PARAPHILIC DISORDERS
WHAT ARE PARAPHILIAS / PARAPHILIC DISORDERS?
DSM-V
Paraphilia – intense & persistent sexual interest other than sexual interest in genital
stimulation / preparatory fondling with phenotypically normal, physically mature,
consenting human partners
Paraphilic disorder – paraphilia that is currently causing distress / impairment to the
individual / a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to
others
Anomalous activity preferences
Courtship disorders – resemble distorted components of human courtship behaviour
(voyeuristic-, exhibitionistic- & frotteuristic disorder)
Algolagnic disorders – involve pain & suffering (sexual masochism- & sexual sadism
disorder)
Anomalous target preferences
Preferences directed at other humans (paedophilic disorder)
Preferences directed elsewhere (fetishistic & transvestic disorder)
Specific paraphilias are generally better described as preferential sexual interests
Paraphilia is necessary BUT NOT sufficient condition for having a paraphilic disorder
Paraphilia by itself does not necessarily justify / require clinical intervention
Diagnosis ONLY if individual meets both Criteria A & B
Often people manifest two or more paraphilias comorbidity
Common risk factors – childhood sexual abuse, substance misuse, sexual preoccupation /
hypersexuality
Course – often likely to vary with age, advancing age may lead to decreasing paraphilic
sexual preferences
All disorders other than paedophilic disorder have a specifier “in full remission”
Individual has not acted on urges with nonconsenting person & there has been no
distress / impairment in social, occupational, or other areas of functioning, for at
least 5 years while in an uncontrolled environment
DSM-V CRITERIA FOR VOYEURISTIC DISORDER
CRITERION A – Over 6 months, recurrent & intense sexual arousal from observing an
unsuspecting person who is
(1) Naked, (2) in the process of disrobing, (3) engaging in sexual activity
,CRITERION B – individual has acted on these sexual urges with a nonconsenting person, or sexual
urges / fantasies cause clinically significant distress / impairment in social, occupational, or other
important areas of functioning
CRITERION C – individual is at least 18 years old
Prevalence – approx. 12% in males & 4% in females
Development – during adolescence
Minimum age 18, because difficult to differentiate voyeuristic disorder from age-
appropriate puberty-related sexual curiosity & activity
Comorbidity – exhibitionistic disorder, depressive, bipolar, anxiety, substance use
disorders, ADHD, conduct disorder, antisocial personality disorder
DSM-V CRITERIA FOR EXHIBITIONISTIC DISORDER
CRITERION A – Over 6 months, recurrent & intense sexual arousal from exposure of one’s
genitals to an unsuspecting person
CRITERION B – individual has acted on these sexual urges with a nonconsenting person, or sexual
urges / fantasies cause clinically significant distress / impairment in social, occupational, or other
important areas of functioning
Specify if – exposure to prepubertal children, physically mature individuals or both
Prevalence – 2%-4% in male population
Development – during adolescence, somewhat later than typical development of
normative sexual interests
Comorbidity – depressive, bipolar, anxiety, substance use disorders, ADHD, other
paraphilic disorders, antisocial personality disorder
DSM-V CRITERIA FOR FROTTEURISTIC DISORDER
CRITERION A – Over 6 months, recurrent & intense sexual arousal from touching / rubbing
against a nonconsenting person
CRITERION B – individual has acted on these sexual urges with a nonconsenting person, or sexual
urges / fantasies cause clinically significant distress / impairment in social, occupational, or other
important areas of functioning
Prevalence – 10%-14% of adult males in outpatient settings for paraphilic disorders &
hypersexuality have presentation that meets diagnostic criteria for frotteuristic
disorder
Development – during late adolescence / emerging adulthood
, Comorbidity – hypersexuality, other paraphilic disorders (exhibitionistic- & voyeuristic
disorder), conduct disorder, antisocial personality disorder, depressive, bipolar,
anxiety, substance use disorders,
DSM-V CRITERIA FOR SEXUAL MASOCHISM DISORDER
CRITERION A – Over 6 months, recurrent & intense sexual arousal from the act of being
(1) humiliated, (2) beaten, (3) bound, (4) otherwise made to suffer
CRITERION B – sexual urges / fantasies cause clinically significant distress / impairment in social,
occupational, or other important areas of functioning
Specify if – with asphyxiophilia: achieving sexual arousal related to restriction of
breathing
Prevalence – Australia: 2.2% of males & 1.3% of females had been involved in bondage
& discipline, sadomasochism, dominance & submission in past 12 months
Development – 19.3 years BUT earlier ages have been reported for onset of masochistic
fantasies
Comorbidity – other paraphilic disorders (transvestic fetishism disorder)
DSM-V CRITERIA FOR SEXUAL SADISM DISORDER
CRITERION A – Over 6 months, recurrent & intense sexual arousal from physical /
psychological suffering of another person
CRITERION B – individual has acted on these sexual urges with a nonconsenting person, or sexual
urges / fantasies cause clinically significant distress / impairment in social, occupational, or other
important areas of functioning
Prevalence – unknown, varies widely from 2%-30%
Development – information extremely limited
Comorbidity – other paraphilic disorders
DSM-V CRITERIA FOR PAEDOPHILIC DISORDER
CRITERION A – Over 6 months, recurrent & intense sexually arousing fantasies, urges,
behaviours involving sexual activity with prepubescent child / children (generally age 13
years or younger)
CRITERION B – individual has acted on these sexual urges with a nonconsenting person, or sexual
urges / fantasies cause marked distress / interpersonal difficulty
CRITERION C – individual is at least age 16 & at least 5 years older than the child/children in
Criterion A
WHAT ARE PARAPHILIAS / PARAPHILIC DISORDERS?
DSM-V
Paraphilia – intense & persistent sexual interest other than sexual interest in genital
stimulation / preparatory fondling with phenotypically normal, physically mature,
consenting human partners
Paraphilic disorder – paraphilia that is currently causing distress / impairment to the
individual / a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to
others
Anomalous activity preferences
Courtship disorders – resemble distorted components of human courtship behaviour
(voyeuristic-, exhibitionistic- & frotteuristic disorder)
Algolagnic disorders – involve pain & suffering (sexual masochism- & sexual sadism
disorder)
Anomalous target preferences
Preferences directed at other humans (paedophilic disorder)
Preferences directed elsewhere (fetishistic & transvestic disorder)
Specific paraphilias are generally better described as preferential sexual interests
Paraphilia is necessary BUT NOT sufficient condition for having a paraphilic disorder
Paraphilia by itself does not necessarily justify / require clinical intervention
Diagnosis ONLY if individual meets both Criteria A & B
Often people manifest two or more paraphilias comorbidity
Common risk factors – childhood sexual abuse, substance misuse, sexual preoccupation /
hypersexuality
Course – often likely to vary with age, advancing age may lead to decreasing paraphilic
sexual preferences
All disorders other than paedophilic disorder have a specifier “in full remission”
Individual has not acted on urges with nonconsenting person & there has been no
distress / impairment in social, occupational, or other areas of functioning, for at
least 5 years while in an uncontrolled environment
DSM-V CRITERIA FOR VOYEURISTIC DISORDER
CRITERION A – Over 6 months, recurrent & intense sexual arousal from observing an
unsuspecting person who is
(1) Naked, (2) in the process of disrobing, (3) engaging in sexual activity
,CRITERION B – individual has acted on these sexual urges with a nonconsenting person, or sexual
urges / fantasies cause clinically significant distress / impairment in social, occupational, or other
important areas of functioning
CRITERION C – individual is at least 18 years old
Prevalence – approx. 12% in males & 4% in females
Development – during adolescence
Minimum age 18, because difficult to differentiate voyeuristic disorder from age-
appropriate puberty-related sexual curiosity & activity
Comorbidity – exhibitionistic disorder, depressive, bipolar, anxiety, substance use
disorders, ADHD, conduct disorder, antisocial personality disorder
DSM-V CRITERIA FOR EXHIBITIONISTIC DISORDER
CRITERION A – Over 6 months, recurrent & intense sexual arousal from exposure of one’s
genitals to an unsuspecting person
CRITERION B – individual has acted on these sexual urges with a nonconsenting person, or sexual
urges / fantasies cause clinically significant distress / impairment in social, occupational, or other
important areas of functioning
Specify if – exposure to prepubertal children, physically mature individuals or both
Prevalence – 2%-4% in male population
Development – during adolescence, somewhat later than typical development of
normative sexual interests
Comorbidity – depressive, bipolar, anxiety, substance use disorders, ADHD, other
paraphilic disorders, antisocial personality disorder
DSM-V CRITERIA FOR FROTTEURISTIC DISORDER
CRITERION A – Over 6 months, recurrent & intense sexual arousal from touching / rubbing
against a nonconsenting person
CRITERION B – individual has acted on these sexual urges with a nonconsenting person, or sexual
urges / fantasies cause clinically significant distress / impairment in social, occupational, or other
important areas of functioning
Prevalence – 10%-14% of adult males in outpatient settings for paraphilic disorders &
hypersexuality have presentation that meets diagnostic criteria for frotteuristic
disorder
Development – during late adolescence / emerging adulthood
, Comorbidity – hypersexuality, other paraphilic disorders (exhibitionistic- & voyeuristic
disorder), conduct disorder, antisocial personality disorder, depressive, bipolar,
anxiety, substance use disorders,
DSM-V CRITERIA FOR SEXUAL MASOCHISM DISORDER
CRITERION A – Over 6 months, recurrent & intense sexual arousal from the act of being
(1) humiliated, (2) beaten, (3) bound, (4) otherwise made to suffer
CRITERION B – sexual urges / fantasies cause clinically significant distress / impairment in social,
occupational, or other important areas of functioning
Specify if – with asphyxiophilia: achieving sexual arousal related to restriction of
breathing
Prevalence – Australia: 2.2% of males & 1.3% of females had been involved in bondage
& discipline, sadomasochism, dominance & submission in past 12 months
Development – 19.3 years BUT earlier ages have been reported for onset of masochistic
fantasies
Comorbidity – other paraphilic disorders (transvestic fetishism disorder)
DSM-V CRITERIA FOR SEXUAL SADISM DISORDER
CRITERION A – Over 6 months, recurrent & intense sexual arousal from physical /
psychological suffering of another person
CRITERION B – individual has acted on these sexual urges with a nonconsenting person, or sexual
urges / fantasies cause clinically significant distress / impairment in social, occupational, or other
important areas of functioning
Prevalence – unknown, varies widely from 2%-30%
Development – information extremely limited
Comorbidity – other paraphilic disorders
DSM-V CRITERIA FOR PAEDOPHILIC DISORDER
CRITERION A – Over 6 months, recurrent & intense sexually arousing fantasies, urges,
behaviours involving sexual activity with prepubescent child / children (generally age 13
years or younger)
CRITERION B – individual has acted on these sexual urges with a nonconsenting person, or sexual
urges / fantasies cause marked distress / interpersonal difficulty
CRITERION C – individual is at least age 16 & at least 5 years older than the child/children in
Criterion A
