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=== Causes and correlations === The causes of paraphilias in people are unclear, but some research points to a possible prenatal [[neurodevelopmental]] correlation. A 2008 study analyzing the sexual fantasies of 200 heterosexual men by using the Wilson Sex Fantasy Questionnaire exam determined that males with a pronounced degree of fetish interest had a greater number of older brothers, a high 2D:4D [[digit ratio]] (which would indicate excessive prenatal estrogen exposure), and an elevated probability of being [[left-handed]], suggesting that disturbed hemispheric [[brain lateralization]] may play a role in paraphilic attractions.<ref>{{cite journal |last1=Quazi |first1=Rahman |last2=Symeonides |first2=Deano J. |date=February 2007 |title=Neurodevelopmental Correlates of Paraphilic Sexual Interests in Men |journal=[[Archives of Sexual Behavior]] |location=New York City |publisher=[[Springer Science + Business Media]] |volume=37 |issue=1 |pages=166β172 |doi=10.1007/s10508-007-9255-3 |pmid=18074220 |s2cid=22274418}}</ref> [[Behaviorism|Behavioral]] explanations propose that paraphilias are [[Classical conditioning|conditioned]] early in life, during an experience that pairs the paraphilic stimulus with intense sexual arousal.<ref name="Nolen-Hoeksema2013">{{cite book |last=Nolen-Hoeksema |first=Susan |url=http://connect.customer.mheducation.com/products/connect-for-nolen-hoeksema-abnormal-psychology-6e/ |title=Abnormal Psychology |date=2013 |publisher=[[McGraw-Hill]] |isbn=978-0-07-803538-8 |edition=6th |location=Boston, Massachusetts |page=385 |author-link=Susan Nolen-Hoeksema |access-date=15 April 2015 |archive-url=https://web.archive.org/web/20171104143831/http://connect.customer.mheducation.com/products/connect-for-nolen-hoeksema-abnormal-psychology-6e/ |archive-date=4 November 2017 |url-status=dead }}</ref> [[Susan Nolen-Hoeksema]] suggests that, once established, [[masturbatory]] fantasies about the stimulus reinforce and broaden the paraphilic arousal.<ref name="Nolen-Hoeksema2013" />
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