We examined whether beliefs about autonomic arousal sensations and sexual sensation seeking explain some of the gender differences in self-reporting paraphilic sexual interests in 672 university students. A serial mediation model was used to test the direct association of gender and the indirect associations of positive interpretations of autonomic arousal sensations and sexual sensation seeking on paraphilic sexual interests. Anxiety sensitivity (e.g., the belief that anxiety sensations are dangerous) was included in the serial mediation model to evaluate the relationship between negative interpretations of autonomic arousal sensations and paraphilic interests. As predicted, men reported more paraphilic interests, sexual sensation seeking, positive beliefs about autonomic arousal sensations, and lower anxiety sensitivity than women. Participants' gender was indirectly related to paraphilic interests through positive beliefs about autonomic arousal sensations and sexual sensation seeking. Notably, positive interpretations of autonomic arousal sensations had a greater association with paraphilic sexual interests than anxiety sensitivity. When autonomic arousal sensations are interpreted positively, they may facilitate sexual sensation seeking, and people may endorse more paraphilic sexual interests. Future research on paraphilias should further examine positive interpretations of autonomic arousal sensations as they may relate to sexual sensation seeking and the endorsement of paraphilic interests.