Paraphilic Disorders

What is a paraphilia?

Intense and persistent sexual interest outside genital stimulation with consenting, physically mature partners.

What makes a paraphilic disorder different from a paraphilia?

It must include distress/impairment OR harm/risk to others.

Can someone have a paraphilia without a disorder?

Yes—if Criterion for distress/impairment/risk/harm is NOT met.

Duration requirement for most paraphilic disorders?

At least 6 months

Two major categories of paraphilic disorders?

• Anomalous activity preferences

• Anomalous target preferences

Courtship disorders include which three?

• Voyeuristic

• Exhibitionistic

• Frotteuristic

Algolagnic disorders include which two?

• Sexual masochism

• Sexual sadism

Target-based disorders include which three?

• Pedophilic

• Fetishistic

• Transvestic

Core feature of voyeuristic disorder?

Observing unsuspecting person naked, disrobing, or having sex.

Age requirement for voyeuristic disorder?

Person must be ≥18 years old

Additional criterion for most paraphilic disorders?

Acting on urges with nonconsenting person OR distress/impairment.

Core feature of exhibitionistic disorder?

Exposing genitals to an unsuspecting person.

Key specifiers for exhibitionistic disorder?

• Prepubertal children

• Physically mature individuals

• Both

Core feature of frotteuristic disorder?

Touching or rubbing against a nonconsenting person.

Core feature of sexual masochism?

Arousal from being humiliated, beaten, bound, or made to suffer.

Unique masochism specifier?

With asphyxiophilia (arousal from restricted breathing)

Key difference in Criterion B of masochism vs others?

Masochism criteria does NOT require a nonconsenting other person, only distress/impairment

Core feature of sexual sadism?

Arousal from another person’s suffering.

Core feature of pedophilic disorder?

Sexual focus on prepubescent children (≤13).

Age requirements of pedophilic disorder?

• Individual ≥16 years old AND

• At least 5 years older than child

Important exclusion of pedophilic disorder?

Consensual relationship between adolescents (e.g., 12–13 with similar-age partner)

Specifiers for pedophilic disorder?

• Exclusive vs nonexclusive

• Attracted to males/females/both

• Limited to incest

Core feature of fetishistic disorder?

Arousal from nonliving objects or specific body parts.

What is excluded from fetishistic disorder?

• Cross-dressing clothing

• Sex toys (e.g., vibrators)

Specifiers for fetishistic disorder?

• Body parts

• Nonliving objects

• Other

Core feature of transvestic disorder?

Sexual arousal from cross-dressing.

Specifiers of transvestic disorder?

• With fetishism

• With autogynephilia

What does “in a controlled environment” mean?

Opportunities to act on urges are restricted (e.g., prison).

What is “in full remission”?

No distress/impairment AND no acting on urges for ≥5 years in uncontrolled environment.

Examples of “other specified”?

• Necrophilia

• Zoophilia

• Coprophilia

• Urophilia

• Telephone scatologia

What does algolagnic mean?

Sexual arousal involving pain or suffering.

What is autogynephilia?

Sexual arousal from thoughts or images of oneself as a woman.