Paraphilic Disorders of the DSM-5

A class of sexual disorders relates to sexual practices and interest. In some cases sexual interest is so unusual that it is known as a paraphilia — a sexual deviation where sexual arousal is obtained from a consistent pattern of inappropriate responses to objects or people, and in which the behaviors associated with the feelings are distressing and dysfunctional. Paraphilias may sometimes be only fantasies, and in other cases may result in actual sexual behavior. The essential feature of a paraphilic disorder, then, is that people with one of these disorders are so psychologically dependent on the target of their desire that they are unable to experience sexual arousal unless this target is present in some form.

Characteristics
Paraphilia Behavior in which an individual has recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving (1) nonhuman objects, (2) children or other nonconsenting persons, or (3) the suffering or humiliation of self or partner
Transvestic disorder Engages in cross-dressing associated with intense distress or impairment
Exhibitionistic disorder Derive pleasure from exposing genitals to an unsuspecting person
Fetishistic disorder and partialism Fetishism is sexual arousal from an object
Partialism is sexual arousal from a part of the body
Frotteuristic disorder Sexual urges and sexually arousing fantasies of rubbing up against or fondling unsuspecting persons
Sexual masochism Masochism is being aroused by being made to suffer (beaten, humiliated, bound)
Pedophilic disorder Sexual arousal for children or adolescents
Sexual sadism Sadism is being aroused by inflicting suffering on another person
Voyeuristic disorder Derive sexual pleasure from observing an unsuspecting person who is naked, disrobing, or engaged in intimate behavior

People with paraphilias are usually rejected by society but for two different reasons. In some cases, such as voyeurism and pedophilia, the behaviour is unacceptable (and illegal) because it involves a lack of consent on the part of the recipient of the sexual advance. But other paraphilias are rejected simply because they are unusual, even though they are consensual and do not cause distress or dysfunction to the partners. Sexual sadism and sexual masochism, for instance, are usually practiced consensually, and thus may not be harmful to the partners or to society. A recent survey found that individuals who engage in sadism and masochism are as psychologically healthy as those who do not (Connolly, 2006). Again, as cultural norms about the appropriateness of behaviours change, the revision of the DSM (2013), changed its classification system of these behaviors.

Pedophilic disorder

Pedophile Mustafa Jabbar (7) | Mustafa Jabbar, a minister of… | Flickr https://www.flickr.com/photos/165545923@N02/44766479184An estimated 20 percent of American children have been sexually molested, making pedophilia a common paraphilia. Offenders are usually family friends or relatives. Types of activities vary and may include just looking at a child or undressing and touching a child. However, acts often involve oral sex or touching of genitals of the child or the offender. Studies suggest that children who feel uncared for or lonely may be at higher risk for sexual abuse.

Associated features

The key feature of this disorder is that the individual experiences sexual arousal when with children that may be equal to, if not greater than, that which he or she experiences with individuals who are physically mature.

Recurring sexual dreams, behaviors, or urges concerning children that are 13 years old or younger. These urges may be directed toward children of the same sex as the pedophiles, or the other sex. Some pedophiles are attracted to both boys and girls. Some are attracted to to only children, while others are attracted to children as well as adults. These issues must be persistent for at least 6 months and must cause impairment to everyday functioning to be considered symptoms. If an individuals is 16 years old and exhibits these behaviors with someone that is at least 5 years younger, he would be considered for this disorder.

To be diagnosed as having Pedophilia, the individual must be at least 16 years of age. The disorder typically begins in adolescence, although some individuals with Pedophilia report that they did not become sexually aroused by children until middle adulthood.

Pedophiles may limit their activity to exposing themselves to the child (sometimes known as flashing), touching and fondling the child gently, undressing the child and looking at him or her, or masturbating in front of the child.

Gender and cultural differences in presentation

The word “Pedophilia” is derived from the Greek words “paidos” (child) and “philia” (love). Until recently, pedophilic individuals had found it relatively easy to gain access to unattended children. Awareness of Pedophilia has been raised in the past two decades, and it has become more difficult for these individuals to find children with whom to act out their fantasies. In response to the scarcity of vulnerable children, many pedophiles have turned to chatrooms and child pornography.

Males are more often diagnosed with this disorder than women. Pedophilia is more prevalent among Caucasians than among other ethnicities. It is also known that if a male prefers males, it is more likely that he will repeat his pedophilic actions. This has led certain religious or otherwise radical activists to suggest that pedophilia and homosexuality are “one and the same,” resulting in further media attention to an already well-covered topic.

One of the biggest issues in assessing behavior as pedophilic or normal is the criteria for Pedophilia; by Western standards, certain cultures (e.g. Islamic) would have higher prevalence of Pedophilia. Some cultures allow “child weddings,” or unions between mature males and prepubescent females. In some tribal societies in Africa, pedophilic behavior is considered perfectly normal; men often take “boy-wives” in addition to wives. The men engage in sexual activity with these boy-wives until it is deemed time for the young boy to choose a wife of his own. At this point, the boy’s “husband” will then aid him in choosing a wife, and the boy will be allowed to leave to start a family of his own. Clearly, it is important to note any religious or cultural backgrounds in individuals being examined as having Pedophilia. This is a very difficult situation, as some groups have voiced the concern that any pedophile can simply convert to a belief system that accommodates and excuses his behaviors

Epidemiology

There is very little known about the prevalence of Pedophilia at this time because, due to the severely negative stigma associated with having Pedophila, many people with Pedophilia rarely seek help from a mental health professional. The ratio of sex offenders against female children and sex offenders against male children is about 2:1. According to data in a (1987; 1988) study, sexual offenders against males have many more victims than those against females. Sexual offenses against female children have a rate of 19.8, while sexual offenses against male children are at a rate of 150.2. Since there is a higher rate of sexual offenders against male children, this may suggest that this group has a greater number of true pedophiles.(Not all sex offenders who victimize children are pedophiles; only about 40 percent of convicted sex offenders meet the diagnostic criteria for the disorder.) Note: The large commercial market in pedophiliac pornography suggests a much higher prevalence than the limited medical data indicates.

Exhibitionist Disorder

The term exhibitionist was first used in 1877 by French physician and psychiatrist Charles Lasègue. Various earlier medical-forensic texts discuss genital self-exhibition, however. Exhibitionism is the act of exposing in a public or semi-public context those parts of one’s body that are not normally exposed – for example, the breasts, genitals or buttocks. The practice may arise from a desire or compulsion to expose themselves in such a manner to groups of friends or acquaintances, or to strangers for their amusement or sexual satisfaction or to shock the bystander. Exposing oneself only to an intimate partner is normally not regarded as exhibitionism. In law, the act of exhibitionism may be called indecent exposure, “exposing one’s person”, or other expressions.

When exhibitionistic sexual interest is acted on with a non-consenting person or interferes with a person’s quality of life or normal functioning, it can be diagnosed as exhibitionistic disorder in the DSM-5. The DSM states that the highest possible prevalence for exhibitionistic disorder in men is 2% to 4%. It is thought to be much less common in women.

DSM-V Diagnostic Criteria for Exhibitionistic Disorder

  • 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.

AND

  • 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.

Specify whether:

Sexually aroused by exposing genitals to prepubertal children.
Sexually aroused by exposing genitals to physically mature individuals Sexually aroused by exposing genitals to prepubertal children and to physically mature individuals.

Specify if;

In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to expose one’s genitals are restricted.
In full remission: The individual has not acted on the urges with a nonconsenting per son, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Associated features

Exhibitionists in some cases masturbate while exposing themselves (or while fantasizing that he/she is exposing himself/herself) to another person. There is a pattern in which males exhibit themselves and there are three characteristic features of the exhibition: 1) It is performed for unknown women. 2) It takes place where sexual intercourse is impossible (e.g. a crowded shopping center). 3) It seems designed to surprise and shock the woman. The male exhibitionist usually exposes his erect penis, but it is not necessarily essential for the activity. Ejaculation may occur at the moment of exposure or develop later with masturbatory stimulation. Some exhibitionists are aware of a conscious desire to shock or upset their target; while others fantasize that the target will become sexually aroused by their display.

Child vs. adult presentation

Generally, society accepts exhibitionism in children as a natural curiosity, not a disorder, however if the behaviors continue a paraphilia is probable. Disorder appears to develop before the age of 18, and rarely is found in people over the age of 50.

Gender and cultural differences in presentation

Most reported cases of exhibitionism involve males. Some scientists argue that women who undress in front of windows (as to invite a person to watch), or who wear low cut gowns are exhibitionists in a sense. Exhibitionism generally appears in Western society and is believed to be almost absent in such countries as Japan, Burma, and India. Additionally, in the American society it can be a crime when committed by a male, but when women expose themselves, excluding total nudity, they are often seen as victims of male voyeurism.

Epidemiology

Prevalence and incidence are not easily defined because people with this disorder usually do not seek treatment voluntarily. Exhibitionism is one of the three most common sexual offenses, the other two being voyeurism and pedophilia. It is rarely diagnosed in general mental health clinics, but most professionals believe that it is probably underdiagnosed and under-reported.

Risk Factors appear to be Antisocial history, Antisocial personality disorder, Alcohol misuse and Pedophilic sexual preference.

Voyeuristic disorder

Voyeurism is the sexual interest in or practice of spying on people engaged in intimate behaviors, such as undressing, sexual activity, or other actions usually considered to be of a private nature. The term comes from the French voir which means “to see”. A male voyeur is commonly labelled as “Peeping Tom” or a “Jags”, a term which originates from the Lady Godiva legend. However, that term is usually applied to a male who observes somebody secretly and, generally, not in a public space.

DSM-V Diagnostic Criteria for Voyeuristic Disorder

  • 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.

AND

  • 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.

AND

  • C. The individual experiencing the arousal and/or acting on the urges is at least 18 years of age.

Specify if:

  • In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in voyeuristic behavior are restricted.

OR

  • In full remission: The individual lias not acted on the urges with a nonconsenting per­ son, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Associated features

Voyeurism, a form of paraphilias, refers to the achievement of sexual gratification by observing or spying on unsuspecting people, especially while they dress, undress, or engage in sexual activity. The observers, often known as “Peeping Tom’s”, may not feel guilt or remorse when intruding upon other individuals’ privacy. Voyeuristic individuals may rationalize their behavior, claiming “no harm, no foul.” Voyeurism is considered a crime in several states, but the definition of voyeurism varies from state to state.

The voyeur may wait outside their victims window and masturbate to the subject undressing, taking a shower, or even a couple having sex. They also may wait until afterwards to masturbate while replaying the incident in their mind. The voyeur may risk injury by assuming precarious positions to catch a preferred view of their target.

Child vs. adult presentation

Lack of maturity and understanding prevents children from being diagnosed with Voyeurism.

Gender and cultural differences in presentation

Men are much more likely to be diagnosed with Voyeurism than women. There does not seem to be any differences with cultural presentation of Voyeurism. However, with the social nature of the prohibited activity it appears to be an important factor in the sexual arousal pertaining to Voyeurism. Voyeurs tend to harbor feelings of inadequacy and to lack social and sexual skills.

Epidemiology

The onset for the disorder is normally before the age of 15 years. Some studies have shown that men express voyeuristic tendencies more often than women, but the disorder is not unique to males (American Psychiatric Association). The prevalence of voyeuristic disorder is 12,000 per 100,000 (12%) among the male population and 4,000 per 100,000 (4%) among the female population. The prevalence rate of this abnormality is not known. Some research suggests that people in the U.S. are showing more voyeuristic characteristics due to the increase in reality television shows being aired. Risk factors appear to be Childhood sexual abuse, Substance misuse, Sexual preoccupation and Hypersexuality.

Frotteuristic disorder

Frotteurism is a paraphilic interest in rubbing, usually one’s pelvic area or erect penis, against a non-consenting person for sexual pleasure. It may involve touching any part of the body, including the genital area. A person who practices frotteuristic acts is known as a frotteur“Frottage” derives from the French verb frotter, meaning “to rub”. The term frotteur, originally meaning “floor polisher”, entered police jargon around 1882. Frotteuristic acts were interpreted as signs of a psychological disorder in 1887 and in ensuing work by French psychiatrist Valentin Magnan, who described three acts of “frottage” in an 1890 study. It was popularized by German sexologist Richard von Krafft-Ebing in his book Psychopathia Sexualis, borrowing from Magnan’s French terminology.

Frotteuristic disorder is a sexual dysfunction disorder characterized by sexual arousal from rubbing against or touching a non-consenting person.

DSM-V Diagnostic Criteria for Frotteuristic Disorder

  • A. Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a non consenting person, as manifested by fantasies, urges, or behaviors.

AND

  • B. The individual has acted on these sexual urges with a non consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to touch or rub against a non consenting person are restricted.
In full remission: The individual has not acted on the urges with a nonconsenting per son, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Associated features

A person who is suffering from Frotteurism usually experiences symptoms such as intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person for over a period of at least six months. These fantasies, urges, and behaviors can cause distress and problems associated with work, social atmospheres, and other important daily activities.

Toucherism is sexual arousal based on grabbing or rubbing one’s hands against an unexpecting (and non-consenting) person. It usually involves touching breasts, buttocks or genital areas, often while quickly walking across the victim’s path. Some psychologists consider toucherism a manifestation of frotteurism, while others distinguish the two.

Frotteurism is also known as “mashing”. Mashing has been reported exclusively among males (DSM, 2000). Mashing usually takes place in crowded places, such as buses, elevators, or subway cars. The man usually incorporates images of his mashing within his masturbation fantasies. Mashing is related to “toucherism”, which is the fondling of nonconsenting strangers. Mashing can be so furtive and fleeting that the victim may not realize what has happened.

Child vs. adult presentation

Typically, children under the age of 12 do not have Frotteurism due to lack of understanding and maturity. Most individuals who participate in frotteurism are between the ages of 15 and 25.Tendencies typically increase the age of 15 and decrease after the age of 25.

Epidemiology

Frotteurism is associated with paraphilic fantasies, but it occurs most commonly in adolescents. This disorder is not associated with traumatic experiences in either adolescent or adult life. Risk Factors appear to be Nonsexual antisocial behavior and Sexual preoccupation/hypersexuality. The DSM estimates that 10%–14% of men seen in clinical settings for paraphilias or hypersexuality have frotteuristic disorder, indicating that the population prevalence is lower. However, frotteuristic acts, as opposed to frotteuristic disorder, may occur in up to 30% of men in the general population. The majority of frotteurs are male and the majority of victims are female, although female on male, female on female, and male on male frotteurs exist. This activity is often done in circumstances where the victim cannot easily respond, in a public place such as a crowded train or concert. Usually, such nonconsensual sexual contact is viewed as a criminal offense: a form of sexual assault albeit often classified as a misdemeanor with minor legal penalties. Conviction may result in a sentence or psychiatric treatment.

Fetishistic disorder

fetish (from French fétiche; from Portuguese feitiço; from Latin facticius, “artificial” and facere, “to make”) is an object believed to have supernatural powers, or in particular a man-made object that has power over others. Later Sigmund Freud appropriated the concept to describe a form of paraphilia where the object of affection is an inanimate object or a specific part of a person.

Sexual fetishism or erotic fetishism is a sexual fixation on a nonliving object or nongenital body part. The object of interest is called the fetish; the person who has a fetish for that object is a fetishist. A sexual fetish may be regarded as a non-pathological aid to sexual excitement, or as a Fetishistic disorder if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life. Sexual arousal from a particular body part can be further classified as partialism. Partialism is sexual interest with an exclusive focus on a specific part of the body other than the genitals. Partialism is categorized as a fetishistic disorder in the DSM-5 only if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life.

Individuals who exhibit partialism sometimes describe the anatomy of interest to them as having equal or greater erotic attraction for them as do the genitals. Partialism occurs in heterosexual, bisexual, and homosexual individuals. The foot is considered one of the most common partialisms.

The following are some of the partialisms commonly found among people:

Formal name Common name Source of arousal
Podophilia Foot fetish Foot
Oculophilia Eye fetish Eye
Maschalagnia Armpit fetish Armpits
Mazophilia Breast fetish Breasts
Pygophilia Buttocks fetish Buttocks
Nasophilia Nose fetish Nose
Trichophilia Hair fetish Hair
Alvinophilia Navel/Belly button fetish Navel
Alvinolagnia Belly/Stomach fetish Belly
Cheirophilia Hand fetish Hands
Crurophilia Leg fetish Legs

While medical definitions restrict the term sexual fetishism to objects or body parts, fetish can, in common discourse, also refer to sexual interest in specific activities. This broader usage of fetish covers parts or features of the body (including obesity and body modifications), objects, situations and activities (such as BDSM – a variety of often erotic practices or roleplaying involving bondage, discipline, dominance and submission, sadomasochism, and other related interpersonal dynamics). Paraphilias such as urophilia, necrophilia and coprophilia have been described as fetishes.

Types

https://en.wikipedia.org/wiki/Sexual_fetishism

The sensory regions for the feet and genitals lie next to each other, as shown in this cortical homunculus.

In a review of 48 cases of clinical fetishism in 1983, fetishes included clothing (58.3%), rubber and rubber items (22.9%), footwear (14.6%), body parts (14.6%), leather (10.4%), and soft materials or fabrics (6.3%). A 2007 study counted members of Internet discussion groups with the word fetish in their name. Of the groups about body parts or features, 47% belonged to groups about feet (podophilia), 9% about body fluids (including urophilia, scatophilia, lactaphilia, menophilia, mucophilia), 9% about body size, 7% about hair (hair fetish), and 5% about muscles (muscle worship). Less popular groups focused on navels (navel fetishism), legs, body hair, mouth, and nails, among other things. Of the groups about clothing, 33% belonged to groups about clothes worn on the legs or buttocks (such as stockings or skirts), 32% about footwear (shoe fetishism), 12% about underwear (underwear fetishism), and 9% about whole-body wear such as jackets. Less popular object groups focused on headwear, stethoscopes, wristwear, pacifiers, and diapers (diaper fetishism).

Erotic asphyxiation is the use of choking to increase the pleasure in sex. The fetish also includes an individualized part that involves choking oneself during the act of masturbation, which is known as auto-erotic asphyxiation. This usually involves a person being connected and strangled by a homemade device that is tight enough to give them pleasure but not tight enough to suffocate them to death. This is dangerous due to the issue of hyperactive pleasure seeking which can result in strangulation when there is no one to help if the device gets too tight and strangles the user.

Devotism involves being attracted to body modifications on another person that are the result of amputation. Devotism is only a sexual fetish when the person who has the fetish considers the amputated body part on another person the object of sexual interest.

Under the DSM-5, fetishism is sexual arousal from nonliving objects or specific nongenital body parts, excluding clothes used for cross-dressing (as that falls under transvestic disorder) and sex toys that are designed for genital stimulation. Fetishism usually becomes evident during puberty, and may develop prior to that. No single cause for fetishism has been conclusively established.

DSM-V Diagnostic Criteria for Fetishistic Disorder 

  • A. Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on non genital body part(s), as manifested by fantasies, urges, or behaviors.

AND

  • B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AND

  • C. The fetish objects are not limited to articles of clothing used in cross-dressing (as in transvestic disorder) or devices specifically designed for the purpose of tactile genital stimulation (e.g., vibrator).

AND

Specify:

  • Body part(s)
  • Nonliving object(s)
  • Other

Specify if:

  • In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in fetishistic behaviors are restricted.
  • In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment.

 

Transvestic Disorder

TransvestFetish.jpg https://en.wikipedia.org/wiki/Transvestic_fetishism

Excessive sexual or erotic interest in cross-dressing

Transvestism is the practice of cross-dressing, which is the act of wearing items of clothing and other accoutrements commonly associated with the opposite sex within a particular society. The term cross-dressing refers to an action or a behavior, without attributing or implying any specific causes or motives for that behavior. Cross-dressing is not synonymous with being transgender. A transvestic fetishist is a person who cross-dresses as part of a sexual fetish. According to the fourth edition of Diagnostic and Statistical Manual of Mental Disorders, this fetishism was limited to heterosexual men; however, DSM-5 does not have this restriction, and opens it to women and men, regardless of their sexual orientation.

There are two key criteria before a psychiatric diagnosis of “transvestic fetishism” is made:

  1. Recurrent, intense sexually arousing fantasies, urges, or behaviour, involving cross-dressing.
  2. This causes clinically significant distress or impairment, whether socially, at work, or elsewhere.

Thus, transvestic fetishism is not considered a mental illness unless it causes significant problems for the person concerned, however many people who are diagnosed with transvestic fetishism are against their fetish being described as an illness.

Transvestic fetishism, fetishistic transvestism and sometimes transvestism are also often used to describe any sexual behavior or arousal that is in any way triggered by the clothes of the other gender. Especially the latter is problematic, because transvestism and cross-dressing are neither a sexual fetish, nor do they necessarily have anything to do with sexual behavior or arousal.

Also, not every sexual behavior where clothes of the opposite gender are involved is transvestic fetishism, they are also often used in sexual roleplay without being a fetish. Also, many transgendered people, mostly transwomen, also cross-dress before coming out in sexual contexts to relieve their cross-gender feelings. This behavior is likewise not considered transvestic fetishism, as it is not cross-dressing for sexual pleasure, rather it is simply their self-gender expression.

Some male transvestic fetishists collect women’s clothing, e.g. nightgowns, babydolls, slips, and other types of nightwear, lingerie stockings and pantyhose, items of a distinct feminine look and feel. They may dress in these feminine garments and take photographs of themselves while living out their secret fantasies. Many men love the feeling of wearing silk or nylon and adore the silky fabric of women’s nightwear, lingerie and nylons.

Most transvestic fetishists are said to be heterosexual men, although there are no studies that accurately represent either their sexual orientation or gender, and most information on this is based on anecdotal evidence or informal surveys.

A small number of people with transvestic fetishism, as the years pass, want to dress and live permanently as women, and desire surgical or hormonal sex reassignment. In such cases the diagnosis should be changed to transsexualism (or gender dysphoria).

DSM-V Diagnostic Criteria for Transvestic Disorder

  • A. Over a period of at least 6 months, recurrent and intense sexual arousal from cross dressing, as manifested by fantasies, urges, or behaviors.

AND

  • B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

  • With fetishism: If sexually aroused by fabrics, materials, or garments.
  • With autogynephiiia: If sexually aroused by thoughts or images of self as female.

Specify if:

  • In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to cross-dress are restricted.
  • In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment.

 

Sexual masochism and Sexual sadism disorders

https://en.wikipedia.org/wiki/Torture

A variety of real and fictitious torture instruments.

Sexual masochism disorder (SMD) is the condition of experiencing recurring and intense sexual arousal in response to enduring moderate or extreme pain, suffering, or humiliation. Conversely, Sexual sadism disorder is the condition of experiencing sexual arousal in response to the extreme pain, suffering or humiliation of others. The words sadism and sadist are derived from Marquis de Sade. Many of Marquis de Sade’s books, including Justine (1791), Juliette (1797) and The 120 Days of Sodom (published posthumously in 1905), are written from a cruelly sadistic viewpoint.

BDSM ( bondage, domination, sadomasochism) is a colloquial term relating to individuals who willingly engage in consenting forms of pain or humiliation, typically for sexual purposes. The term BDSM describes the activities between consenting partners that contain sadistic and masochistic elements. Many behaviors such as erotic spanking, tickling and love-bites that many people think of only as “rough” sex also contain elements of sado-masochism. It is not currently a diagnosable condition in either the DSM or ICD system.

 

DSM-V Diagnostic Criteria for Sexual Sadism Disorder

  • A. Over a period of at least 6 months, recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors.

AND

  • B. The individual has acted on these sexual urges with a non consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

  • In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in sadistic sexual behaviors are restricted.
  • In full remission: The individual has not acted on the urges with a non consenting person,and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

DSM-V Diagnostic Criteria for Sexual Masochism Disorder 

  • A. Over a period of at least 6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviors.

AND

  • B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

  • With asphyxiophilia: If the individual engages in the practice of achieving sexual arousal related to restriction of breathing.

Specify if:

  • In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in masochistic sexual behaviors are restricted.
  • In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at last 5 years while in an uncontrolled environment.

The prevalence of sexual masochism disorder in the population is unknown, but the DSM-5 suggests that 2.2% of males and 1.3% of females may be involved in BDSM, whether they have sexual masochism disorder or not. Extensive use of pornography depicting humiliation is sometimes associated with sexual masochism disorder.

Behaviors associated with sexual masochism disorder can be acted out alone (e.g., binding, self-sticking pins, self-administration of electric shock, or self-mutilation) or with a partner (e.g., physical restraint, blindfolding, paddling, spanking, whipping, beating, electric shock, cutting, pinning and piercing, and humiliation such as by being urinated or defecated upon, being forced to crawl and bark like a dog, or being subjected to verbal abuse). Behaviors sometimes include being forced to cross-dress or being treated like an infant.

Following a phenomenological study of individual involved in sexual masochistic sessions, Sexual Masochism was described as an addiction-like tendency, with several features resembling that of drug addiction: craving, intoxication, tolerance and withdrawal. It was also demonstrated how the first masochistic experience is placed on a pedestal, with subsequent use aiming at retrieving this lost sensation, much as described in the descriptive literature on addiction. The addictive pattern presented in this study suggests an association with behavioral spin as found in problem gamblers. A behavioral spin is described as a process one goes through that is characterized by a behavior growing in frequency and magnitude, as indicated by the Criminal Spin theory. As it develops, it gains its own momentum which the individual finds almost impossible to terminate even when faced with known unwanted outcomes. For the participants in sexual masochistic sessions, the behavioral spin is manifested as a continuously reinforced process leading the masochist to engage in masochistic activity, perpetuating itself, and binding the addict to his/her behavior.

Paraphilic coercive disorder refers to the preference for non-consenting over consenting sexual partners. It differs from sexual sadism disorder in that although the individual with this disorder may inflict pain or threats of pain in order to gain the compliance of the victim, the infliction of pain is not the actual goal of the individual. The condition is typically described as a paraphilia and continues to undergo research, but does not appear in the current DSM or ICD. Alternate terms for the condition have included Biastophilia, Coercive Paraphilic Disorder, and Preferential Rape.

With paraphilic coercive disorder, the individual employs enough force to subdue a victim, but with sexual sadism disorder, the individual often continues to inflict harm regardless of the compliance of the victim, which sometimes escalates not only to the death of the victim, but also to the mutilation of the body. What is experienced by the sadist as sexual does not always appear obviously sexual to non-sadists: Sadistic rapes do not necessarily include penile penetration of the victim. In a survey of offenses, 77% of cases included sexual bondage, 73% included anal rape, 60% included blunt force trauma, 57% included vaginal rape, and 40% included penetration of the victim by a foreign object. In 40% of cases, the offender kept a personal item of the victim as a souvenir.

On personality testing, sadistic rapists apprehended by law enforcement have shown elevated traits of impulsivity, hypersexuality, callousness, and psychopathy.

Although there appears to be a continuum of severity from mild (hyperdominance or BDSM) to moderate (paraphilic coercive disorder) to severe (sexual sadism disorder), it is not clear if they are genuinely related or only appear related superficially.

Very little is known about how sexual sadism disorder develops. Most of the people diagnosed with sexual sadism disorder come to the attention of authorities by committing sexually motivated crimes. Surveys have also been conducted to include people who are interested in only mild and consensual forms of sexual pain/humiliation (BDSM).

Most of the people with full-blown sexual sadism disorder are male, whereas the sex ratio of people interested in BDSM is closer to 2:1 male-to-female. People with sexual sadism disorder are at an elevated likelihood of having other paraphilic sexual interests.

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Key Takeaways

BDSM ( bondage, domination, sadomasochism) 

A colloquial term relating to individuals who willingly engage in consenting forms of pain or humiliation, typically for sexual purposes.

Exhibitionism

The act of exposing in a public or semi-public context those parts of one’s body that are not normally exposed – for example, the breasts, genitals or buttocks.

Frotteurism

A paraphilic interest in rubbing, usually one’s pelvic area or erect penis, against a non-consenting person for sexual pleasure.

Paraphilia

Behavior in which an individual has recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving (1) nonhuman objects, (2) children or other nonconsenting persons, or (3) the suffering or humiliation of self or partner.

Paraphilic coercive disorder 

Refers to the preference for non-consenting over consenting sexual partners.

Partialism 

Sexual interest with an exclusive focus on a specific part of the body other than the genitals.

Sexual fetishism or erotic fetishism

A sexual fixation on a nonliving object or nongenital body part.

Toucherism

Sexual arousal based on grabbing or rubbing one’s hands against an unexpecting (and non-consenting) person.

Transvestism 

The practice of cross-dressing, which is the act of wearing items of clothing and other accoutrements commonly associated with the opposite sex within a particular society.

Voyeurism

Sexual interest in or practice of spying on people engaged in intimate behaviors, such as undressing, sexual activity, or other actions usually considered to be of a private nature.