Editing Paraphilia (section)

== Diagnostic and Statistical Manual of Mental Disorders (DSM) ==
{{main|Diagnostic and Statistical Manual of Mental Disorders}}

=== DSM-I and DSM-II ===
In American psychiatry, prior to the publication of the DSM-I, paraphilias were classified as cases of "[[psychopathic]] personality with pathologic sexuality". The DSM-I (1952) included sexual deviation as a [[personality disorder]] of [[Antisocial personality disorder|sociopathic]] subtype. The only diagnostic guidance was that sexual deviation should have been "reserved for deviant sexuality which [was] not symptomatic of more extensive syndromes, such as [[schizophrenic]] or obsessional reactions". The specifics of the disorder were to be provided by the clinician as a "supplementary term" to the sexual deviation diagnosis; there were no restrictions in the DSM-I on what this supplementary term could be.<ref>Laws and, O'Donohue (2008) pp. 384–385 citing DSM-I pp. 7, 38–39</ref> Researcher [[Anil Aggrawal]] writes that the now-obsolete DSM-I listed examples of supplementary terms for pathological behavior to include "homosexuality, [[transvestism]], [[pedophilia]], [[Sexual fetishism|fetishism]], and [[sexual sadism]], including [[rape]], [[sexual assault]], mutilation."<ref>{{Cite book|last=Aggrawal|first=Anil|author-link=Anil Aggrawal|year=2008|title=Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices|page=47|chapter=Chapter 2: Pedophillia and Child Sexual Abuse|publisher=[[CRC Press]]|location=Boca Raton, Florida|isbn=978-1-4200-4308-2}}</ref>

The DSM-II (1968) continued to use the term ''sexual deviations'', no longer ascribed them under personality disorders but rather alongside them in a broad category titled "personality disorders and certain other nonpsychotic mental disorders". The types of sexual deviations listed in the DSM-II were: sexual orientation disturbance (homosexuality), fetishism, pedophilia, transvestitism, [[exhibitionism]], [[voyeurism]], [[sadistic personality disorder|sadism]], [[masochism]], and "other sexual deviation". No definition or examples were provided for "other sexual deviation" but the general category of sexual deviation was meant to describe the sexual preference of individuals that was "directed primarily toward objects other than people of opposite sex, toward sexual acts not usually associated with [[coitus]], or toward coitus performed under bizarre circumstances, as in [[necrophilia]], pedophilia, sexual sadism, and fetishism."<ref>Laws and, O'Donohue (2008) p. 385 citing DSM-II p. 44</ref> Except for the removal of homosexuality from the DSM-III onwards, this definition provided a general standard that has guided specific definitions of paraphilias in subsequent DSM editions, up to DSM-IV-TR.<ref name="Laws and, O'Donohue 2008 p. 386">Laws and O'Donohue (2008) p. 386</ref>

=== DSM-III through DSM-IV ===
The term ''paraphilia'' was introduced in the DSM-III (1980) as a subset of the new category of "psychosexual disorders". The DSM-III-R (1987) renamed the broad category to sexual disorders, renamed atypical paraphilia to paraphilia NOS (not otherwise specified), renamed transvestism as [[transvestic fetishism]], added [[frotteurism]], and moved [[zoophilia]] to the NOS category. It also provided seven nonexhaustive examples of NOS paraphilias, which besides [[zoophilia]] included [[exhibitionism]], [[necrophilia]], [[partialism]], [[coprophilia]], [[klismaphilia]], and [[urophilia]].<ref>Laws and, O'Donohue (2008) p. 385</ref> The DSM-IV (1994) retained the sexual disorders classification for paraphilias, but added an even broader category, "sexual and [[gender identity disorder]]s", which includes them. The DSM-IV retained the same types of paraphilias listed in DSM-III-R, including the NOS examples, but introduced some changes to the definitions of some specific types.<ref name="Laws and, O'Donohue 2008 p. 386" />

=== DSM-IV-TR ===
The DSM-IV-TR describes paraphilias as "recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving nonhuman objects, the suffering or humiliation of oneself or one's partner, or children or other nonconsenting persons that occur over a period of six months" (criterion A), which "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" (criterion B). DSM-IV-TR names eight specific paraphilic disorders ([[exhibitionism]], [[Sexual fetishism|fetishism]], [[frotteurism]], [[pedophilia]], [[Sexual masochism disorder|sexual masochism]], [[sexual sadism]], [[voyeurism]], and [[transvestic fetishism]], plus a residual category, [[Paraphilia not otherwise specified|paraphilia—not otherwise specified]]).<ref>{{cite web|url=http://www.psychiatrictimes.com/display/article/10168/55266|title=Paraphilias: Clinical and Forensic Considerations|website=psychiatrictimes.com|access-date=10 August 2008|archive-date=22 January 2010|archive-url=https://web.archive.org/web/20100122162131/http://www.psychiatrictimes.com/display/article/10168/55266|url-status=dead}}</ref> Criterion B differs for exhibitionism, frotteurism, and pedophilia to include acting on these urges, and for sadism, acting on these urges with a nonconsenting person.<ref name=DSM>American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). pp. 569–570, 572, 574, Washington, DC: Author.</ref> [[Sexual arousal]] in association with objects that were designed for sexual purposes is not diagnosable.<ref name=DSM/> Some paraphilias may interfere with the capacity for sexual activity with consenting adult partners.<ref name="DSM" /> In the current version of the [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM-IV-TR), a paraphilia is not diagnosable as a [[psychiatric disorder]] unless it causes distress to the individual or harm to others.<ref name="DSMTR" />

=== DSM-5 ===
The [[DSM-5]] adds a distinction between ''paraphilias'' and ''"paraphilic disorders"'', stating that paraphilias do not require or justify psychiatric treatment in themselves, and defining ''paraphilic disorder'' as "a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others".<ref name="DSM-5, intro"/> The DSM-5 Paraphilias Subworkgroup reached a "consensus that paraphilias are not ''ipso facto'' psychiatric disorders", and proposed "that the DSM-V make a distinction between ''paraphilias'' and paraphilic ''disorders''. One would ''ascertain'' a paraphilia (according to the nature of the urges, fantasies, or behaviors) but ''diagnose'' a paraphilic disorder (on the basis of distress and impairment). In this conception, having a paraphilia would be a necessary but not a sufficient condition for having a paraphilic disorder." The 'Rationale' page of any paraphilia in the electronic DSM-5 draft continues: "This approach leaves intact the distinction between normative and non-normative sexual behavior, which could be important to researchers, but without automatically labeling non-normative sexual behavior as psychopathological. It also eliminates certain logical absurdities in the DSM-IV-TR. In that version, for example, a man cannot be classified as a transvestite—however much he cross-dresses and however sexually exciting that is to him—unless he is unhappy about this activity or impaired by it. This change in viewpoint would be reflected in the diagnostic criteria sets by the addition of the word 'Disorder' to all the paraphilias. Thus, Sexual Sadism would become [[Sexual sadism disorder|Sexual Sadism Disorder]]; Sexual Masochism would become [[Sexual masochism disorder|Sexual Masochism Disorder]], and so on."<ref name="dsm5">{{cite web|url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid%3D186|title=302.2 Pedophilia|website=DSM-5|access-date=2012-02-10|url-status=dead|archive-url=https://web.archive.org/web/20100215165810/http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=186|archive-date=15 February 2010}}</ref>

[[Bioethics]] professor [[Alice Dreger]] interpreted these changes as "a subtle way of saying sexual kinks are basically okay – so okay, the sub-work group doesn't actually bother to define paraphilia. But a paraphilic disorder is defined: that's when an atypical sexual interest causes distress or impairment to the individual or harm to others." Interviewed by Dreger, [[Ray Blanchard]], the Chair of the Paraphilias Sub-Work Group, stated, "We tried to go as far as we could in depathologizing mild and harmless paraphilias, while recognizing that severe paraphilias that distress or impair people or cause them to do harm to others are validly regarded as disorders."<ref>Alice Dreger (19 Feb 2010) ''[http://www.thehastingscenter.org/of-kinks-crimes-and-kinds-the-paraphilias-proposal-for-the-dsm-5 Of Kinks, Crimes, and Kinds: The Paraphilias Proposal for the DSM-5]'', [[Hastings Center]]</ref> [[Charles Allen Moser]] stated that this change is not really substantive, as the DSM-IV already acknowledged a difference between paraphilias and non-pathological but unusual sexual interests, a distinction that is virtually identical to what was being proposed for DSM-5, and it is a distinction that, in practice, has often been ignored.<ref>{{cite journal|author=Moser C|year=2010|title=Problems with Ascertainment|journal=Archives of Sexual Behavior|volume=39|issue=6|pages=1225–1227|doi=10.1007/s10508-010-9661-9|pmid=20652734|s2cid=11927813}}</ref> Linguist Andrew Clinton Hinderliter argued that "including some sexual interests—but not others—in the DSM creates a fundamental asymmetry and communicates a negative value judgment against the sexual interests included," and leaves the paraphilias in a situation similar to [[ego-dystonic homosexuality]], which was removed from the DSM because it was no longer recognized as a mental disorder.<ref>{{cite journal|first=Andrew Clinton|last=Hinderliter|author-link=Andrew Clinton Hinderliter|year=2010|title=Defining paraphilia: excluding exclusion|journal=Open Access Journal of Forensic Psychology|volume=2|pages=241–271|url=http://web.me.com/gregdeclue/Site/Volume_2__2010_files/Hinderliter%202010.pdf|access-date=12 November 2010|archive-date=15 October 2011|archive-url=https://web.archive.org/web/20111015022211/http://web.me.com/gregdeclue/Site/Volume_2__2010_files/Hinderliter%202010.pdf|url-status=dead}}</ref>

The [[DSM-5]] has specific listings for eight paraphilic disorders.<ref name="DSM-5, intro"/> These are voyeuristic disorder, exhibitionistic disorder, [[frotteuristic disorder]], sexual masochism disorder, sexual sadism disorder, pedophilic disorder, fetishistic disorder, and [[Transvestic fetishism|transvestic disorder]].<ref name="DSM-5, intro"/> Other paraphilic disorders can be diagnosed under the [[Other Specified Paraphilic Disorder]] or Unspecified Paraphilic Disorder listings, if accompanied by distress or impairment.<ref>{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders|edition=Fifth|chapter=Other Specified Paraphilic Disorder; Unspecified Paraphilic Disorder|editor=American Psychiatric Association|year=2013|publisher=American Psychiatric Publishing|page=705}}</ref>