disorder traits were related to decreased normophilic interests. Psychopathic traits, sexual sensation seeking, and sexual compulsivity were related to paraphilia dimensions, especially courtship paraphilias and domination/sadism; the former was also associated with negative attitudes about establishing consent. Men, non-monogamous, and non-heterosexual participants indicated greater sexual fantasies and behaviors compared to women (except in the case of submission and masochism), monogamous, and heterosexual participants, respectively.

The Development, Content Validation, and Pilot Testing of the Paraphilic Interests and Disorders Scale

The prevalence rates of paraphilic interests and disorders in the general population have been understudied, in large part due to the lack of a standardized assessment measure. As a result, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 provides little information regarding the prevalence of paraphilic disorders. The present study involved the development of a self-report measure, Paraphilic Interests and Disorders Scale (PIDS), that can be used to assess for the eight paraphilic interests/disorders in the DSM-5 for use with general population samples. Study 1 established the content validity of the PIDS using feedback from 22 experts in the field, and recommendations from these experts were utilized to modify the measure. In Study 2, the PIDS was piloted on 100 individuals in the general population, which supported the feasibility of implementation and its limited-efficacy. While the PIDS requires further psychometric support, the current research suggests the PIDS is a promising tool to gather self-report, population-based data on DSM-5 paraphilic interests and disorders.

Atypical Sexual Interests in Compulsive Sexual Behavior: Results From a Phallometric Study

The link between Compulsive Sexual Behavior (CSB) and atypical sexual interests is elusive. This study aimed to provide preliminary insights into the relationship between both aspects. The study sample comprised 61 self-identified straight men. CSB was measured through a composite self-report index assessing symptoms of CSB, whereas sexual interests -atypical and normophilic- were assessed objectively through penile plethysmography. The CSB index had small, non-significant correlation with greater sexual response to different sexual stimuli (r_{general sexual responsiveness}=.127 [95% CI: -.137, .384]). In terms of overall sexual interest, increased scores on the CSB index had small, non-significant correlation with a higher preference for younger sexual stimuli (r = -.098 [95% CI: -.499, .215]) and persuasive sex (r = .10 [95% CI: -.168, .316]). Finally, CSB had a moderate correlation with sexual response when presented with stimuli depicting "female toddler coercive" (r = .27 [95% CI: -.083, .544]). We conclude that our findings do not support the hypotheses that CSB is significantly related to an increased arousability across sexual stimuli. The study findings also suggest that CSB may be, to a small degree, predisposed to experience sexual attraction toward children. Given the preliminary nature of the study, these conclusions warrant further research. Alternative explanations for the study findings related to the particular components of CSB that may be related to typical and atypical sexual interests are also considered.

Risky Sexual Behavior, Paraphilic Interest, and Sexual Offending: The Study of a Community Sample of Young Adults in Hong Kong

Limited information is available on the prevalence and nature of sexual offending in Hong Kong. This cross-sectional study seeks to explore the role of risky sexual behavior (RSB) and paraphilic interests in self-reported sexual offending behavior (i.e., nonpenetrative-only, penetrative-only, and nonpenetrative-plus-penetrative sexual assault) in a community sample of young adults in Hong Kong. Using a large sample (N = 1885) of university students, the lifetime prevalence of self-reported sexual offending was 18% (n = 342; 23% males (n = 166), 15% females (n = 176)). Based on the study subsample of 342 participants who self-reported sexual offending (aged 18-35), the findings indicated that males reported significantly higher levels of general, penetrative-only, nonpenetrative-plus-penetrative sexual assault; and paraphilic interest in voyeurism, frotteurism, biastophilia, scatophilia, and hebephilia than females; while females reported a significantly higher level of transvestic fetishism than males. No significant difference was found in RSB between males and females. Logistic regressions found that the participants who possessed a higher level of RSB, particularly penetrative behaviors, and paraphilic interest in voyeurism and zoophilia were less likely to engage in a nonpenetrative-only sexual offense. Conversely, the participants who possessed higher levels of RSB, especially penetrative behaviors, and paraphilic interest in exhibitionism and zoophilia, were more likely to engage in nonpenetrative-plus-penetrative sexual assault. The implications for practice in areas such as public education and offender rehabilitation are discussed.

Sex Drive as a Possible Mediator of the Gender Difference in the Prevalence of Paraphilic Interests in a Nonclinical Sample

There is a general gender difference in paraphilic interests, such that men report more interest (and greater engagement) in a variety of paraphilic behaviors. Using a nonclinical sample, Dawson et al. (Sexual Abuse, 28(1):20-45, 2016, https://doi.org/10.1177/1079063214525645 ) found that the gender difference in paraphilic interests was eliminated when scores on measures of sex drive were used as mediators. However, their measures of sex drive were about more than just sex drive and included a measure of hypersexuality (i.e., distress, perceived lack of control, and problematic consequences of one's sexuality). This study had two aims: to replicate Dawson et al.'s mediation results (using the same measures and scoring methods), and to discern the effect of sex drive itself (by replacing their measure of hypersexuality with a measure of sex drive). A nonclinical sample of 517 men and 615 women completed an online questionnaire. As expected, men reported less repulsion than women for most paraphilic themes. The gender difference in paraphilic interests was reduced (but not eliminated) both when reproducing Dawson et al.'s analysis and when examining a mediation model focused on sex drive specifically. The same results were obtained when examining the paraphilic interest with the largest gender difference (i.e., voyeurism). A full mediation effect was obtained in an unplanned supplementary analysis using a factor score (derived from eight measures) putatively assessing sex drive. While the main findings are consistent with Dawson et al.'s conclusions that sex drive is a possible mediator, they also suggest that other factors need to be considered to help explain the gender difference in the prevalence of paraphilic interests.

A Brief Report on Fetishism in Romania: An Approach Based on Gender and Sexual Orientation

Objectives: With this research, we aimed to assess the level of fetishism in Romania, to explore the gender and sexual orientation differences and to inspect its relationship with sexual satisfaction and well-being. Methods: This study analyses data from 525 participants from the non-clinical population. Results: The analyses showed that some levels of fetishism are present in almost 70 % of the sample, that queer participants report higher scores and that it does not impact sexual satisfaction and well-being. Conclusion: These findings can be used for a better understanding of fetishism and its impact by both clinicians and individuals with fetishes.

Exploratory Factor Analysis of Unusual Sexual Interests

BACKGROUND

Unusual sexual interests are largely intercorrelated, yet not much is known about underlying patterns of clusters between various sexual interests.

AIM

To identify underlying clusters of unusual sexual interests using exploratory factor analysis.

METHODS

We conducted exploratory factor analysis with self-reported interest in a wide variety of unusual sexual acts for an online, international sample (N = 669; 61% female), and for women and men separately. Factor regression weights were correlated to self-reported sex life satisfaction, sexual outlet, and psychiatric symptoms.

OUTCOMES

Participants rated the attractiveness of 50 unusual sexual activities, and reported on their sex life satisfaction (Arizona Sexual Experiences Scale), sexual outlet, and symptoms regarding ADHD (Adult ADHD Self-Report Screening Scale for DSM-5), depression, anxiety, and stress (Depression, Anxiety, and Stress Scale).

RESULTS

We identified 5 factors of unusual sexual interests that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia (attraction to dirtiness or soiled things), and fetishism. For women, unusual sexual interests related to more psychiatric symptoms and higher sexual outlet, whereas this relation was less explicit for men.

CLINICAL IMPLICATIONS

Different factors of unusual sexual interests may serve different underlying functions or motivations, for instance related to sexual, and emotional regulation. A better understanding of the nature of unusual sexual interests is important to be able to influence sexual interests that are unwanted or cause damage to others.

STRENGTHS & LIMITATIONS

Strength of this study include its anonymity, the avoidance of sexual orientation effects, and the possibility to indicate only a slight endorsement toward sexual items. Limitations include the sample's generalizability and the truthfulness of online responding.

CONCLUSION

Unusual sexual interests could be clustered into 5 factors that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism. Schippers EE, Smid WJ, Huckelba AL, et al. Exploratory Factor Analysis of Unusual Sexual Interests. J Sex Med 2021;18:1615-1631.

Sex Differences in Voyeuristic and Exhibitionistic Interests: Exploring the Mediating Roles of Sociosexuality and Sexual Compulsivity from an Evolutionary Perspective

Sociosexuality and sexual compulsivity predict sex differences in voyeuristic interest in the population. In this study, we used a sample of 1113 participants from the UK (46% men) to consider whether sociosexuality and sexual compulsivity interacted to explain these sex differences and whether this relationship extended to the related domain of exhibitionism. In doing so, we tested novel predictions derived from an evolutionary perspective which views voyeuristic and exhibitionistic interest as manifestations of a short-term mating strategy. Participants reported their levels of repulsion toward voyeurism and exhibitionism and their interest in performing such acts under different levels of risk. There were clear sex differences in voyeuristic and exhibitionistic repulsion that were partially mediated by the serial combination of sociosexuality and sexual compulsivity. Examining the sexes separately revealed qualitatively different relationships between sociosexuality and sexual compulsivity when predicting exhibitionistic, but not voyeuristic, repulsion. Combined, sociosexuality and sexual compulsivity also mediated the sex difference in willingness to commit acts of voyeurism, but not exhibitionism, which was equally low for both sexes. The results highlight the role sociosexuality plays in voyeuristic and exhibitionistic interest, which coupled with an evolutionary perspective, may have implications for how we view courtship disorders.

Prevalence and correlates of individuals with sexual interest in children: A systematic review

BACKGROUND

Despite debates on what should constitute sexual interest in children in terms of definition and diagnostic criteria and its strong association with individuals who commit sexual offences against children, research in this area has shown that sexual interest in children is also commonly seen in the general population. Studies in this field have investigated its prevalence and its correlates. However, most research on this topic has focused on men and most particularly sex offender populations. When investigating the general population, again the vast majority of studies used male samples and students.

OBJECTIVE

This systematic review aimed to critically evaluate previous research on the prevalence of sexual interest in children across populations and to examine its correlates.

METHODS

A search of relevant databases was conducted as well as a hand search of selected journals to identify eligible papers. Studies meeting the inclusion criteria had their data extracted and were assessed for risk of bias, with a second rater to establish inter-rater reliability.

RESULTS

A total of 30 studies were reviewed and results indicated a mean prevalence rate of sexual interest in children between 2 %-24 %. Findings also indicated correlates such as the presence of mental health problems and adverse childhood experiences. Most studies showed poor external validity, with the majority of them scoring high on risk of bias.

CONCLUSION

Overall, the findings indicate inconsistencies in terms of methodology and definition/diagnostic criteria of sexual interest in children. Further research in this area using recommended methodology to avoid biases is recommended.

Concordance of Paraphilic Interests and Behaviors

We examined the concordance of paraphilic interests and behaviors across 13 themes in an online sample of 1,036 men and women. Paraphilic interests were significantly and positively correlated with behaviors across all 13 themes. Associations were strongest for masochism and sadism, and weakest for pedohebephilia and frotteurism. Paraphilic interest and behavior were significantly and positively correlated after accounting for gender and sexual orientation. Moderated moderation analysis was significant for five themes. Gender was a moderator for eroticized gender, but only among heterosexual participants, where concordance was higher for heterosexual men than for heterosexual women. For both exhibitionism and frotteurism, gender was a significant moderator, but only for nonheterosexual participants, where concordance was stronger for nonheterosexual men than for nonheterosexual women. For pedohebephilia, interest was significantly associated with behavior for heterosexual men, heterosexual women, and nonheterosexual men, but not for nonheterosexual women. For zoophilia, there was a significant association between interest and behavior for heterosexual men, nonheterosexual men, and nonheterosexual women, but not heterosexual women. Additional analyses found sex drive moderated the positive associations of 7 of 13 paraphilic themes, with 5 of these 7 showing the expected effect of higher concordance of interests and behaviors at higher levels of sex drive.

An examination of autoerotic asphyxiation in a community sample

Autoerotic asphyxiation (AEA) is a sexual interest that involves heightening sexual arousal by deliberately self-inducing a reduced supply of oxygen to the brain. Most of the literature on AEA is comprised of case studies and research based on people who have died from the practice. The present study explored information about AEA practices and the degree of overlap between AEA and other paraphilias in community participants. Participants (n = 395) were recruited through different online platforms to complete an anonymous survey and 165 were classified as having AEA by reporting mild to strong sexual arousal in AEA. These individuals reported that their interest emerged in late adolescence, and many reported that they discovered AEA via the internet. Regarding safety precautions people take during their AEA practice, 19% of participants reported that they did not use safety precautions. Most people (> 80%) were not distressed by their AEA interest. Additionally, significant relationships were found between AEA interest and many paraphilic interests with masochism being the only paraphilia associated with AEA when considering other paraphilic interests. These results suggest that most individuals engage in less risky manifestations of AEA than what is reported in the clinical literature and that AEA is appropriately conceptualized as a subtype of masochism. The results underscore the importance of gathering information about alternative sexual practices in community samples.

Exploring the relationship between paraphilic interests, sex, and sexual and life satisfaction in non-clinical samples

Limited research has indicated that paraphilic interests and behaviours do not necessarily decrease sexual and life satisfaction; some research suggests such interests may actually enhance satisfaction. The present study assessed how paraphilic-associated interests and behaviours were related to sexual and life satisfaction in a sample of 173 men and 356 women. Paraphilic interest rates were similar to existing population-based studies. Men reported significantly higher levels of most paraphilic interests than women, apart from masochism. Those with paraphilic interests rarely felt negatively affected. However, those interested in criminal paraphilic interests or both criminal and legally feasible paraphilic interests had lower levels of sexual satisfaction when they did not engage in paraphilia-associated sexual behaviour. The sexual satisfaction of those interested only in legally feasible paraphilic interests was not impacted whether or not they engaged in paraphilia-associated sexual behaviour. Further analyses indicated that those without a paraphilic interest and those who have a paraphilic interest and have disclosed to their partner have higher levels of sexual satisfaction than those who have not disclosed to their partner or who do not have a stable partner. Additionally, among those who had disclosed to a partner, sexual satisfaction was not affected whether the individual engaged in the paraphilic interest with or without their partner. These results suggest a multifaceted relationship that warrants further consideration and examination.

More than one flavour: University students’ specific sexual fantasies, interests, and experiences

Sexual fantasies, interests, and experiences are three important aspects of human sexual expression that likely are related yet distinct. Updated and comprehensive information on patterns in these three areas of sexual expression is important for developing knowledge on the extent to which fantasies are distinct from interests and experiences as well as whether social sexual norms are changing. Thus, the overall goal of this study was to explore patterns in university students’ sexual expression. Participants (N = 236; 65 men, 171 women) completed a background questionnaire and a measure of 43 specific sexual fantasies, interests, and experiences. We used Joyal, Cossette, and Lapierre’s (2015) categories to determine which specific fantasies, interests, and experiences were typical, common, uncommon, unusual, and rare. The results suggested that typical and common fantasies, interests, and experiences are those that fit with sexual norms and evolutionary pressures. However, some activities that fall outside of social norms, or evolutionary benefits, may be common or uncommon, rather than unusual or rare. For the most part, the prevalence and diversity of sexual fantasies aligned closely with sexual interests. We found more gender similarities than differences; when men and women differed, it was in specific sexual fantasies and interests rather than sexual experiences. Our findings suggest that young men and women fantasize about, are interested in, and engage in diverse sexual activities that are somewhat guided by social norms and evolutionary pressures. These findings provide novel, contemporary information on social norms, gender similarities, and diversity in young adults’ sexual expression.

Taxometric Analysis of the Latent Structure of Pedophilic Interest

The present study examined the latent structure of pedophilic interest. Using data from phallometric tests for pedophilic interest across four samples of offenders (ns = 805, 632, 531, 261), taxometric analyses were conducted to identify whether pedophilic interest is best characterized as taxonic or dimensional. Across the samples, the majority of analyses supported taxonic latent structure in pedophilic interest. Visual inspection of taxometric curves indicated trichotomous latent structure (i.e., three-ordered classes) may characterize pedophilic interest in these samples. In a second step of taxometric analysis, the results supported trichotomous latent structure, indicating the presence of a complement taxon and two pedophilic taxa. In comparison with the complement taxon, the men in the first pedophilic taxon were non-exclusively pedophilic and had similar rates of sexual recidivism and sexual compulsivity. The men in the second pedophilic taxon were exclusively pedophilic, had more child victims and total victims, sexually re-offended at a higher rate, and were more sexually compulsive. The finding of trichotomous latent structure in pedophilic interest is both consistent and inconsistent with previous taxometric studies and has implications for research, assessment, and treatment of pedophilic interest.