The Sexually Disordered Couple
Len Sperry, Katherine Helm, Jon Carlson in The Disordered Couple, 2019
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.
Disordered and offensive sexual behaviour
John C. Gunn, Pamela J. Taylor in Forensic Psychiatry, 2014
Paraphilia is a diagnostic term used in the DSM-IV (American Psychiatric Association, 2000) for sexual behaviours that are considered to amount to mental disorder; in the ICD-10 (World Health Organization, 1993), the phrase ‘disorders of sexual preference’ is favoured. Both classification systems require symptoms or behaviours to be persistent or recurrent, and for them to cause distress to the individual or to interfere with the individual’s personal functioning; the impact of the behaviour on others is not part of the definition. Recognition of disorders of sexual preference as a psychiatric disorder in their own right is a relatively recent phenomenon, with the first two editions of the DSM, for example, categorizing them under ‘personality disorder’.
Beneath the covers
Lester D. Friedman, Therese Jones in 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.
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
Given this, the present study looked to evaluate the current practice of pharmacotherapy with patients suffering from paraphilic disorders in three different geographical regions: North America, Western Europe and Eastern Europe. These areas were chosen as they share a broad historical and legal background. The research involved collecting and assessing the opinions of practitioners engaged in administering pharmacological treatment to individuals with a paraphilic disorder. Based on current research it is reasonable to conclude that most paraphilic patients treated with pharmacological agents have been convicted of a sexual offence. To enable a precise analysis and interpretation of practitioners’ views it was therefore important to assess the legislative basis for this treatment. This approach enabled us to analyse and discuss the results in light of differing legal systems and the recommendations provided by the WFSBP guidelines (Thibaut et al. 2010).
The pharmacologic treatment of problematic sexual interests, paraphilic disorders, and sexual preoccupation in adult men who have committed a sexual offence
Published in International Review of Psychiatry, 2019
Belinda Winder, J. Paul Fedoroff, Don Grubin, Kateřina Klapilová, Maxim Kamenskov, Douglas Tucker, Irina A. Basinskaya, Georgy E. Vvedensky
A variety of articles have been published in recent years which provide recommendations for the prescription of medications for problematic sexual behaviour, including which patients are most appropriate for consideration of this treatment, as well as specific indications and dosages (Assumpção et al., 2014; Garcia, 2013; Holoyda & Kellaher, 2016; Murphy, Bradford, & Fedoroff, 2014; Turner et al., 2017). The most comprehensive review of pharmacologic treatment for paraphilic disorders was published almost a decade ago (Thibaut et al., 2010), and is currently undergoing revision. The 2010 World Federation of Societies of Biological (WFSBP) guidelines conclude that ‘… little is known about which treatments are most effective, for which offenders, over what duration, or in what combination’ (p. 644). The guidelines propose a hierarchical treatment protocol in which treatment is largely based on risk, and progresses from psychotherapy (offered at all stages) to an ultimate stage where the paraphilic disorder is considered ‘catastrophic’ (i.e. can result in serious injury or death). At this most severe stage, the combination of a GnRH agonist with an antiandrogen and/or SSRI is recommended. It should be noted that the WFSBP guidelines indicate that paraphilias should be considered ‘chronic disorders’, and that ‘sexual orientation will not change during treatment’ (p. 648). However, the view that paraphilias are necessarily chronic and that paraphilias are ‘orientations’ has been challenged (Fedoroff, 2018).
Related Knowledge Centers
- Pedophilia
- Psychoanalysis
- Sexual Fetishism
- Sexual Arousal
- Sexology
- Love
- Perversion
- Object Sexuality
- Bdsm
- Rape