Sexual Abuse: A Journal of Research and Treatment [saj] pp526-sebu-375650 August 23, 2002 10:20 Style ﬁle version June 4th, 2002
Sexual Abuse: A Journal of Research and Treatment, Vol. 14, No. 4, October 2002 (
A DSM-IV Axis I Comorbidity Study
of Males (n = 120) With Paraphilias
and Paraphilia-Related Disorders
Martin P. Kafka
and John Hennen
One hundred and twenty consecutively evaluated outpatient males with paraphil-
ias (PAs; n = 88, including 60 sex offenders) and paraphilia-related disorders
(PRDs; n = 32) were systematically assessed for certain developmental vari-
ables and DSM-IV-deﬁned Axis I comorbidity. In comparison with the PRDs,
the PA group was statistically signiﬁcantly more likely to self-report a higher in-
cidence of physical (but not sexual) abuse, fewer years of completed education, a
higher prevalence of school-associated learning and behavioral problems, more
psychiatric/substance abuse hospitalizations, and increased employment-related
disability as well as more lifetime contact with the criminal justice system. In
both groups, the most prevalent Axis I disorders were mood disorders (71.6%),
especially early onset dysthymic disorder (55%) and major depression (39%).
Anxiety disorders (38.3%), especially social phobia (21.6%), and psychoactive
substance abuse (40.8%), especially alcohol abuse (30%), were reported as well.
Cocaine abuse was statistically signiﬁcantly associated with PA males (p = .03).
There was a statistically signiﬁcant correlation between the lifetime prevalence of
Axis Inonsexualdiagnosesand hypersexual diagnoses(PAs andPRDs). Thepreva-
lence of retrospectively diagnosed attention deﬁcit hyperactivity disorder (ADHD)
was 35.8%, the third most prevalent Axis I disorder. ADHD (p = .01), especially
ADHD-combined subtype (p = .009), was statistically signiﬁcantly associated
with PA status. ADHD was statistically signiﬁcantly associated with conduct dis-
order, and both of these Axis I disorders were associated with the propensity for
multiple PAs and a higher likelihood of incarceration. When the diagnosis of
ADHD was controlled, the differences reported above between PAs and PRDs
either became statistically nonsigniﬁcant or remained as only statistical trends.
Department of Psychiatry, McLean Hospital, Belmont, Massachusetts.
Biostatistics Laboratory, McLean Hospital, Belmont, Massachusetts.
To whom correspondence should be addressed at Department of Psychiatry, McLean Hospital, 115
Mill Street, Belmont, Massachusetts 02478; e-mail: firstname.lastname@example.org.
2002 Plenum Publishing Corporation