Paraphilic fantasies and disorders in Brazil: insights from a nationwide study on prevalence, risk factors, and public health implications.

OBJECTIVE

Paraphilias, atypical sexual preferences outside societal norms, present a psychiatric challenge. The DSM-5-TR differentiates paraphilic fantasies (PFs) from disorders, with the latter causing distress or impairment. Social stigma and underreporting hinder understanding. This study examines PF and disorders in Brazil, focusing on pedophilia and hebephilia, to inform public health policies and crime prevention.

METHODS

This cross-sectional, online study included 5,335 Brazilian participants. The survey collected sociodemographic data and applied the Paraphilic Assessment Protocol, adapted from the Dunkelfeld Project, to assess fantasies, temporal criteria, and distress or impairment.

RESULTS

Most respondents (62.2%) reported three or more PFs, with masochism (64.4%), body part fetishism (58%), and sadism (49.2%) being most common. Nonconsensual fantasies included pedophilia (3.7%), hebephilia (6.6%), frotteurism (7.5%), and exhibitionism (6.8%). Pedophilic and hebephilic disorders were found in 1.87 and 2.46% of participants, respectively, and were associated with young age (18-24 years), cisgender male identity, bisexual orientation, and single marital status. Notably, working in healthcare and education was associated with these disorders.

CONCLUSION

As Brazil's first nationwide survey on paraphilias, this study underscores the need for targeted interventions to prevent sexual crimes and improve treatment options. Further research is essential despite ongoing stigma.