Deviance or Normalcy? The Relationship Among Paraphilic Thoughts and Behaviors, Hypersexuality, and Psychopathology in a Sample of University Students

J Sex Med. 2018 Sep;15(9):1322-1335. doi: 10.1016/j.jsxm.2018.07.015.


Introduction: The actual definitions of paraphilic thoughts or behaviors and hypersexuality are still a matter of debate in the scientific community, and few studies have evaluated their psychopathological correlates in non-clinical samples of both men and women.

Aim: This study aimed at shedding light on the gender differences in terms of frequency of paraphilic fantasies and behaviors, and the relationship among paraphilias, hypersexuality, and general psychopathology.

Methods: A sample of 775 university students (243 men, 532 women) was recruited from 6 Italian universities using questionnaires posted in social networks. Paraphilic behaviors, fantasies, and masturbation during these fantasies were evaluated, as well as hypersexuality, psychopathological correlates, self-perceived gender identity, and a history of adverse childhood conditions.

Main outcome measures: Participants were assessed on the presence of paraphilic fantasies, behaviors, and masturbation related to paraphilic thoughts, and evaluated by means of the Symptom Checklist 90-Revised, the Hypersexual Disorder Screening Inventory, the International Index of Erectile Function, the Female Sexual Function Index, the Gender Identity/Gender Dysphoria Questionnaire, and the Childhood Experience of Care and Abuse Questionnaire.

Results: In the present survey, 50.6% of the men and 41.5% of the women reported at least 1 behavior considered paraphilic. A gender difference in the prevalence of the main paraphilic interests and behaviors was observed, with men reporting a higher prevalence of voyeurism, exhibitionism, sadism, and frotteurism, and a higher prevalence of fetishism and masochism in women. Both general psychopathology and sexual dysfunctions were associated with hypersexuality, rather than with the content of sexual fantasies. Finally, an association between childhood adversities and hypersexuality was found in women but not in men.

Clinical implications: Understanding the psychopathological correlates of paraphilic fantasies/behaviors and hypersexuality may allow clinicians to develop specific psychological and pharmacological interventions.

Strengths & limitations: This is one of the few studies assessing paraphilic phenomenology and psychopathological correlates of hypersexuality in a non-clinical sample of both men and women.

Conclusion: The results seem to demonstrate that paraphilic thoughts and behaviors are not really a deviation from normalcy, rather they are quite widespread in the young population, and the distinction between healthy and pathological sexual interests may be better replaced by an all-encompassing approach considering ego-dystonic sexuality, hypersexuality, and their psychopathological correlates. Castellini G, Rellini AH, Appignanesi C, et al. Deviance or Normalcy? The Relationship Among Paraphilic Thoughts and Behaviors, Hypersexuality, and Psychopathology in a Sample of University Students. J Sex Med 2018;15:1322-1335.

Keywords: Childhood Abuse; Hypersexuality; Paraphilia; Psychopathology.

Publication types

  • Multicenter Study

MeSH terms

  • Female
  • Gender Identity
  • Humans
  • Italy / epidemiology
  • Male
  • Paraphilic Disorders / epidemiology*
  • Paraphilic Disorders / psychology
  • Prevalence
  • Sex Factors
  • Sexual Behavior / psychology*
  • Students / psychology*
  • Surveys and Questionnaires
  • Universities
  • Young Adult