Journal of Psychiatric Practice November 2001 391 In this article, the first of a two-part series, the authors present reasons for considering the para- philic and hypersexual disorders together and pro- vide an overview of these disorders. The DSM-IV diagnostic criteria for paraphilias are reviewed, and proposed criteria for hypersexual disorders are presented. The question of whether the paraphilic and hypersexual disorders should be considered within the spectrum of obsessive-compulsive disor- ders is considered. The authors then review the epi- demiology of these disorders, and discuss some implications of recent sexual predator legislation. The authors discuss the etiology of the paraphilias and hypersexual disorders, and consider the role of endocrinological function, findings from brain imaging and neuropsychological testing, findings from primate research, the monoamine hypothesis, the imprinting hypothesis, social learning theory, the concept of courtship disorder, the role of obses- sive-compulsive elements, psychodynamic theories, and genetic factors. The phenomenology of the paraphilias and hypersexual disorders is discussed, including the tendency for multiple paraphilias to co-occur, the lack of a specific offender profile, the predominance of males among those with paraphil- ias, the incidence of a history of victimization in individuals with paraphilias and compulsive sexual disorders, the onset and course of both types of dis- orders, and the lack of internal motivation for change in individuals with paraphilias and hyper- sexual disorders. The authors then discuss disor- ders that commonly co-occur with paraphilias and compulsive sexual disorders, including mood disor- ders, substance abuse and dependence disorders, attention-deficit/hyperactivity disorder, anxiety and impulse control disorders, and personality dis- orders. The second article in the series will discuss the clinical assessment and the behavioral and psy- chopharmacological treatment of these disorders. A guide for clinicians and patients on where and how to find specialized clinicians and treatment resources in the United States will also be provided. (Journal of Psychiatric Practice 2001;7:391–403) KEY WORDS: paraphilias, sex offenders, hypersexual disorders, obsessive-compulsive spectrum disorders, sex- ual predator legislation, endocrinological function, brain imaging, mood disorders, substance abuse, substance dependence, attention-deficit/hyperactivity disorder, per- sonality disorders he paraphilias and hypersexual disorders are subjects of increasing interest. The paraphilias, which are included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), 1 are more familiar to the average clinician than are hypersexual disorders. The essential features of the paraphilias involve recurrent, intense, sexually arousing fantasies, urges or behaviors involving 1) nonhuman objects, 2) the suffering or humiliation of oneself or one’s partner, or 3) children or other nonconsenting persons. The DSM-IV criteria for these disorders require either subjective dis- tress or an impairment in social, occupational or other important areas of functioning. 1 Many of the paraphilias blend with consensual sexual practices that are not a source of distress or impairment of functioning but rather constitute forms of sexual expression that are chosen and practiced by significant numbers of individuals. The hypersexual disorders involve a disturbance of more con- ventional sexual functioning, such as masturbation or the use of pornography, to a point where such use is compul- sive or excessive and becomes a source of distress to the individual engaged in the behavior or to those around him or her. Variously described as “compulsive sexual behavior,” 2–4 “nonparaphilic compulsive sexual behavior,” “paraphilia- related disorder,” 5, 6 or sexual addiction,” 7, 8 hypersexual behavior was originally described by Krafft-Ebing. 9 Stein et al. 10 have suggested that this category be considered for inclusion in the Diagnostic and Statistical Manual of the American Psychiatric Association. For the most part, the paraphilias and hypersexual disorders have been considered and discussed separate- RICHARD B. KRUEGER, MD MEG S. KAPLAN, PhD The Paraphilic and Hypersexual Disorders: An Overview KRUEGER and KAPLAN: Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute. Copyright © Lippincott Williams & Wilkins Inc. Please send correspondence and reprint requests to: Richard B. Krueger, MD, Medical Director, Sexual Behavior Clinic, New York State Psychiatric Institute, Unit #45, 1051 Riverside Drive, New York, NY 10032–2695. T T