Defining “Normophilic” and “Paraphilic” Sexual Fantasies in a Population‐Based Sample: On the Importance of Considering Subgroups

INTRODUCTION According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), a sexual fantasy (SF) is paraphilic if it concerns activities outside the realm of "genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners" (normophilic). Intensity of the paraphilic SF is also "greater than or equal to normophilic interests." Surprisingly, however, very few data are available to corroborate that definition of a paraphilic SF. Although the relatively high prevalence of paraphilic SF in the general population is well known, the magnitude of difference between intensity of "normophilic" and "paraphilic" SF remains to be assessed. AIM The main goal of this study was to analyze the SF of adults recruited in the general population to obtain person profiles based on the nature and intensity of their SF. METHODS Multiple correspondence analysis (MCA) were used with data collected from 1,501 adults recruited in the general population to generate subgroups of participants based on the nature and intensity of their SF. MAIN OUTCOME MEASURES The main outcome measures used was a revised version of the Wilson Sex Fantasy Questionnaire. RESULTS When all participants are considered as a unique group, the mean intensity of the most intense "normophilic" SF (oral sex) is significantly higher than the mean intensity of the most intense "paraphilic" SF (being sexually dominated for women and watching two women having sex for men), as expected from the DSM-5. When clusters of participants are considered separately, however, conclusions are nuanced. Four significant clusters of participants (two predominantly female and two predominantly male) reported at least one paraphilic SF with intensity as high as that of their most intense "normophilic" SF. In fact, 57% of this sample met the criteria of paraphilia. CONCLUSION These results suggest that the current criteria for paraphilia are too inclusive. Suggestions are given to improve the definition of pathological sexual interests, and the crucial difference between SF and sexual interest is underlined. Joyal CC. Defining "normophilic" and "paraphilic" sexual fantasies in a population-based sample: On the importance of considering subgroups. Sex Med 2015;3:321-330.