Biological factors are likely predisposing and modulating elements in sexually deviant behavior. The observation that paraphilic behavior tends to cluster in some families is intriguing and potentially raises questions as to whether shared genetic factors may play a role in the transmission of paraphilia. This pilot study introduces five families in which we found presence of paraphilia over generations. We constructed genograms on the basis of a standardized family history. Results document the aggregation of sexual deviations within the sample of families and support a clinical/phenomenological heterogeneity of sexual deviation. The concept of paraphilia in relation to phenotypic expressions and the likelihood of a spectrum of related disorders must be clarified before conclusions can be reached as to family aggregation of paraphilia based on biological factors. 1. Introduction Paraphilias are classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) [1] as sexual disorders characterized by intense, recurrent sexual fantasies, thoughts, and/or behaviors. Diagnostic criteria for these disorders require either marked subjective distress or interpersonal difficulty. Despite operational categorization as psychiatric disorders, paraphilias have not been established as classical major mental illnesses such as schizophrenia or affective disorder and have often been equated with antisocial behavior. Although this argument has been raised, the DSM-IV, in effect, has characterized the paraphilias as Axis I Disorders involving a fundamental aberration in sexual makeup and phenomenology. In that sense, simply behaving in an antisocial fashion by engaging in sexually improper behavior does not necessarily constitute a sufficient basis for diagnosing a paraphilic disorder. Of the various paraphilias, the most common forms encountered in clinical practice involve pedophilia, voyeurism, and exhibitionism [1]. Individuals suffering from pedophilia, voyeurism, or exhibitionism represent most apprehended sexual offenders [1]. Several forensic psychiatric programs run specialized clinics to address the need for risk assessment of these individuals and further, to provide comprehensive assessments and treatments. In this context, it would be helpful to gain a better understanding of the etiology of paraphilia as it may bear a direct impact on treatment and counseling. While the etiology of paraphilias remains largely unknown, various theories have been put forth to account for the occurrence of these sexual disorders. According to social learning
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