TABLE 1

Impediments to Identification of AEA

1. Patient embarrassment/shame
2. Anticipation that disclosure will result in the physician's discomfort, provoking judgment, repugnance, condemnation, or rejection (in part, this may represent a projection of his or her own self-condemnation upon the physician).
3. Paraphilic thoughts/behaviors are experienced by the patient as odd but ego-syntonic and thus not a problem.
4. The physician's discomfort in taking a sexual history may stem from concerns involving his or her own sexuality or paraphilic thoughts or behaviors, resulting in distancing from similar behavior in the patient.
5. The patient's view that behavior that others regard as deviant (“abnormal”), whether experienced as acceptable or unacceptable to himself or herself, is a private matter that has no bearing in his or her consultations with physicians for what they regard as purely medical (or even psychiatric) reasons.
6. The physician lacks knowledge of paraphilias and their manifestations, course, and preventive and therapeutic options.
7. The sexual behavior of choking games or AEA may (mistakenly) be regarded as “harmless” or “victimless” by either the AEA practitioner or the physician.