One literal translation of paraphilia—love beyond the usual—casts a benign, if not romantic, hue over a subject that has been marked by considerable professional dissidence (1). Although this chapter will not provide a critique of the paraphilia construct, any responsible discussion of the paraphilias must acknowledge the cultural underpinnings of efforts to define normality vs. abnormality in human behavior. This theoretical debate plays out in the literature, where a range of positions are evident, from loyal adherence to traditional definitions of pathological sex to advocacy for the elimination or radical revision of the paraphilia diagnostic category (2-4). Only a greater empirical base will resolve this controversy and provide a reasonably objective basis on which clinicians can define the boundary between "normal" and "abnormal" sexuality.

The focus of this chapter is not to engage the debate regarding normalcy, but to provide a clear conceptualization of the paraphilias, a review of etiological theories, and an articulation of current treatments. A core assumption throughout the chapter is that the most reasoned understanding of the paraphilias is one that integrates both biological and psychological perspective.

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