There is little reliable data regarding the prevalence of the paraphilias. As individuals with paraphilias rarely present in mental health or medical facilities, it is assumed that the prevalence in the general population is higher than estimates based on clinical samples. A 1983 review of psychiatric hospital records revealed a 0.08% incidence of fetishism (9). In contrast, a 10-year review of the records from the authors' specialty clinic showed a 5.4% incidence of fetishism, highlighting the variation in patient samples depending on contextual variables.

The same review revealed an overall prevalence rate of 24% for the paraphilias and paraphilia not otherwise specified relative to sexual dysfunction, sexual pain, and gender identity disorder diagnoses. For the specific paraphilias, the following rates were revealed: transvestic fetishism 35%, paraphilia NOS 31%, sexual masochism 8%, exhibitionism 7.4%, pedophilia 6.7%, fetishism 5.4%, voyeurism and sexual sadism 2.7% each, and frotteurism <1%. Again, it is important to note that patient samples are not representative of the general population and patient samples in specialty clinics are not representative of general medical or psychiatric samples.

Much of the prevalence data for the offending paraphilias have been drawn from sexual offender arrest or treatment records. Such records often do not distinguish between paraphilic and nonparaphilic offenders. As a result, the prevalence of specific paraphilias among sex offenders or in the general population is unknown and data gathered from arrest records likely under-reflect the incidence of paraphilias (10).

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