Abstract Introduction According to the literature, the development and expression of paraphilic interests and disorders are influenced by a range of intersectional factors. Psychiatric conditions seem to be in comorbidity with several paraphilic disorders. The dark tetrad traits (narcissism, Machiavellianism, psychopathy, and sadism) are associated with a greater probability of developing deviant sexual interests and engaging in sexually aggressive behaviors. Finally, Adverse Childhood Experiences (ACE) can be predisposing factors for paraphilic interests and disorders. This data highlights the importance of recognizing atypical sexual interests in patients affected by mental disorders. Objective To investigate the associations between sexual and paraphilic fantasies/masturbation/partnered sexual activity and ACE, the Dark Tetrad personality traits, and psychopathological dimensions in a sample of individuals admitted to a Psychiatric Intensive Care Unit. Methods Patients from the Mental Health Department of XXXX in XXXX were administered the Childhood Trauma Questionnaire (CTQ), the Brief Psychiatric Rating Scale Expanded Version (BPRS), the Clinical Interview for the assessment of paraphilias (DSM-5 TR), the Sexual Fantasies Questionnaire (SFQ), and the Short Dark Tetrad scale. Results To date, a total of 39 patients (51.3% female, 20/39; 48.7% male, 19/39) have been enrolled. The mean age was 38.9 (SD 17) for males, and 35.4 (SD 14.4) for females. The prevalent psychiatric diagnosis was bipolar disorder type I for both males (15%; 6/39) and females (23%; 9/39). Traumas have been reported by 77.5% of the sample. Paraphilias of high intensity were reported as follows: 30% voyeurism, 2% exhibitionism, 27.5% fetishism, 7.5% transvestic fetishism, 12.5% masochism, 20% sadism, 7.5% frotteurism, 5% pedophilia. Correlations between ACE and paraphilic fantasies were significant for physical abuse and the fantasy “unliving objects” (r=0.32; p=0.047), sexual abuse and fantasy “exhibitionism” (r=-0.35; p=0.025), and “sadism” (r=0.39; p=0.013). Correlations between ACE and paraphilic fantasies during masturbation were significant for: emotional abuse with “exhibitionism” (r=-0.32; p=0.039), physical abuse with “fetishism” (r=0.36; p=0.025). Correlations between ACE and paraphilic fantasies applied to sexual activity were significant for: physical abuse with exhibitionism (r= 0.37; p=0.020), and with fetishism (r=0.4; p=0.013). For the relationship between Dark tetrad and paraphilic fantasy, we found a significant correlation between psychopathy and voyeurism (r=0.32; p=0.047), sadism and paraphilic fantasy of fetishism (r=0.3; p=0.052), and with fantasy of sex with minors (age16 years), (r=0.36; p=0.021). For masturbation, we found significant correlations between narcissism and fetishism (r=0.33; p=0.034), psychopathy and fetishism (r=0.42; p=0.007), and sadism with fetishism (r=0.35; p=0.024). For sexual behavior, we found significant correlations between Macchiavellianism and fetishism (r=0.51; p0.001), psychopathy and fetishism (r=0.39; p=0.012), sadism and fetishism (r=0.37; p=0.018). Conclusions Preliminary results indicate that different types of ACE may be associated with specific types of paraphilic fantasies, applied also to masturbation and sexual activity. There is a need to improve the knowledge about the role of specific factors in increasing the risk of adopting sexually aggressive behaviors. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Bayer, FQM, Ibsa, Kanna, Lundbeck, Menarini, Merck, Mia, Otsuka, Pfizer, Recordati, Shionogi, and Viatris
Limoncin et al. (Mon,) studied this question.
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