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. |