AN EFFECTIVE MANAGEMENT OF PARAPHALIC AND RELATED DISORDERS IN CLINICAL SETTING

Abstract

Paraphilic sexual interests are characterized as unusual and anomalous, yet the true prevalence in nonclinical samples is unknown (J;, J. C. (n.d.). In the last century, the diagnostic criteria of paraphilias/paraphilic disorders have been developed and become more descriptive and specific (Downing L., DSM-V). But no diagnostic system including DSM-5 or any other tool can fully encompass the diverse spectrum of paraphilic pathology (Balon, R. (2016)). In previous research, it was reported that 62.4 % of people are facing at least one paraphilia type. Voyeurism is the most prevalent form of paraphilia and manifests in approximately five percent of men and three percent of women (Gandhi, Dr. V. A., 2022). A similar case of a 20-year-old boy was referred with overtly presenting complaints of insecurity, guilt, sexual thoughts, masturbation, aggression, sadness, irritability, feelings of rejection, and worthlessness with the duration of many years starting from childhood. However, after initiating therapeutic sessions, client reported some other clinical symptoms which helped to understand the underlying issue and aided in developing a management plan. Client reported significant symptoms of uncontrolled obsessive sexual thoughts, masturbation, and roaming around previously encountered females. Without consent touching their private parts, exposing his genital to stranger females, and using their clothes for sexual satisfaction. The formal and informal assessment was done by using structured clinical interview, behavioral observation, and baseline charts. The motivational Interviewing (MI) technique was used frequently in sessions to keep the client motivated for therapy and coming to sessions for purpose of behavior change.  In therapeutic sessions relaxation exercises and CBT techniques were used. For the management of the client's sexual thoughts and other related symptoms specifically strengthening of familial support was highly promoted, and strategies were implemented for engaging more in educational activities, ensuring a protective environment, and reducing access to objects or triggers which were the main cause of increasing sexual activities. A total of 14 sessions were conducted with the client and 55% improvement was reported. The provisional diagnosis of the client was Paraphilia disorder, with the subtypes of Exhibitionistic 302.4 (F65.2) Frotteuristic 302.89 (F65.81), and Fetishistic 302.4 (F65.2).