PARAPHILIC DISORDERS In full remission: the individual has not acted on the
urges with a nonconsenting person, and there has
-described by the intense and persistent sexual
interest other than sexual interest in genital
stimulation or preparatory fondling with mature
consenting humans
Paraphilic Disorders: DEVELOPMENT
DSM I & II:
-sexual problems were included as
Personality Disturbance
DSM III:
-they were called Psychosexual Disorders
DSM IV:
-they were then included in one chapter,
under Sexual Dysfunctions, Paraphilic
Disorders, and Gender Identity Disorder
DSM 5:
-currently, the disorders were removed
from only one chapter in DSM IV and was
classified in a separate chapter: Paraphilic
Disorders
Paraphilia V.S. Paraphilic Disorders
Paraphilia- it is the experience of intense sexual
arousal to atypical objects, situations, fantasies,
behaviors, or individuals
-it is necessary but is not a sufficient
condition to warrant a diagnosis
-it may or may not require clinical
intervention
Paraphilic Disorders- would require a paraphilia
(paraphilia as a symptom)
-may cause distress or impairment to the
individual
-it poses harm to self or others
Paraphilic Disorders: CRITERIA
Criterion A: qualitative nature of the paraphilia
(e.g., cross-dressing)
Criterion B: negative consequences of the
paraphilia (significant distress or impairment in
important areas of functioning)
Paraphilic Disorders: SPECIFIERS
In a controlled environment: primarily applicable to
individuals living in institutional or other settings
where opportunities to engage in voyeuristic
behavior are restricted
been no distress or impairment in social,
occupational, or other areas of functioning, for at
least 5 years while in an uncontrolled environment
Paraphilic Disorders: DSM 5
Anomalous Activity Preferences:
-Courtship Disorders (Voyeuristic,
Exhibitionistic, an Frotteuristic Disorders)
-Algolagnic Disorders (Sexual Masochism
and Sexual Sadism Disorders)
Anomalous Target Preferences:
-Directed at other humans (Pedophilic
Disorders)
-Directed elsewhere (Fetishistic Disorder
and Transvestic Disorder)
1. Voyeuristic Disorder
2. Exhibitionistic Disorder
3. Frotteuristic Disorder
4. Sexual Masochism Disorder
5. Sexual Sadism Disorder
6. Pedophilic Disorder
7. Fetishistic Disorder
8. Transvestic Disorder
Voyeuristic Disorder: CRITERIA
Criterion A: Over a period of AT LEAST 6 MONTHS,
recurrent and intense sexual arousal from observing
an unsuspecting person who is naked, in the
process of disrobing, or engaging in sexual activity,
as manifested by fantasies, urges, or behaviors.
Criterion B: The individual has acted on these sexual
urges with a nonconsenting person, or the sexual
urges or fantasies cause clinically significant distress
or impairment in social, occupational, or other
important areas of functioning.
Criterion C: The individual experiencing the arousal
and/or acting on the urges is at least 18 years of
age.
Exhibitionistic Disorder: CRITERIA
Criterion A: Over a period of AT LEAST 6 MONTHS,
recurrent and intense sexual arousal from the
exposure of one’s genitals to an unsuspecting
person, as manifested by fantasies, urges, or
behaviors.
Criterion B: The individual has acted on these sexual urges with
a nonconsenting person, or the sexual urges or fantasies cause
clinically significant distress or impairment in important areas
of functioning.
Specify whether: Criterion B: The individual has acted on these sexual
urges, or the sexual urges or fantasies cause marked
-Sexually aroused by exposing genitals to
distress or interpersonal difficulty.
prepubertal children
Criterion C: The individual is AT LEAST AGE 16
-Sexually aroused by exposing genitals to
YEARS AND AT LEAST 5 YEARS OLDER than the child
physically mature individuals
or children in Criterion A.
-Sexually aroused by exposing genitals to
-individuals in late adolescence involved in
prepubertal children and to physically
an ongoing sexual relationship with a 12- or
mature individuals
13-year-old is not included
-there is a need to specify these as clinicians
-SEE DSM 5 for Specifiers (pp. 697-698)-
must know the triggers behind the behavior
for the appropriate treatment Fetishistic Disorder: CRITERIA

Frotteuristic Disorder: CRITERIA Criterion A: Over a period of AT LEAST 6 MONTHS,

recurrent and intense sexual arousal from either the
Criterion A: Over a period of AT LEAST 6 MONTHS,
use of nonliving objects or a highly specific focus on
recurrent and intense sexual arousal from touching
non-genital body part(s), as manifested by fantasies,
or rubbing against a nonconsenting person, as
urges, or behaviors.
manifested by fantasies, urges, or behaviors.
Criterion B: The fantasies, sexual urges, or
Criterion B: The individual has acted on these sexual
behaviors cause clinically significant distress or
urges with a nonconsenting person, or the sexual
impairment in important areas of functioning.
urges or fantasies cause clinically significant distress
or impairment in important areas of functioning. Criterion C: The fetish objects are not limited to
articles of clothing used in cross-dressing (as in
Sexual Masochism Disorder: CRITERIA
transvestic disorder) or devices specifically designed
Criterion A: Over a period of AT LEAST 6 MONTHS, for the purpose of tactile genital stimulation (e.g.,
recurrent and intense sexual arousal from the act of vibrator).
being humiliated, beaten, bound, or otherwise
Transvestic Disorder: CRITERIA
made to suffer, as manifested by fantasies, urges, or
behaviors. Criterion A: Over a period of AT LEAST 6 MONTHS,
recurrent and intense sexual arousal from
Criterion B: The fantasies, sexual urges, or
crossdressing, as manifested by fantasies, urges, or
behaviors cause clinically significant distress or
behaviors.
impairment in important areas of functioning.
Criterion B: The fantasies, sexual urges, or
Specify if:
behaviors cause clinically significant distress or
With asphyxiophilia: If the individual impairment in important areas of functioning.
engages in the practice of achieving sexual
Specify if:
arousal related to restriction of breathing.
With fetishism: If sexually aroused by
Sexual Sadism Disorder: CRITERIA
fabrics, materials, or garments.
Criterion A: Over a period of AT LEAST 6 MONTHS,
With autogynephilia: If sexually aroused by
recurrent and intense sexual arousal from the
thoughts or images of self as female.
physical or psychological suffering of another
person, as manifested by fantasies, urges, or Paraphilic Disorders: ETIOLOGY
behaviors.
Biology:
Criterion B: The individual has acted on these sexual
1. Brain activity during sexual arousal
urges with a nonconsenting person, or the sexual
urges or fantasies cause clinically significant distress 2. General brain structure: frontal lobes and
or impairment in important areas of functioning. diencephalic structures
Pedophilic Disorder: CRITERIA Psychological:
Criterion A: Over a period of AT LEAST 6 MONTHS, Temperament- tendency to be overly
recurrent, intense sexually arousing fantasies, inhibited or uncontrolled with emotions and
sexual urges, or behaviors involving sexual activity behaviors
with a prepubescent child or children (generally age
13 years or younger).
 Early Relationship Formation- a lack of
stable self-awareness, trouble managing
emotions, and in seeking help and comfort
from others

Trauma Repetition- people who are at the

victim of sexual or other forms of abuse,
especially from childhood, may identify with
the abuser such that they act out was
inflicted on them by victimizing others in
some way

-they may also act out the trauma

by somehow harming themselves

Disrupted Development of Sexuality- the

patterns of what brings one sexual pleasure
tend to form by adolescence

-people raised in a household that is

either excessively sexually
permissive or inhibited are at higher
risk for developing a paraphilia

Social:

-high conflict between parents

-low supervision by parents

-lack of affection from the mother and

generally not feeling treated well by their
parents

-people with paraphilia tend to have trouble

making and keeping friends and other
relationships

Paraphilic Disorders: TREATMENT

1. Recognize and combat rationalizations about

their behavior

2. Develop empathy for the victim and in techniques

3. Control their sexual impulses

4. Anticipate situations that increase the risk of

sexually acting out and finding ways to avoid or
more productively respond to those triggers

5. Social skills training to help them develop age-

appropriate, reciprocal relationships

6. Medications to suppress production of

Testosterone and SSRI