Sexual deviations

Most variants of sexual orientation and behaviour, sometimes called 'paraphilias' or 'alternative sexual practices', are no longer classed as psychiatric disorders, and more liberal attitudes in society during recent years have reduced the frequency of psychiatric involvement with them. However, sometimes these variants are associated with psychiatric disorder, social maladjustment, or transgressions of the law.

Psychiatric treatment is only indicated in carefully selected cases. When a sexual deviation leads to the patient's developing secondary psychiatric problems, such as depression or substance misuse, psychiatric assessment may be appropriate. However, the boundaries have to be clear. The patient must be clearly told that he retains responsibility for his behaviour. In deviations which lead to conflict with the law, such as paedophilia, mental health services have to be extremely cautious about involvement, in case they are blamed - probably wrongly, but mud sticks - if the subject reoffends.

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