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Paraphilias are complex emotional expressions of embodied, prelinguistic memory associated with traumatic ruptures in the child’s sensory skin-ego (the earliest mind projected onto the skin) that form the structural basis for the paraphilia. The skin-ego ruptures function as lifelong vulnerabilities to structural deficit in self-development and may preclude the development of a cohesive self (as ancillary to an adult mind), derail desire and sexuality, and lead to paraphilias (delusional second-skins that conceal rendings in the child’s sensory skin-ego and impair the formation of a neurotypical adult-emotional mind). Moreover, paraphilias fail to protect the self against further decompensation (e.g., in symbol formation and abstract reasoning), making long-term psychotherapy a necessity.
Treatment for paraphilias must initially focus on the structural failures in skin-ego and the evolving separation anxiety and impaired self-cohesion. The treatment focus can then shift to the content of the paraphilia, which reflects the influence of familial, cultural, spiritual, and personal meanings associated with the traumatic ruptures that are being enacted as a form of a narcissistic behavioral disorder. Three cases are presented (two men and one women) to demonstrate the relationship between the rendings of the skin-ego, disorders of the self and mind, and the need for long-term treatment of the paraphilias.