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- With the publication of the DSM-5, this family of disorders has been renamed Paraphilic Disorders and all the disorders in this group require the presence of a paraphilia.
- A paraphilia involves intense and persistent sexual interest (recurrent fantasies, urges or behaviors of a sexual nature) that center around children, non-humans (animals, objects, materials), or harming others or one's self during sexual activity. Sometimes this sexual interest focuses on the person's own erotic/sexual activities while in other cases, it focuses on the target of the person's sexual interest.
- In order to be diagnosed with one of these disorders, the paraphilia also needs to be causing significant distress or impairment, or involve personal harm or risk of harm to others. You can have a paraphilia, but not have a paraphilic disorder. It is only when it causes impairment, harm or the risk of harm that it become a clinical diagnosis.
- This category of disorders includes:
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- This diagnosis is given when:
- over a period of 6 months, a person 18 years or older has had recurrent and intense sexual arousing fantasies, urges or behaviors from observing an unsuspecting person who is naked, in the process of disrobing, or engaged in sexual activity.
- the person has acted on these sexual urges with a non-consenting person, or the sexual urges and fantasies have caused significant distress or impairment in social, occupational, or other areas of daily functioning.
- The prevalence of Voyeuristic Disorder is not currently known. However, it is estimated that the highest possible lifetime prevalence is 12% in males and 4% in females, therefore making it 3 times more likely to occur in males.
- The cause and effect of risk factors has not been determined for this disorder, but possible risk factors include childhood sexual abuse, substance abuse, having a preoccupation with sex, and being hypersexual (having extremely frequent or suddenly increased sexual urges or sexual activity).
- People with this condition do not often seek treatment on their own and do not generally recognize that they have a problem until they have ended up in court and are then required to enter treatment.
- Common treatments include psychotherapy and medication.
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- Symptoms of Exhibitionistic Disorder include:
- over a period of at least 6 months, a person has recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one\'s genitals to an unsuspecting stranger.
- the person has either acted on these impulses with a nonconsenting person or the fantasies and sexual urges are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Subtypes of the disorder are based on the age or physical maturity of the nonconsenting individual that the person prefers to expose his/her genitals to and include:
- Sexually aroused by exposing genitals to prepubertal children (children who have not yet gone through puberty)
- Sexually aroused by exposing genitals to physically mature individuals
- Sexually aroused by exposing genitals to prepubertal children (children who have not yet gone through puberty) and to physically mature individuals
- The prevalence rate for this disorder is not currently known, but is estimated to be 2-4% of the general population. It is also estimated to occur much less often in females than in males.
- Risk factors including antisocial history, antisocial personality disorder, alcohol misuse, and pedophilic sexual preference (being sexually attracted/aroused by children) are thought to increase the risk of exhibitionistic tendencies.
- People with this condition do not often seek treatment on their own and do not generally recognize that they have a problem until they have ended up in court and are then required to enter treatment.
- Common treatments include psychotherapy and medication.
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- Symptoms of Frotteuristic Disorder include:
- over a period of at least 6 months, a person has had recurrent and intense sexually arousing fantasies, urges or behaviors from touching or rubbing against a nonconsenting person.
- the person has either acted on these impulses with a nonconsenting person or the fantasies and sexual urges are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The prevalence for Frotteuristic Disorder in the general population is unknown. Frotteuristic acts, including uninvited sexual touching or rubbing against another individual are thought to occur in up to 30% of adult males in the general population.
- Cause and effect risk factors have not yet been identified for this disorder, but it is believed that nonsexual antisocial behavior, a preoccupation with sex, and hypersexuality (having extremely frequent or suddenly increased sexual urges or sexual activity) might be risk factors.
- People with this condition do not often seek treatment on their own and do not generally recognize that they have a problem until they have ended up in court and are then required to enter treatment.
- Common treatments include psychotherapy and medication.
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- Symptoms of Sexual Masochism Disorder include:
- over a period of at least 6 months, a person has had recurrent, intense sexually arousing fantasies, sexual urges, or behaviors from the act of being humiliated, beaten, bound, or otherwise made to suffer.
- the fantasies and sexual urges are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The prevalence for Sexual Masochism Disorder in the general population is unknown. Research in Australia estimated that 2.2% of males and 1.3% of females had been involved in bondage and discipline, or dominance and submission in a 12-month period.
- Research in this area has focused on people who are currently in treatment for the disorder. This means that the co-occurring conditions found in this population might not be the same as in the general population that has sexual masochism disorder. They typically include other paraphilic disorders, such as transvestic disorder (males who feel sexually aroused by dressing in women\'s clothing).
- Common treatments include psychotherapy and medication.
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- Symptoms of Sexual Sadism Disorder include:
- over a period of at least 6 months, a person has had recurrent, intense sexually arousing fantasies, sexual urges, or behaviors from the physical or psychological suffering of another person.
- the individual has acted on these sexual urges with a nonconsenting person, or the fantasies and sexual urges are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The prevalence for Sexual Sadism Disorder in the general population is unknown. According to the DSM-5, depending on the criteria for sexual sadism, prevalence varies widely from 2% to 30%. Among committed sexual offenders in the United States, less than 10% have this disorder. Among those that have committed sexually motivated killings, rates of sexual sadism disorder range from 37% to 75%.
- Research in this area has focused on people (mostly males) who have been convicted of criminal acts involving sadistic behavior against nonconsenting individuals. This means that the co-occurring conditions found in this population might not be the same as in the general population. They typically include other paraphilic disorders.
- Common treatments include psychotherapy and medication.
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- Symptoms of Pedophilic Disorder include:
- over a period of at least 6 months, a person has had recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child (a child who has not yet gone through puberty) or children. Typically, the child or children are age 13 years or younger.
- the individual has acted on these sexual urges, or the fantasies and sexual urges are causing marked distress or interpersonal difficulties.
- The individual is at least 16 years old and at least 5 years older than the child or children involved.
- If someone feels no guilt, shame or anxiety about their sexual urges, does not have any limitations in daily functioning because of the fantasies or urges, and has never actually acted on the urges, they are said to have a pedophilic sexual orientation, but would not be diagnosed with Pedophilic Disorder.
- The prevalence for Pedophilic Disorder in the general population is unknown. Estimates for the highest percentage in males is thought to be 3-5% and in females is thought to be a small fraction of the rate in males.
- There are temperamental, environmental and genetic/physiological risk factors for this disorder.
- Common treatments include psychotherapy and medication.
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- Symptoms of Fetishistic Disorder include:
- over a period of at least 6 months, a person has had recurrent and intense sexual arousal from fantasies, sexual urges or behaviors from either the use of nonliving objects, or a highly specific focus on nongenital body parts.
- the fantasies, sexual urges and behaviors are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The fetish objects are not limited to articles of clothing used in cross-dressing (as is transvestic disorder) or devices specifically designed for the purpose of genital stimulation (such as a vibrator).
- Clinicians can specify if the fetish is a:
- Body part(s) - often includes feet, toes, and hair.
- Nonliving object(s) - Frequently, fetish objects include shoes (men\'s or women\'s), and women\'s underwear, panties or bras. They may be made of particular materials such as leather or rubber. It is common for a person with a fetish to not be able to achieve orgasm without involving their fetish object in the sexual act (e.g., by getting their partner to wear the fetish object).
- Other
- This disorder may occur with other paraphilic disorders and hypersexuality (having extremely frequent or suddenly increased sexual urges or sexual activity).
- Because those with this disorder can feel extremely embarrassed or shameful, they rarely seek professional treatment. When they do so, psychotherapy is the most common treatment.
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- Symptoms of Transvestic Disorder include:
- over a period of at least 6 months, a person has had recurrent and intense sexual arousal from fantasies, sexual urges or behaviors from cross-dressing (most often when a heterosexual male has fantasies about and/or acts out dressing up in woman\'s clothing).
- the fantasies, sexual urges and behaviors are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Clinicians can specify:
- With fetishism - sexually aroused by fabrics, materials or clothing
- With autogynephilia - if the male is sexually aroused by thoughts or images of himself as female.
- The prevalence for Transvestic Disorder in the general population is unknown. It is rare in males and extremely rare in females. Research has found that fewer than 3% of males report having ever seen sexually aroused by dressing in women\'s clothing.
- This disorder may occur with other paraphilias including fetishism and masochism.
- Because those with this disorder can feel extremely embarrassed or shameful, they rarely seek professional treatment on their own, but may do so at the request of a partner. When they do so, psychotherapy is the most common treatment.
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