There is very little certainty about what causes a paraphilia. Psychoanalysts generally theorize that these conditions represent a regression to or a fixation at an earlier level of psychosexual development resulting in a repetitive pattern of sexual behavior that is not mature in its application and expression. In other words, an individual repeats or reverts to a sexual habit arising early in life. Another psychoanalytic theory holds that these conditions are all expressions of hostility in which sexual fantasies or unusual sexual acts become a means of obtaining revenge for a childhood trauma. The persistent, repetitive nature of the paraphilia is caused by an inability to erase the underlying trauma completely. Indeed, a history of childhood sexual abuse is sometimes seen in individuals with paraphilias.

However, behaviorists suggest, instead, that the paraphilia begins via a process of conditioning. Nonsexual objects can become sexually arousing if they are frequently and repeatedly associated with a pleasurable sexual activity. The development of a paraphilia is not usually a matter of conditioning alone; there must usually be some predisposing factor, such as difficulty forming person-to-person sexual relationships or poor self-esteem.

The following are situations or causes that might lead someone in a paraphiliac direction:

• parents who humiliate and punish a small boy for strutting around with an erect penis
• a young boy who is sexually abused
• an individual who is dressed in a woman's clothes as a form of parental punishment
• fear of sexual performance or intimacy
• inadequate counseling
• excessive alcohol intake
• physiological problems
• sociocultural factors
• psychosexual trauma