Paraphilic disorders

A distinctive feature of paraphilic disorders is that they are diagnosed largely in forensic settings. Indeed, paraphilic disorders are related to criminal activity to varying degrees, depending on the particular disorder. For example, acting on paedophilic sexual arousal results in criminal sexual activity with children, whereas fetishistic sexual arousal may result in sexual behaviour between consenting adults. However, fetishism may also involve criminal activity; for example, stealing feminine articles of clothing. Atypical patterns of sexual arousal have been familiar to practitioners of psychiatry and psychology since Richard von Krafft-Ebing's landmark work Psychopathia Sexualis in the late 19th century. The European psychiatrist described numerous cases of fetishism, sadism, masochism, and other sexual behaviour. Atypical sexual arousal was known as sexual deviation in the second edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-II), but the term paraphilia replaced it in subsequent editions. The current edition, Diagnostic and Statistical Manual of Mental Disorders: (5th ed.; DSM-5; American Psychiatric Association, 2013), retains the term “paraphilia,” but introduces the additional term of “paraphilic disorder.” With the intent of reducing stigma associated with atypical sexual arousal, the DSM-5 defines the term “paraphilia” as an intense, persistent sexual interest other than in genital stimulation or preparatory sexual fondling with physically mature, consenting human partners. In itself, this would not constitute a disorder. However, a paraphilic disorder is a paraphilia that is accompanied by clinically significant distress or impairment. Therefore, the DSM-5's paraphilic disorders require two criteria to be met for a diagnosis. Criterion A is the paraphilia component, which requires an atypical focus of sexual arousal and an arousal pattern that is recurrent, intense, and persists for a minimum of 6 months. Criterion B is a harm component, which requires the presence of distress, impairment in functioning, or the involvement of non-consenting persons. Some paraphilic disorders include a third criterion which is specific to that paraphilia. The DSM-5 lists eight specific paraphilic disorders: voyeuristic, exhibitionistic, frotteuristic, sexual masochism, sexual sadism, paedophilic, fetishistic, and transvestic. There are two additional residual disorder categories: other specified paraphilic disorder and unspecified paraphilic disorder.