A Dimensional Relationship between Autistic and Paraphilic Traits

Background: Autism spectrum conditions (ASC) are typified by visual thinking, that is, by the attachment of meaning and significance to concrete visual representations, and by an aversion to the unpredictable and unscripted nature of conventional social interaction. Also typified by attachment of undue significance to sensory (usually visual) stimuli and a tendency to scripted behaviour is paraphilia, in which a stimulus or situation that is not conventionally sexual becomes an occasion for sexual arousal. Most paraphilias are innocuous (e.g. involving specific clothing, or scripted roleplay) except insofar as compulsive interest in the paraphilic sexual outlet may displace interest in the human partner, interfering with formation and maintenance of healthy relationships. Our own case data suggest heightened incidence of such effects in ASC and the broader autism phenotype (BAP). Paraphilic traits, like autistic traits, may vary dimensionally and in subclinical cases may simply constitute unusual object-centred and/or scripted interests integrated into healthy sexual relationships.

Objectives: We queried whether paraphilic traits extend transdiagnostically, and whether scripted and sensory aspects of such dimensional paraphilic traits correlate with dimensional autistic traits.

Methods: Qualitative interviews with 16 young adults (7 male) generated common paraphilic themes within the bounds of typical sexual outlet. The resulting items were included in a 220-item questionnaire administered to 300 typical individuals (107 men, 187 women, 6 unspecified gender, age 23.72±8.26, range 18-56), 161 of whom (62 men, 99 women) thereafter consented also to complete the Autism Spectrum Quotient (AQ) and the Broader Autism Phenotype Questionnaire (BAPQ). Principal components analysis was conducted on the paraphilia questionnaire, resulting factors were labelled, and items not loading strongly (>0.4) on any single factor were dropped, yielding a 190-item scale. Loadings were used to compute factor scores for each individual. Each of the three BAPQ subscales and the AQ was entered alongside gender as a predictor in an analysis of covariance with each of these factor scores, using Type III sums of squares. Holm-Bonferroni correction was applied to tail probabilities.

Results: Principal components analysis generated fourteen factors accounting for 51.13% of variance in reported paraphilic interest, all but one of which were significantly greater in males. Nine of these fourteen paraphilic trait factors correlated significantly with measures of autistic traits. The AQ captured a subset of the relationships captured by BAPQ subscales. BAPQ Aloof predicted a cluster of factors relating to desire to be violated (e.g. wet-and-messy fetishes, submission, desire to be victimised). Similarly BAPQ Aloof, and in males also BAPQ Rigid, predicted a cluster relating to desire to replay a defeat as a victory (e.g. transvestism, frotteurism, voyeurism). BAPQ Rigid predicted a cluster relating to desire to be disempowered (positive effect on desire to be mothered, negative effect on desire to dominate).

Conclusions: Autistic traits correlate with paraphilic traits in the general population. Paraphilic interests thus are likely to be of high incidence in autism and in its broader phenotype. Knowledge of this association can inform relationship counselling for couples affected by ASC/BAP, dispelling stigma and aiding integration of paraphilic interests into healthy relationships.