A paraphilic disorder is a mental disorder in which a paraphilia (sometimes called a sexual fetish or kink) involves people who do not consent, or causes marked distress which is not just due to rejection or fear of rejection, or significantly risks injury or death. In the International Classification of Diseases, paraphilic disorders include exhibitionistic disorder, voyeuristic disorder, pedophilic disorder, coercive sexual sadism disorder, frotteuristic disorder, and other paraphilic disorders. The United States Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR has a slightly different list, specifically including sexual masochism disorder and transvestic disorder. Paraphilic disorders occur in adults and occasionally adolescents, but as the behaviour must be persistent. Many sex crimes are not due to such disorders.
Definition The International Classification of Diseases describes:
Paraphilic disorders are characterised by persistent and intense patterns of atypical sexual arousal, manifested by sexual thoughts, fantasies, urges, or behaviours, the focus of which involves others whose age or status renders them unwilling or unable to consent and on which the person has acted or by which he or she is markedly distressed. Paraphilic disorders may include arousal patterns involving solitary behaviours or consenting individuals only when these are associated with marked distress that is not simply a result of rejection or feared rejection of the arousal pattern by others or with significant risk of injury or death.
Definition of typical versus atypical interests Clinical literature contains reports of many paraphilias, only some of which receive separate entries in the diagnostic taxonomies of the American Psychiatric Association or the World Health Organization. There is disagreement regarding which sexual interests should be deemed paraphilic disorders versus normal variants of sexual interest. The DSM-IV-TR also acknowledges that the diagnosis and classification 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". Some argue that cultural relativism is important to consider when discussing paraphilias because there is wide variance concerning what is sexually acceptable across cultures. Consensual adult activities and adult entertainment involving sexual roleplay; novel, superficial, or trivial aspects of sexual fetishism; or incorporating the use of sex toys are not necessarily paraphilic. Paraphiliacs often have other psychiatric comorbidities such as depression, attachment disorders, anxiety, emotional avoidance, obsessive or compulsive behaviours and identity disorders. All of these disorders are common symptoms of physical, psychological, emotional, or sexual abuse during childhood and can be treated with appropriate psychotrauma support.
International Classification of Diseases
ICD-6, ICD-7, ICD-8 In the ICD-6 (1948) and ICD-7 (1955), a category of "sexual deviation" was listed with "other Pathological personality disorders". In the ICD-8 (1965), "sexual deviations" were categorized as homosexuality, fetishism, pedophilia, transvestism, exhibitionism, voyeurism, sadism and masochism.
ICD-9 In the ICD-9 (1975), the category of sexual deviations and disorders was expanded to include transsexualism, sexual dysfunctions, and psychosexual identity disorders. The list contained homosexuality, bestiality, pedophilia, transvestism, exhibitionism, transexualism, Disorders of psychosexual identity, frigidity and impotence, Other sexual deviations and disorders (including fetishism, masochism, and sadism).
ICD-10 In the ICD-10 (1990), the category "sexual deviations and disorders" was divided into several subcategories. Paraphilias were placed in subcategory of "sexual preference disorders". The list included fetishism, fetishistic transvestism, exhibitionism, voyeurism, pedophilia, sadomasochism and other disorders of sexual preference (including frotteurism, necrophilia, and zoophilia). Homosexuality was removed from the list, but ego-dystonic sexual orientation was still considered a deviation which was placed in subcategory "psychological and behavioural disorders associated with sexual development and orientation".
ICD-11 In the ICD-11 (2022), "paraphilia" has been replaced with "paraphilic disorder". Any paraphilia and any other arousal pattern by itself no longer constitutes a disorder. To date, the diagnosis must meet criteria of paraphilia and one of the following: 1) a marked distress associated with arousal pattern (but not one that comes from rejection or fear of rejection); 2) the person has acted on the arousal pattern towards unwilling others or others considered as unable to give consent; 3) a serious risk of injury or death. The list of the paraphilic disorders includes: Exhibitionistic Disorder, Voyeuristic Disorder, Pedophilic Disorder, Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals. As of now, disorders associated with sexual orientation have been removed from the ICD. Gender issues have been removed from the mental health category and have been placed under "Conditions related to sexual health".
Diagnostic and Statistical Manual of Mental Disorders (DSM)
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