The Prevalence of Paraphilic Interests in the Czech Population: The high prevalence of some paraphilic patterns might render their pathologization problematic

The Prevalence of Paraphilic Interests in the Czech Population: Preference, Arousal, the Use of Pornography, Fantasy, and Behavior. Klára Bártová et al. The Journal of Sex Research, Jan 9 2020. https://doi.org/10.1080/00224499.2019.1707468

ABSTRACT: The number of population-based studies focused on the prevalence of paraphilic sexual interests in men is very low and for women, the subject remains largely unexplored. The two main aims of this study are to investigate the prevalence of paraphilias and to explore sex differences in an online representative sample of Czech men and women using various dimensions of sexual experience. We collected data about sexual motivations and behavior from a representative online sample of 10,044 Czechs (5,023 men and 5,021 women). In a standardized online interview, participants answered questions about selected dimensions of sexual experience within specific paraphilic patterns: sexual preferences, sexual arousal, sexual fantasies in the past 6 months, pornography use in the past 6 months, and experience with paraphilic behaviors. Our results show that 31.3% of men (n = 1,571) and 13.6% of women (n = 683) admitted to at least one paraphilic preference. Moreover, 15.5% of men and 5% of women reported more than one paraphilic preference. Except for beating/torture and humiliation/submission, in terms of real experience with such behaviors almost all paraphilias were more common among men than among women. Our results indicate that the high prevalence of some paraphilic patterns might render their pathologization problematic.


Discussion

Following the main aims of this study, we collected data on
the prevalence of paraphilic sexual interests and paraphilia in
five dimensions of sexual experience using a large and representative online sample of Czech men and women (N =
10,044). We found a relatively high general prevalence of
paraphilias in the population: 31.3% of men and 13.6% of
women admitted preference for at least one paraphilia. The
most prevalent paraphilic patterns across all dimensions (in
both men and women) were voyeurism, frotteurism/toucherism, and fetishism. Their prevalence exceeded statistical criteria for rare (less than 2.3%) or unusual (less than 15.9%)
population phenomena. Paraphilias and paraphilic interests
including paraphilic objects (i.e., not phenotypically normal,
physically mature, consenting human partners, as noted in the
definition of paraphilia in DSM-5; APA, 2013) were uncommon, especially in women where their prevalence was close to
zero. We also found that very few of the individuals who
indicated a strong preference for some paraphilic pattern
sought the help of health-care professionals.
In all dimensions, we confirmed a higher prevalence of
paraphilias in men than in women, the only exception being
paraphilic patterns related to BDSM practices such as beating/
torture and humiliation/submission, which were in some
dimensions more common in women. With the exception of
differences in the most prevalent paraphilic patterns (voyeurism, frotteurism/toucherism, and fetishism), which reached
moderate effect sizes, the effect sizes were either statistically
negligible or low. Associations between the dimensions of
sexual experience (Preference, Arousal, Fantasy, Porn Use,
and Behavior) were all significant and of moderate or large
effect sizes, with high internal consistency across dimensions
in all paraphilias. This suggests that assessments of paraphilia
and paraphilic interests should indeed treat all dimensions of
sexual experience as relevant.
Our findings are in line with a recent study by Joyal and
Carpentier (2017), especially with respect to the behavioral
dimension of paraphilia (“I often behave in line with
a paraphilic pattern”), the desire to engage in a paraphilic behavior (“I absolutely wish to experience …”), and regarding the
dimension of Preference. Similar to Joyal and Carpentier (2017),
the prevalence rates we found are higher than those found in
older, mostly non-representative surveys undertaken in the
1990s or earlier (e.g., Janus & Janus, 1993). These surveys were
conducted prior to the social change which led to a higher
acceptance of unusual sexual preferences and prior to the cultural spread (via, e.g., popular literature) of unusual practices
such as BDSM. This cultural shift took place mainly in recent
decades (Peter & Valkenburg, 2006). We found a relatively high
general prevalence of any paraphilia and especially in the case of
voyeurism, fetishism, and toucherism/frotteurism (across all
dimensions), the rates exceed statistical norms for being rare
or unusual. Earlier studies (e.g., Ahlers et al., 2011; Dawson et al.,
2016; Joyal & Carpentier, 2017) have also demonstrated high
prevalence of voyeurism, fetishism, frotteurism/toucherism, and
sadism/masochism, which suggests that a priori labeling of these
patterns as atypical or pathological may be at least problematic.
However, high numbers of these patterns could also be false
positives due to discrepancies in definitions of paraphilic patterns. For example, not all studies (including ours) clearly specify
the potential victim as being unaware of the behavior in definition, which is key to acknowledge a pattern as paraphilic and is
present in the ICD-10 definition (e.g., “carried out without the
observed people being aware”). Another important factor is
intentionality of voyeuristic or toucheristic/frotteuristic acts,
which is rarely included in questionnaires and thus, behaviors
which happened by chance are not always excluded from the
behavioral dimension.
Based on these results, we would like to argue that one
ought to make a strict distinction not only between paraphilic
interests and paraphilias but also between paraphilias as variants of sexuality and paraphilic disorders that should be
treated (and acknowledged by the DSM – 5). Moreover, in
the light of a recent modification in the ICD 11, which
removed sadomasochism, fetishism, and transvestism from
its list of paraphilias, thus diverging significantly from the
DSM-5, it seems even more important to use as precise
a language as possible when speaking about these subjects.
High prevalence does not, however, imply that the affected
individuals do not find life with their preference in current
society problematic. Studies on individuals with paraphilic
interests (such as pedophilia) show increased rates of personality disturbances, mood disorders, and intimacy deficits
(Gerwinn et al., 2018; Raymond et al., 1999), which can be
related to their sexual preference. It might also be a result of
the stigmatization stress that these individuals face in contemporary societies (e.g., Jahnke, 2018).
It should be noted, though, that due to methodological
differences, comparisons of the prevalence of paraphilic patterns reported by different studies can be problematic.
Different authors use different questions (for instance, asking
about “experience with a behavior” is different from asking
about “desire for a behavior”, with the latter likely to yield
higher prevalence), different scales, and different criteria, so
that some authors, for example, report any arousal higher
than zero (Dawson et al., 2016), whereas others, such as
ourselves and Joyal and Carpentier (2017), report only strong
arousal. Meta-analytic comparison of existing studies based
on unified criteria and transformed scales may be needed to
gain a more accurate view of similarities and differences
between surveys, let alone entire nations and cultures.
In line with our hypothesis and with previous research (e.g.,
Ahlers et al., 2011; Dawson et al., 2016; Joyal & Carpentier, 2017;
Makanjuola, Adegunloye, & Adelekan, 2008; Oliveira Júnior &
Abdo, 2010), we found that paraphilias are more common
among men than among women in all dimensions of sexual
experience. Compared to 13.6% of women, almost one-third of
men admitted to the presence of at least one paraphilia in the
dimension of Preference. In the dimension of Arousal, the
differences were even greater: 40.2% of men compared to
18.7% of women. In the remaining dimensions of Porn Use,
Fantasy, and Behavior, the prevalence was over 20% in men and
5% in women. Regarding the type of paraphilia, we found support for the prediction that sex differences would be present in
all paraphilic patterns except for activities related to BDSM
practices. This result is partly congruent with previous research
(Joyal & Carpentier, 2017) in the sense that one could expect
a comparable prevalence of complementary activities. This was
mostly seen in the Behavior dimension (prevalence in men:
beating and torture 1.6%, humiliation/submission 2.2%; prevalence in women: beating and torture 1.9%, humiliation/submission 2.1%).
Our study also shows that paraphilias and paraphilic
interests involving unusual targets (e.g., pedophilia, zoophilia, hebephilia) are less common than paraphilic patterns
involving unusual activities. In women, the prevalence of
interest in paraphilic objects was close to zero. This is in
line with evolutionary logic which highlights the importance
of appropriate mate choice for reproductive success and
inclusive fitness of both sexes. The choice of a partner
with suitable reproduction-relevant characteristics, i.e., phenotypically normal, physically mature, consenting human
partners as noted in the definition of paraphilia in DSM-5
(APA, 2013), is subject to intense selection and leaves less
space for errors and mutations. This holds particularly for
women, in whom the cost of reproduction and offspring
nurture is higher than in men (Trivers, 1972). When it
comes to extreme options, such as paraphilic objects or
unusual partners, one can thus expect women to be more
selective in their mate choice than men are.
Moreover, Dawson et al. (2016) suggested that sex differences
in the prevalence of paraphilias could be linked to the level of sex
drive which is on average higher among men than among
women (Baumeister et al., 2001; Lippa, 2006). Higher sex drive
motivates interest in paraphilic activities. Furthermore, this
assumption is in line with studies which showed that high sex
drive is linked to diverse sexual activities and could also lower
the baseline of sexual aversion and disgust (Baumeister et al.,
2001; de Jong, van Overveld, & Borg, 2013).
In regard to the possibility of socio-sexual explanations of sex
differences e.g., women being more sexually restricted by society
than men (Bhugra, Popelyuk, & McMullen, 2010), it must be
noted that studies from across the world examining societies
with various levels of restrictiveness (from very liberal to very
conservative), all show higher prevalence of paraphilic interests
and paraphilia in men. Interestingly, Långström and Seto (2006)
found that the immigrant status of a respondent was not
a significant correlate of paraphilic behavior and based on their
findings, these authors claimed that “paraphilia-like behavior is
not specific to sociocultural subgroups” (p. 433).
The abovementioned theoretical explanations could also
account for sex differences and ought to be further explored in
detail. Doing so, however, was beyond the scope of the present
study. Nevertheless, it should be noted that with the exception of
sex differences in the most prevalent paraphilic patterns (voyeurism, frotteurism/toucherism, and fetishism), which were of
moderate effect size, differences between the prevalence of studied patterns were of negligible or low effect size.
The surprisingly low percentage of people with paraphilias
who confided in health-care professionals found in our study
could be the cause of some concern for public safety and
health policies because it indicates that most people with
paraphilias tend to remain undetected until they violate the
law. This finding may be specific to the Czech society (we
have no comparison data from other countries) and it may be
due to either a low need of external management of paraphilias on the part of affected individuals, due to the lack of an
effective system of help and prevention on the part of the
society, and at least in some cases, also due to a denial of one’s
own sexual problems. Of importance may also be the extreme
stigmatization of paraphiles (e.g., Jahnke, Schmidt, Geradt, &
Hoyer, 2015), which lowers the likelihood of contacting
a health-care professional. In line with this explanation, individuals who admitted to pedophilia reported by far the lowest
level of help seeking (the percentage in our sample was even
lower than in Dombert et al., 2016, where 12.3% of pedophiles
reported they think about seeking professional help). This is
associated with the fact that pedophilic interest is heavily
stigmatized (for an overview, see Jahnke, 2018). Further
exploration of this subject is clearly needed.
The high internal consistency found across dimensions of
sexual experience in most paraphilic patterns indicates that the
results of various studies could perhaps be compared by proxy,
that is, by using a different dimension highly correlated with the
one in question. Based on our findings, the use of composite or
factor scores is justified and could be recommended for future
research. Nevertheless, in some paraphilias, we also found some
interesting differences between their dimensions. For instance,
zoophilia was the only paraphilia that displayed low levels of
internal consistency across the tested dimensions for both men
and women. It may thus seem that zoophilia-like behaviors may
not be a manifestation of real zoophilic preference but rather of a
different paraphilia (for instance, BDSM practices can involve
sex with animals but the purpose is to humiliate a partner). In
women, low levels of internal consistency were found also in
other paraphilias, namely those involving human paraphilic
subjects (hebephilia and pedophilia) and in activities involving
crossdressing (autoandrophilia and transvestitism). Mostly,
however, we found a notable discrepancy between behavioral
aspects (Behavior, Porn Use) and other ratings of preference,
which indicates that fantasies, preferences, and actual behavior
do not necessarily match. This could be due to women being
more fearful of the criminalization of sexually inappropriate
behavior or also possibly due to fears of being victimized and
a wish to remain in control of one’s behavior.
In general, our results suggest that behavior might be
constrained by external factors, such as lack of opportunity
(e.g., paraphilic patterns related to BDSM require a willing
partner) or law (e.g., pedophilia, biastophilia, zoophilia).


Limitations

The following limitations of our study should be considered.
First of all, as discussed above, the prevalence rate is a direct
result of the methodology used and may account for many
differences among studies. Moreover, the number of paraphilic patterns described in the literature (Aggrawal, 2008) is
large but the format of a national survey made it impossible
to include them all. Another methodological concern has to
do with the representativeness of our internet-based sample
and generalization of results based on this sample to the
population as a whole. The mode of contact is an important
aspect of research that deals with subjects as intimate as sexual
behavior and sexual preferences. On the one hand, an online
setting provides an increased feeling of anonymity, so that
individuals may well be more willing to reveal their preferences. Moreover, the online format enables access even to
persons who live in remote areas or unique communities.
On the other hand, this format also makes it more difficult
to control the characteristics of people involved in a study.
Generalizability of our results is furthermore limited by the
fact that individuals without internet access are highly unlikely to get involved (Wright, 2006). Nevertheless, a previous
study which compared two modes of contact (representative
surveys conducted online and by phone) found no differences
in the prevalence rates of paraphilic interests between the two
modes of data collection (Joyal & Carpentier, 2017). We,
therefore, believe that our internet-based data do provide
a valid and important insight into the distribution of paraphilic preferences in the current Czech population.