There is considerable co-occurrence of other paraphilias in patients diagnosed with one (7,20-24). A recent study of men with pedophilia showed the following comorbidity patterns with additional paraphilias: voyeurism 13.3%, frotteurism 11%, exhibitionism, transvestic fetishism, and paraphilia NOS 6.7% each, and fetishism and sexual sadism 4.4% each (25).
Kafka and Prentky conducted a study of lifetime comorbid nonsexual diagnoses in males with paraphilias and paraphilia-related disorders (26). Almost 72% had a lifetime prevalence of a mood disorder, with dysthymic disorder occurring most frequently. Interestingly, there were no significant differences in comorbidity patterns between men with paraphilias and men with paraphi-lia-related disorders, with the exception of retrospectively diagnosed childhood ADHD, which was identified in 50% of the paraphilia group but in only 17% of the paraphilia-related group. Similar comorbidity patterns were found in a later study (27).
It is known that many individuals with fetishistic cross-dressing have comorbid psychiatric disorders. A sample of transvestites who sought psychiatric evaluation in a sexual behaviors clinic were found to have high rates of mood or substance abuse disorders (28). This was consistent with a previous study wherein 80% of gender dysphoric transvestites qualified for a concurrent Axis I diagnosis, generally an affective disorder (29). A recent study of comorbidity between alcoholism and specific paraphilias found that >50% of sexual sadists were alcohol dependent, with the lowest association between transvestism and alcoholism (30).
A recent study of the co-occurrence of personality disorders in sex offenders revealed that 72% of the sample had at least one personality disorder (31).
The most prevalent was antisocial personality disorder. All subjects had impulse control disorder and a paraphilia, but it is not clear how many of the offenders in the study had a diagnosis of pedophilia or other specific paraphilias.
In another recent study, Raymond et al. (25) found that 93% of individuals with pedophilia had at least one lifetime comorbid axis I diagnosis. Highest were comorbid mood and anxiety disorders. There was high co-occurrence of alcohol and cannabis use disorders, and 60% had comorbid personality disorders, in particular obsessive-compulsive, antisocial, avoidant, and narcissistic. Contrary to commonly held assumptions, there was a relatively low incidence—23%—of antisocial personality disorder.
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