Extracted from DSM VI
(Diagnostic & Statistical Manual for Mental Disorders, 4th Edition)
The essential features of a Paraphilia are recurrent, intense sexually arousing fantasies, sexual urges or behaviours generally involving 1) non-human objects, 2) the suffering or humiliation of oneself or one's partner, 3) children or other non-consenting persons, that occur over a period of at least six months (Criteria A). For some individuals paraphiliac fantasies or stimuli are obligatory for erotic arousal and are always included in sexual activity. In other cases, the paraphiliac preferences occur one episodically (e.g.) perhaps during periods of stress), whereas at other times the person is able to function sexually without paraphiliac fantasies or stimuli. The behaviour, sexual urges or fantasies cause clinically significant distress or impairment in social, occupational or other important areas of functioning (Criteria B).
What this means, in layman's terms, is that for a Paraphilia to be classed as a mental disorder it needs to meet both criteria : Criteria A, in that you present some, most or all of the "symptoms" described, usually for a period of six months or more, and Criteria B, in that these "symptoms" are preventing you from leading a normal life within society. Some Paraphilias may have more than two criteria to meet.
A Paraphilia must be distinguished from the nonpathological use of sexual fantasies, behaviours, or objects as a stimulus for sexual excitement in individuals without a Paraphilia. Fantasies, behaviours, or objects are paraphiliac only when they lead to clinically significant distress or impairment (e.g., are obligatory, result in sexual dysfunction, require participation of nonconsenting individuals, lead to legal complications, interfere with social relationships).
The individual Paraphilias can be distinguished based on differences in the characteristic paraphiliac focus. However, if the individual's sexual preferences meet criteria for more than one Paraphilia, all can be diagnosed. Exhibitionism must be distinguished from public urination, which is sometimes offered as an explanation for the behaviour. Fetishism and Transvestic Fetishism both often involve articles of feminine clothing. In Fetishism, the focus of sexual arousal is on the article of clothing
itself (e.g., panties), whereas in Transvestic Fetishism the sexual arousal comes from the act of cross-dressing. Cross-dressing, which is present in Transvestic Fetishism, may also be present in Sexual Masochism. In Sexual Masochism, it is the humiliation of being forced to cross-dress, not the garments themselves, that is sexually exciting. Cross-dressing may be associated with gender dysphoria. If some gender dysphoria is present but the full criteria for Gender Identity Disorder are not met, the diagnosis is Transvestic Fetishism. With Gender Dysphoria, Individuals should receive the additional diagnosis of Gender Identity Disorder if their presentation meets the full criteria for Gender Identity Disorder.
Specific Culture and Gender Features
The diagnosis of Paraphilias across cultures or religions is complicated by the fact that what is considered deviant in one cultural setting may be more acceptable in another setting. Except for Sexual Masochism, where the sex ratio is estimated to be 20 males for each female, the other Paraphilias are almost never diagnosed in females, although some cases have been reported.
Although Paraphilias are rarely diagnosed in general clinical facilities, the large commercial market in paraphiliac pornography and paraphernalia suggests that its prevalence in the community is likely to be higher. The most common presenting problems in clinics that specialise in the treatment of Paraphilias are Paedophilia, Voyeurism, and Exhibitionism. Sexual Masochism and Sexual Sadism are much less commonly seen. Approximately one-half of the individuals with Paraphilias seen clinically are married.
Paraphilia Not Otherwise Specified
Examples include, but are not limited to, telephone scatologia (obscene phone calls), necrophilia (corpses), partialism (exclusive focus on part of body), zoophilia (animals), coprophilia (faeces), klismaphilia (enemas), and urophilia (urine).
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