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Box 1. In this article, we will use the terms hypersexual behavior or hypersexuality referring to quantitatively relatively frequent sexual fantasies, sexual desire, and behaviors. This led to the ICD exclusion of fetishistic, sexual masochism, and transvestic disorder, 41 , 45 behaviors that have been reported in ASD individuals. After having reviewed the literature, we aimed to investigate hypersexual behaviors as well as paraphilic fantasies and behaviors in a large sample of male and female ASD patients compared with HCs matched according to gender, age, and educational level. Characteristics of participants. So far, only very few studies have assessed hypersexual or paraphilic behaviors in individuals with ASD, and most of them are case reports reporting about ASD individuals showing excessive masturbation, 46 - 50 exhibitionistic behaviors, 51 pedophilic fantasies or behaviors, 52 , 53 fetishistic fantasies or behaviors, 54 , 55 sadomasochism, 50 or other forms of paraphilias. The individual experiences increased tension or affective arousal immediately before the sexual activity, and relief or dissipation of tension afterwards. The rationale to include only individuals with high-functioning autism or Asperger syndrome was to reduce the potentially confounding effect of intellectual disability and thus be able to directly study the impact of ASD on sexuality. Overview of paraphilic disorders included in current diagnostic manuals.
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