China
Africa
Explore chapters and articles related to this topic
The Sexually Disordered Couple
Published in Len Sperry, Katherine Helm, Jon Carlson, The Disordered Couple, 2019
Shannon B. Dermer, Molli E. Mercer
The fact that Doug and Christa liked to engage in kinky sex did not constitute a disorder (or even a paraphilia), but the fact that the infantilism was persistent, intense, and equal to or exceeding his interest in normophilic sex, and started to cause significant distress for Doug and his relationship with Christa, meant a Paraphilic Disorder should be considered. Doug had engaged in infantilistic sexual fantasies and behaviors on and off since he was in his 20s. Infantilism is a paraphilia, but does not fit with the eight Paraphilic Disorders described in the DSM-5. Because the paraphilia was intense, persistent, had lasted more than six months, and was causing distress, Doug could be diagnosed with other Specified Paraphilic Disorder, Autonepiophilia. The other Specified Paraphilic Disorder is used when the sexual urges, fantasies, and/or behaviors do not meet the criteria and qualitative description for one of the eight Paraphilic Disorders.
Beneath the covers
Published in Lester D. Friedman, Therese Jones, Routledge Handbook of Health and Media, 2022
To be diagnosed with a paraphilic disorder, the paraphilia causes significant distress or impairment to the individual or involves personal harm or risk of harm to others. Having a paraphilia does not necessarily mean that the individual has a paraphilic disorder, illustrating how an individual might not have an “illness of sex” until suffering or harm to self or other is experienced and/or identified (e.g., Pedophilic Disorder). In other words, an individual spanking or whipping a consenting adult might simply focus on this erotic activity (rather than the sexual partner) for arousal, which would be deemed a paraphilia (i.e., sadism). But according to the psychiatric community, if the individual experiences distress or impairment in social, occupational settings or acts on their intense urges with a nonconsenting person, they have a Sexual Sadism Disorder. The individual might recognize the illness and seek clinical help or might be criminalized for the act with or without required clinical care. Despite the distinctions between paraphilia and paraphilic disorder according to the psychiatric community, however, an individual may still feel “ill” regarding any emotional distress in the experience of causing physical harm to another consenting individual who, in turn, desires this sexual interaction. Alternatively, some individuals might not feel ill but are regarded as such by medical, religious, and other social communities (e.g., homosexuality). Such emotional distress, for example, can stem from society’s belief that sadism is a sexual perversion and that by failing to uphold social expectations, an individual contends with feeling that they are is abnormal or exhibit unnatural sexual behavior.
Deconstructing “Sexual Deviance”: Identifying and Empirically Examining Assumptions about “Deviant” Sexual Fantasy in the DSM
Published in The Journal of Sex Research, 2023
Tamara Turner-Moore, Mitch Waterman
Further research is needed into the personal and social impacts of thoughts containing socially transgressive elements. In the DSM, these thoughts are closely linked to notions of presumed dangerousness; that is, that they can cause harm to self (constructed as distress or impairment of functioning) or harm to others (constructed as fantasies or urges that might be “acted out” or “acted on”; APA, 2000, 2013). We need to interrogate, empirically, whether these thoughts and fantasies, and the elements therein, are indeed “dangerous,” and if so, how, to whom and in what circumstances. Although some studies have begun to explore this (e.g., Ahlers et al., 2011; Bailey et al., 2016; Brown et al., 2020; Turner-Moore & Waterman, 2017), much more research is needed. Crucially, without evidence for the “dangerousness” of fantasies with socially transgressive elements, a DSM diagnosis of “paraphilic disorder,” informed by a preference for “deviant” sexual fantasies, becomes simply a means to regulate socially undesirable aspects of a person’s inner world.
The Prevalence of Paraphilic Interests in the Czech Population: Preference, Arousal, the Use of Pornography, Fantasy, and Behavior
Published in The Journal of Sex Research, 2021
Klára Bártová, Renáta Androvičová, Lucie Krejčová, Petr Weiss, Kateřina Klapilová
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5, American Psychiatric Association [APA], 2013), a paraphilic interest can be defined as sexual interest in an anomalous target or activity. If this interest is present for 6 months or more, and equal or superior to “normophilic” interest for the achievement of sexual pleasure, it is considered to be a paraphilia. If it causes significant distress or disrupts sexual functioning, it is classified as a paraphilic disorder. Paraphilia, as represented by recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors, tends to involve i) nonhuman objects (for instance, in fetishism or zoophilia), ii) suffering or humiliation of oneself or one’s partner (for instance, in sadism or masochism), or iii) minors (for example, pedophilia). In this respect, it should be noted that ICD 11, which will come into effect in 2022, removes sadomasochism, fetishism, and transvestism from its list of paraphilic disorders. This decision was based on suggestions of the ICD 11 working group (Krueger et al., 2017; Reed et al., 2016). In comparison to DSM-5, ICD 11 uses absence of consent (regardless of the age of victim) as the core feature of paraphilic disorders, which implies that some instances of rape can be classified as manifestations of a paraphilic disorder. Consensual or solitary behaviors can be viewed as paraphilic disorders only if they cause substantial distress or pose a direct risk of injury or death to the individual concerned.
Pharmacological treatment of patients with paraphilic disorders and risk of sexual offending: An international perspective
Published in The World Journal of Biological Psychiatry, 2019
Daniel Turner, Julius Petermann, Karen Harrison, Richard Krueger, Peer Briken
The presence of paraphilic disorders in individuals has been found to be a major risk factor in sexual offending, with at least one paraphilic disorder being found in approximately 50% of sexual offender samples (Hanson and Morton-Bourgon 2005; Eher et al. 2010). Recognizing the close link between these disorders and sexual offending, the World Federation of Societies of Biological Psychiatry (WFSBP) treatment guidelines set out a hierarchy of drugs to be used with those who present with paraphilic fantasies and impulses and are deemed risky in terms of criminal behaviour (Thibaut et al. 2010, 2016). According to the guidelines, clinicians should first use selective serotonin-reuptake inhibitors (SSRIs), followed by steroidal antiandrogens (cyproterone acetate (CPA) or medroxyprogesterone acetate (MPA)) and finally gonadotropin-releasing hormone agonists (GnRH agonists) (Thibaut et al. 2010). On the basis that both steroidal antiandrogens and GnRH agonists lead to a considerable decrease in serum testosterone levels, they are referred to as androgen-deprivation therapy (ADT). Factors which clinicians usually take into consideration when making the decision whether or not ADT should be used include a history of previous treatment failures and sexual violations while either in detention or under community supervision (Turner et al. 2014).