{"id":819,"date":"2020-08-10T20:33:10","date_gmt":"2020-08-10T20:33:10","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=819"},"modified":"2022-07-26T20:06:24","modified_gmt":"2022-07-26T20:06:24","slug":"paraphilic-disorders","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/paraphilic-disorders\/","title":{"raw":"Paraphilic Disorders","rendered":"Paraphilic Disorders"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li style=\"font-weight: 400;\">Describe and differentiate between paraphilias: fetishism, transvestic fetishism, exhibitionism, voyeurism, frotteurism, sexual sadism, sexual masochism, and pedophilia<\/li>\r\n<\/ul>\r\n<\/div>\r\nAs mentioned earlier,<strong> paraphilias<\/strong> are persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature.\u00a0We will discuss the characteristics and etiology of the\u00a0eight paraphilias listed in the DSM-5\u00a0<span style=\"font-size: 1em;\">fetishism, transvestic fetishism,<\/span><span style=\"font-size: 1rem; text-align: initial;\">\u00a0exhibitionism, voyeurism,\u00a0<\/span><span style=\"font-size: 1em;\">frotteurism,\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">sexual sadism, sexual masochism, and\u00a0<\/span><span style=\"text-align: initial;\"><span style=\"font-size: 1em;\">pedophilia. Pedophilia will be discussed in a separate section <\/span>because<span style=\"font-size: 1em;\">\u00a0of its close relationship to criminal behavior and will be <\/span>followed<span style=\"font-size: 1em;\">\u00a0by a discussion on sex and violence.\u00a0<\/span><\/span>\r\n\r\nNo consensus has been found for any precise border between unusual sexual interests and paraphilic ones. There is debate over which, if any, of the paraphilias should be listed in diagnostic manuals, such as the DSM-5 or ICD-11.\u00a0The number and taxonomy of paraphilias is under debate; one source lists as many as 549 types of paraphilias. The DSM-5 has specific listings for eight paraphilic disorders, but several sub-classifications of the paraphilias have been proposed and some argue that a fully dimensional, spectrum, or complaint-oriented approach would better reflect the evidence.\r\n\r\nThe 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.\"[footnote]\"Paraphilic Disorders\". <em>Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.)<\/em>. Philadelphia, Pennsylvania: American Psychiatric Publishing. 2013. pp. 685\u2013686.[\/footnote]\r\n<h2>Types of Paraphilias<\/h2>\r\n[caption id=\"attachment_4131\" align=\"alignright\" width=\"189\"]<img class=\"wp-image-4131\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/04190746\/Crossdressing_boy-225x300.jpg\" alt=\"A cross-dressing man.\" width=\"189\" height=\"252\" \/> <strong>Figure 1<\/strong>. Cross-dressing is not always a result of transvestic fetishism.[\/caption]\r\n\r\n<span style=\"font-size: 1em;\"><strong>Fetishism<\/strong> is the use of nonliving objects, most commonly shoes and undergarments, for sexual pleasure. <strong>Transvestic fetishism<\/strong> is the derivation of sexual arousal from cross-dressing or dressing in clothes of the opposite sex.\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\"><strong>Exhibitionism<\/strong> is the exposure of an individual\u2019s genitalia to unsuspecting strangers for sexual satisfaction.\u00a0<strong>Voyeurism<\/strong> is the viewing of an unsuspecting person engaging in disrobing or sexual activity. <strong>Frotteurism<\/strong> is the touching of or rubbing against a nonconsenting person. <strong>Sexual masochism<\/strong> is the derivation of sexual arousal from being the recipient of physical or mental abuse and\/or humiliation. <strong>Sexual sadism<\/strong> is when sexual arousal is gained from inflicting mental or physical suffering on a nonconsenting person. <strong>Pedophilia<\/strong> is any sexual activity with or sexual fantasies about a prepubescent child, where the offender is at least sixteen years of age.\u00a0<\/span>\r\n<h2>Etiology<\/h2>\r\nThe exact etiology of paraphilia and paraphilic disorders is unknown. However, it is thought that a combination of neurobiological, interpersonal, and cognitive processes all play a role. Literature also points towards various genetic factors contributing to the development of pedophilia and pedophilic disorder, with recent evidence displaying a positive correlation of the COMT Val158Met (rs4680) polymorphism in paraphilic child sexual offenders. A recent study focusing on neurotransmission of paraphilic disorders found evidence to suggest that central dopamine plays a key role in the pathogenesis of paraphilic disorders as well as the general disturbance of the conscious regulation of behavior. The results of this study revealed increased levels of serotonin and norepinephrine, with a decreased concentration of DOPAC (3,4-dihydroxyphenylacetic acid) in urine samples of the test population diagnosed with paraphilic disorders. A correlation was made between serotonin and norepinephrine with obsessive disturbances and an association of DOPAC with affective and dissociative disorders.\r\n<h2>Epidemiology<\/h2>\r\nLiterature is lacking with information pertaining to the epidemiology of paraphilia and paraphilic disorders. Literature is also limited from an epidemiological standpoint, with paraphilia typically studied in a general sense rather than pertaining to specific paraphilia or paraphilic disorders. Paraphilias, in general, are more common in men, with reasons unknown. A recent study conducted looked specifically at the desire for and experience of paraphilic behaviors of a sample population demographically representative of the general population. The sample size contained a total of 1,040 persons classified according to gender, age, education, ethnicity, religion, and location of residency. It was found that almost half of the study population expressed interest in one or more paraphilic categories, with approximately one-third of this population actually acting on this interest at least once. Specifically, fetishism, frotteurism, voyeurism, and masochism held a prevalence of 15.9% (value considered to be statistically unusual), with interest in both males and females. Interest levels in fetishism and masochism revealed no statistically significant difference amongst males and females. It was also found that the most common paraphilic interest amongst men is often voyeurism and fetishism.\r\n\r\nLet's learn a little bit more about the types of paraphillic disorders.\r\n<h2>Fetishistic Disorder<\/h2>\r\n[caption id=\"attachment_4133\" align=\"alignleft\" width=\"269\"]<img class=\"wp-image-4133\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/04191016\/35755503564_ed818d4bae_k-300x200.jpg\" alt=\"A foot with toenails painted purple wearing a sandal.\" width=\"269\" height=\"179\" \/> <strong>Figure 2<\/strong>. Foot fetishes are more common than you think.[\/caption]\r\n\r\n<b>Sexual fetishism<\/b>\u00a0or\u00a0<b>erotic fetishism<\/b>\u00a0is a sexual fixation on a nonliving object or nongenital body part.\u00a0The object of interest is called the\u00a0<b>fetish<\/b>; the person who has\u00a0<i>a fetish<\/i>\u00a0for that object is a\u00a0<b>fetishist<\/b>.\u00a0Sexual arousal\u00a0from a particular body part can be further classified as\u00a0<strong>partialism<\/strong>, or\u00a0sexual interest\u00a0with an exclusive focus on a specific part of the body other than the genitals.<sup id=\"cite_ref-DSM-5_1-0\" class=\"reference\"><\/sup><sup id=\"cite_ref-h_2-0\" class=\"reference\"><\/sup>\u00a0Partialism is categorized as a\u00a0fetishistic disorder\u00a0in the\u00a0DSM-5\u00a0only if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life. Fetishism is diagnosed by\u00a0recurrent 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 that occur for at least six months. It must cause significant stress or impairment and not be related to clothing used in cross-dressing (transvestic disorder) or objects used for genital stimulation, like a vibrator.\r\n\r\nIndividuals who exhibit partialism sometimes describe the anatomy of interest to them as having an equal or greater\u00a0erotic attraction\u00a0for them as do the genitals.\u00a0Partialism occurs in\u00a0heterosexual,\u00a0bisexual, and\u00a0homosexual\u00a0individuals.\u00a0The\u00a0foot\u00a0is considered one of the most common partialisms.\r\n<div class=\"textbox exercises\">\r\n<h3>Partialisms<\/h3>\r\nThe following are some of the partialisms commonly found among those with fetishes:\r\n<table class=\"wikitable\">\r\n<tbody>\r\n<tr>\r\n<th>Formal name<\/th>\r\n<th>Common name<\/th>\r\n<th>Source of arousal<\/th>\r\n<\/tr>\r\n<tr>\r\n<td>Podophilia<\/td>\r\n<td>Foot fetish<\/td>\r\n<td>Foot<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Oculophilia<\/td>\r\n<td>Eye fetish<\/td>\r\n<td>Eye<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Maschalagnia<\/td>\r\n<td>Armpit fetish<\/td>\r\n<td>Armpits<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Mazophilia<\/td>\r\n<td>Breast fetish<\/td>\r\n<td>Breasts<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Pygophilia<\/td>\r\n<td>Buttocks fetish<\/td>\r\n<td>Buttocks<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Nasophilia<\/td>\r\n<td>Nose fetish<\/td>\r\n<td>Nose<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Trichophilia<\/td>\r\n<td>Hair fetish<\/td>\r\n<td>Hair<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Alvinophilia<\/td>\r\n<td>Navel\/Belly button fetish<\/td>\r\n<td>Navel<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Alvinolagnia<\/td>\r\n<td>Belly\/Stomach fetish<\/td>\r\n<td>Belly<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Cheirophilia<\/td>\r\n<td>Hand fetish<\/td>\r\n<td>Hands<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Crurophilia<\/td>\r\n<td>Leg fetish<\/td>\r\n<td>Legs<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\nWhile medical definitions restrict the term\u00a0<i>sexual fetishism<\/i>\u00a0to objects or body parts,\u00a0<i>fetish<\/i>\u00a0can, in common discourse, also refer to sexual interest in specific activities.\u00a0This broader usage of\u00a0<i>fetish<\/i>\u00a0covers parts or features of the body (including obesity and body modifications), objects, situations and activities (such as\u00a0<strong>BDSM<\/strong>\u2014a variety of often\u00a0erotic\u00a0practices or\u00a0roleplaying\u00a0involving\u00a0bondage,\u00a0discipline,\u00a0dominance and submission,\u00a0sadomasochism, and other related interpersonal dynamics).\u00a0Paraphilias\u00a0such as\u00a0urophilia,\u00a0necrophilia, and\u00a0coprophilia\u00a0have been described as fetishes.\r\n\r\n<strong>Erotic<\/strong> <strong>asphyxiation<\/strong>\u00a0is 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 that can result in strangulation when there is no one to help if the device gets too tight and strangles the user.\r\n<h2>Transvestic Disorder<\/h2>\r\n<b>Transvestism\u00a0<\/b>is the practice of\u00a0cross-dressing<b>, <\/b>which\u00a0is the act of wearing items of clothing and other\u00a0accoutrements\u00a0commonly associated with the opposite sex within a particular society.\u00a0The term\u00a0<i>cross-dressing<\/i>\u00a0refers 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\u00a0transgender. A transvestic disorder is characterized by intense sexual arousal from cross-dressing that has occurred for at least six months, which also causes significant distress or impairment. It should be specified if it occurs with fetishism, meaning arousal by materials related to cross-dressing, or with autogynephilia, which includes arousal by thoughts of oneself as a female.\r\n\r\nA\u00a0transvestic fetishist\u00a0is a person who cross-dresses as part of a\u00a0sexual fetish. According to the DSM-4, this fetishism was limited to\u00a0heterosexual\u00a0men; however, DSM-5 does not have this restriction, and opens it to women and men, regardless of their\u00a0sexual orientation.\r\n\r\nTransvestic fetishism,\u00a0<i>fetishistic transvestism<\/i>,\u00a0and sometimes\u00a0<i>transvestism<\/i>\u00a0are also often used to describe\u00a0<i>any<\/i>\u00a0sexual\u00a0behavior or\u00a0arousal\u00a0that is in any way triggered by the\u00a0clothes\u00a0of the other\u00a0gender. Especially the latter is problematic because transvestism and cross-dressing are neither a\u00a0sexual\u00a0fetish nor do they necessarily have anything to do with sexual behavior or arousal.\r\n\r\nAlso, not every sexual behavior where clothes of the opposite gender are involved is\u00a0<i>transvestic fetishism<\/i>; they are also often used in sexual\u00a0roleplay\u00a0without being a\u00a0fetish. Also, many\u00a0transgendered\u00a0people, mostly\u00a0transwomen, also cross-dress before\u00a0coming out\u00a0in sexual contexts to relieve their cross-gender feelings. This behavior is likewise not considered\u00a0<i>transvestic fetishism<\/i>, as it is not cross-dressing for sexual\u00a0pleasure, rather it is simply their self-gender expression.\r\n\r\nSome male transvestic fetishists collect women's\u00a0clothing, e.g., nightgowns,\u00a0babydolls,\u00a0slips, other types of\u00a0nightwear,\u00a0lingerie\u00a0stockings, 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\u00a0silk\u00a0or\u00a0nylon\u00a0and adore the\u00a0silky\u00a0fabric of women's nightwear, lingerie, and nylons.\r\n\r\nMost transvestic fetishists are said to be\u00a0heterosexual\u00a0men, although there are no studies that accurately represent either their\u00a0sexual orientation\u00a0or\u00a0gender, 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\u00a0women, and desire surgical or hormonal gender-affirming services. In such cases the diagnosis should be changed to\u00a0transsexualism (or gender dysphoria).\r\n<h2>Exhibitionist Disorder<\/h2>\r\n[caption id=\"attachment_4134\" align=\"alignright\" width=\"300\"]<img class=\"wp-image-4134 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/04191552\/exhibitionism-3066668_1920-300x214.jpg\" alt=\"Two figurines. One has its coat open and is exposing itself to the the other. \" width=\"300\" height=\"214\" \/> <strong>Figure 3.<\/strong> Exposing oneself to only an intimate partner may not be considered exhibitionism.[\/caption]\r\n\r\n<b>Exhibitionism<\/b>\u00a0is the act of exposing in a public or semi-public context those parts of one's body that are not normally exposed\u2014for example, the\u00a0breasts,\u00a0genitals, or\u00a0buttocks. 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.\u00a0Exposing oneself only to an\u00a0intimate partner\u00a0is normally not regarded as exhibitionism. In law, the act of exhibitionism may be called\u00a0indecent exposure, \"exposing one's person,\" or other expressions.\r\n\r\nWhen exhibitionistic sexual interest is acted on with a non-consenting person or interferes with a person's quality of life or\u00a0normal\u00a0functioning, it can be diagnosed as\u00a0<strong>exhibitionistic disorder<\/strong>\u00a0in the\u00a0DSM-5. The DSM states that the highest possible prevalence for exhibitionistic disorder in men is 2%-4%. It is thought to be much less common in women.\r\n\r\nExhibitionists in some cases masturbate while exposing themselves (or while fantasizing that they are exposing themselves) 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.\r\n<h3>Child versus Adult Presentation<\/h3>\r\nGenerally, society accepts exhibitionism in children as a natural curiosity, not a disorder; however, if the behaviors continue, a paraphilia is probable. The disorder appears to develop before the age of 18 and rarely is found in people over the age of 50.\r\n<h3>Gender and Cultural Differences in Presentation<\/h3>\r\nMost 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 outfits 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 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.\r\n<h4>Epidemiology<\/h4>\r\nPrevalence 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.\u00a0<span id=\"Risk_Factors\" class=\"mw-headline\">Risk factors appear to be a<\/span>ntisocial history, antisocial personality disorder, a<span style=\"font-size: 1em;\">lcohol misuse, and p<\/span><span style=\"font-size: 1em;\">edophilic sexual preference.<\/span>\r\n<h2 id=\"firstHeading\" class=\"firstHeading\" lang=\"en\">Voyeuristic Disorder<\/h2>\r\nVoyeurism 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.\u00a0The term comes from the French\u00a0<i>voir<\/i>\u00a0which means \"to see.\" A male voyeur is commonly labelled as \"Peeping Tom\" or a \"Jags,\" a term which originates from the\u00a0Lady Godiva\u00a0legend.\u00a0However, that term is usually applied to a male who observes somebody secretly and, generally, not in a\u00a0public space.\r\n\r\nIt is diagnosed by recurrent and intense sexual arousal stemming from observing an unsuspecting person who is naked, undressing, or engaging in sexual activity. It should cause significant distress and the person must be at least 18 years old.\r\n\r\nResearch found voyeurism to be the most common sexual law-breaking behavior in both clinical and general populations.[footnote]\"The DSM Diagnostic Criteria for Exhibitionism, Voyeurism, and Frotteurism\" (PDF). Niklas Langstrom. Retrieved 2013-04-04.[\/footnote] In the same study, it was found that 42% of college males who had never been convicted of a crime had watched others in sexual situations. An earlier study indicates that 54% of men have voyeuristic fantasies, and that 42% have tried voyeurism. In a national study of Sweden, it was found that 7.7% of the population (both men and women) had engaged in voyeurism at some point.[footnote]L\u00e5ngstr\u00f6m, Niklas; Seto, Michael C. (2006). \"Exhibitionistic and Voyeuristic Behavior in a Swedish National Population Survey\". Archives of Sexual Behavior. 35 (4): 427\u201335. doi:10.1007\/s10508-006-9042-6. PMID 16900414[\/footnote] It is also believed that voyeurism occurs up to 150 times more frequently than police reports indicate. This same study also indicates that there are high levels of co-occurrence between voyeurism and exhibitionism, finding that 63% of voyeurs also report exhibitionist behavior.\r\n<h2 id=\"firstHeading\" class=\"firstHeading\" lang=\"en\">Frotteuristic Disorder<\/h2>\r\nFrotteurism\u00a0is a\u00a0paraphilic\u00a0interest in rubbing, usually one's\u00a0pelvic\u00a0area or erect\u00a0penis, against a non-consenting person for\u00a0sexual pleasure. It may involve touching any part of the body, including the genital area.\u00a0<strong>Frotteuristic disorder<\/strong> is a sexual dysfunction disorder characterized by sexual arousal from rubbing against or touching a non-consenting person.\r\n\r\nThe DSM-5 lists the following diagnostic criteria for frotteuristic disorder:\r\n<ul>\r\n \t<li>Over a period of at least six months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors.<\/li>\r\n \t<li>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.<\/li>\r\n<\/ul>\r\nIf the individual has not acted on their interest and experiences no distress or impairment, they are considered to have a frotteuristic sexual interest, but not frotteuristic disorder. Some sexologists distinguish between frotteurism (as pelvic rubbing) and toucherism (as groping with hands), but the DSM does not.\r\n\r\nThe prevalence of frotteurism is unknown. The DSM estimates that 10\u201314% 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.\r\n\r\nUsually, 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.\r\n<h2 class=\"firstHeading\" lang=\"en\">Sexual Masochism and Sexual Sadism Disorders<\/h2>\r\n<b>Sexual masochism disorder<\/b>\u00a0<strong>(SMD)<\/strong> is the condition of experiencing recurring and intense\u00a0sexual arousal\u00a0in response to enduring moderate or extreme pain, suffering, or\u00a0humiliation. Conversely, <strong>s<\/strong><b>exual sadism disorder<\/b>\u00a0is the condition of experiencing\u00a0sexual arousal\u00a0in response to the extreme pain, suffering, or\u00a0humiliation\u00a0of others.\u00a0The words\u00a0<em>sadism<\/em>\u00a0and\u00a0<i>sadist<\/i>\u00a0are derived from\u00a0Marquis de Sade.\u00a0Many of\u00a0Marquis de Sade's books, including\u00a0<i>Justine<\/i>\u00a0(1791),\u00a0<i>Juliette<\/i>\u00a0(1797) and\u00a0<i>The 120 Days of Sodom<\/i>\u00a0(published posthumously in 1905), are written from a cruelly sadistic viewpoint.\r\n\r\n<strong>BDSM<\/strong>\u00a0(bondage, domination, sadomasochism) is a colloquial term relating to individuals who willingly engage in consenting forms of pain or humiliation, typically for sexual purposes.\u00a0The term\u00a0BDSM\u00a0describes the activities between consenting partners that contain sadistic and masochistic elements. Many behaviors such as\u00a0erotic spanking,\u00a0tickling, and\u00a0love-bites\u00a0that many people think of only as \"rough\" sex also contain elements of sado-masochism. BDSM is not currently a diagnosable condition in either the DSM or ICD system.\r\n<h3>Sexual Masochism<\/h3>\r\nThe formal diagnosis of sexual masochism disorder according to the DSM-5 involves \"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.\" It applies only if the individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning.\r\n\r\nThe 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.\r\n\r\nBehaviors 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).\u00a0Behaviors sometimes include being forced to cross-dress or being treated like an infant.\r\n\r\nFollowing a phenomenological study of individuals 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.\u00a0A behavioral spin is described as a process one goes through that is characterized by a behavior growing in frequency and magnitude. 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.\r\n<h3>Sexual Sadism Disorder<\/h3>\r\nSexual sadism disorder refers to the \"recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors.\" The formal diagnosis of sexual sadism disorder would apply if the individual has acted on these urges with a nonconsenting person or if the urges cause significant distress to the individual.\r\n\r\n<strong>Paraphilic coercive disorder\u00a0<\/strong>refers to the preference for non-consenting over consenting sexual partners.\u00a0It 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\u00a0Biastophilia,\u00a0Coercive Paraphilic Disorder,\u00a0and\u00a0Preferential Rape.\r\n\r\nWith 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,\u00a0but 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.\u00a0In 40% of cases, the offender kept a personal item of the victim as a souvenir.\r\n\r\nOn personality testing, sadistic rapists apprehended by law enforcement have shown elevated traits of impulsivity, hypersexuality, callousness, and psychopathy.\u00a0Although there appears to be a continuum of severity from mild (<i>hyperdominance<\/i>\u00a0or\u00a0<i>BDSM<\/i>) to moderate (<i>paraphilic coercive disorder<\/i>) to severe (<i>sexual sadism disorder<\/i>), it is not clear if they are genuinely related or only appear related superficially.\r\n\r\nVery little is known about how sexual sadism disorder develops.\u00a0Most of the people diagnosed with sexual sadism disorder come to the attention of authorities by committing sexually motivated crimes.\u00a0Surveys have also been conducted to include people who are interested in only mild and consensual forms of sexual pain\/humiliation (BDSM).\r\n\r\nMost 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.\u00a0<sup id=\"cite_ref-20\" class=\"reference\"><\/sup><sup id=\"cite_ref-21\" class=\"reference\"><\/sup><sup id=\"cite_ref-22\" class=\"reference\"><\/sup>People with sexual sadism disorder are at an elevated likelihood of having other paraphilic sexual interests.\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/52ee333a-6040-4ef3-8bed-5d1066bbfbe2\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/448fe4d3-9c25-4c0e-a349-5699b0d56e70\r\n\r\n<\/div>\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nWatch this video to review the main components of each of the paraphilic disorders in the DSM-5.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=5576161&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=YOV61lKxqxY&amp;video_target=tpm-plugin-3hikt5b6-YOV61lKxqxY\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/WhatAreParaphilicDisorders_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"What are Paraphilic Disorders?\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Key Takeaways: Paraphilic Disorders<\/h3>\r\n<table style=\"height: 218px; width: 847px;\"><caption>\u00a0<\/caption>\r\n<thead>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"width: 834.097px; height: 11px;\" colspan=\"3\">Table 1. Paraphilic Disorders as Described in the\u00a0DSM-5<\/th>\r\n<\/tr>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"width: 137.431px; height: 11px;\">Disorder<\/th>\r\n<th style=\"width: 385.208px; height: 11px;\">Description<\/th>\r\n<th style=\"width: 288.542px; height: 11px;\">Prevalence<\/th>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr style=\"height: 23px;\">\r\n<td style=\"width: 137.431px; height: 23px;\">Voyeuristic Disorder<\/td>\r\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from watching another person who is naked, undressing, or engaged in sexual activities.<\/td>\r\n<td style=\"width: 288.542px; height: 23px;\">Lifetime prevalence is estimated at the high end to be up to 12% in males and 4% in females.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<td style=\"width: 137.431px; height: 23px;\">Exhibitionistic Disorder<\/td>\r\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from showing genitals to an unsuspecting person.<\/td>\r\n<td style=\"width: 288.542px; height: 23px;\">Highest prevalence predicted to be 2%-4% of males, and unknown for females.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<td style=\"width: 137.431px; height: 23px;\">Frotteuristic Disorder<\/td>\r\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person.<\/td>\r\n<td style=\"width: 288.542px; height: 23px;\">Unknown<\/td>\r\n<\/tr>\r\n<tr style=\"height: 35px;\">\r\n<td style=\"width: 137.431px; height: 35px;\">Sexual Masochism Disorder<\/td>\r\n<td style=\"width: 385.208px; height: 35px;\">Recurrent and intense sexual arousal from being bound, beaten, or made to suffer in some way.<\/td>\r\n<td style=\"width: 288.542px; height: 35px;\">Unknown; Australia estimates show that 2.2% of males and 1.3% of females were involved in sadomasochistic behaviors in the past 12 months.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<td style=\"width: 137.431px; height: 23px;\">Sexual Sadism Disorder<\/td>\r\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from the physical or psychological suffering of another person.<\/td>\r\n<td style=\"width: 288.542px; height: 23px;\">Unknown, estimates vary between 2% and 20%. Of sex offenders in the United States, 10% have sexual sadism.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<td style=\"width: 137.431px; height: 23px;\">Pedophilic Disorder<\/td>\r\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal and fantasies related to sexual activity with a prepubescent child or children under age 13.<\/td>\r\n<td style=\"width: 288.542px; height: 23px;\">Unknown; highest prevalence approximately 3%-5%.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<td style=\"width: 137.431px; height: 23px;\">Fetishistic Disorder<\/td>\r\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from either nonliving objects, or on nongenital body parts.<\/td>\r\n<td style=\"width: 288.542px; height: 23px;\">Unknown<\/td>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<td style=\"width: 137.431px; height: 23px;\">Transvestic Disorder<\/td>\r\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from cross-dressing.<\/td>\r\n<td style=\"width: 288.542px; height: 23px;\">Unknown; fewer than 3% of men report ever being aroused by cross-dressing.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n&nbsp;\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>BDSM<\/strong>\u00a0<strong>(bondage, domination, sadomasochism):<\/strong> a\u00a0colloquial term relating to individuals who willingly engage in consenting forms of pain or humiliation, typically for sexual purposes\r\n\r\n<strong>exhibitionism:\u00a0<\/strong>the exposure of an individual\u2019s genitalia to unsuspecting strangers for sexual satisfaction\r\n\r\n<strong>frotteurism:\u00a0<\/strong>the touching of or rubbing against a nonconsenting person\r\n\r\n<strong>paraphilias:\u00a0<\/strong>persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature\r\n\r\n<strong>paraphilic coercive disorder: <\/strong>the preference for non-consenting over consenting sexual partners\r\n\r\n<strong>Partialism: <\/strong>sexual interest\u00a0with an exclusive focus on a specific part of the body other than the genitals\r\n\r\n<strong>pedophilia:<\/strong> any sexual activity with a prepubescent child, where the offender\/patient is at least sixteen years of age, and the victim is at least five years younger\r\n\r\n<strong>sexual fetishism<\/strong>\u00a0or\u00a0<strong>erotic fetishism:<\/strong>\u00a0sexual fixation on a nonliving object or nongenital body part\r\n\r\n<strong>sexual masochism:<\/strong>\u00a0the derivation of sexual arousal from being the recipient of physical or mental abuse and\/or humiliation\r\n\r\n<strong>sexual sadism:<\/strong>\u00a0when sexual arousal is gained from inflicting mental or physical suffering on a nonconsenting person\r\n\r\n<strong>toucherism: <\/strong>sexual arousal\u00a0based on grabbing or rubbing one\u2019s hands against an unexpecting (and non-consenting) person\r\n\r\n<strong>transvestic fetishism:<\/strong>\u00a0the derivation of sexual arousal from cross-dressing or dressing in clothes of the opposite sex\r\n\r\n<strong>voyeurism:\u00a0<\/strong>the viewing of an unsuspecting person engaging in disrobing or sexual activity\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li style=\"font-weight: 400;\">Describe and differentiate between paraphilias: fetishism, transvestic fetishism, exhibitionism, voyeurism, frotteurism, sexual sadism, sexual masochism, and pedophilia<\/li>\n<\/ul>\n<\/div>\n<p>As mentioned earlier,<strong> paraphilias<\/strong> are persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature.\u00a0We will discuss the characteristics and etiology of the\u00a0eight paraphilias listed in the DSM-5\u00a0<span style=\"font-size: 1em;\">fetishism, transvestic fetishism,<\/span><span style=\"font-size: 1rem; text-align: initial;\">\u00a0exhibitionism, voyeurism,\u00a0<\/span><span style=\"font-size: 1em;\">frotteurism,\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">sexual sadism, sexual masochism, and\u00a0<\/span><span style=\"text-align: initial;\"><span style=\"font-size: 1em;\">pedophilia. Pedophilia will be discussed in a separate section <\/span>because<span style=\"font-size: 1em;\">\u00a0of its close relationship to criminal behavior and will be <\/span>followed<span style=\"font-size: 1em;\">\u00a0by a discussion on sex and violence.\u00a0<\/span><\/span><\/p>\n<p>No consensus has been found for any precise border between unusual sexual interests and paraphilic ones. There is debate over which, if any, of the paraphilias should be listed in diagnostic manuals, such as the DSM-5 or ICD-11.\u00a0The number and taxonomy of paraphilias is under debate; one source lists as many as 549 types of paraphilias. The DSM-5 has specific listings for eight paraphilic disorders, but several sub-classifications of the paraphilias have been proposed and some argue that a fully dimensional, spectrum, or complaint-oriented approach would better reflect the evidence.<\/p>\n<p>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 &#8220;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.&#8221;<a class=\"footnote\" title=\"&quot;Paraphilic Disorders&quot;. Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Philadelphia, Pennsylvania: American Psychiatric Publishing. 2013. pp. 685\u2013686.\" id=\"return-footnote-819-1\" href=\"#footnote-819-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<h2>Types of Paraphilias<\/h2>\n<div id=\"attachment_4131\" style=\"width: 199px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4131\" class=\"wp-image-4131\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/04190746\/Crossdressing_boy-225x300.jpg\" alt=\"A cross-dressing man.\" width=\"189\" height=\"252\" \/><\/p>\n<p id=\"caption-attachment-4131\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Cross-dressing is not always a result of transvestic fetishism.<\/p>\n<\/div>\n<p><span style=\"font-size: 1em;\"><strong>Fetishism<\/strong> is the use of nonliving objects, most commonly shoes and undergarments, for sexual pleasure. <strong>Transvestic fetishism<\/strong> is the derivation of sexual arousal from cross-dressing or dressing in clothes of the opposite sex.\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\"><strong>Exhibitionism<\/strong> is the exposure of an individual\u2019s genitalia to unsuspecting strangers for sexual satisfaction.\u00a0<strong>Voyeurism<\/strong> is the viewing of an unsuspecting person engaging in disrobing or sexual activity. <strong>Frotteurism<\/strong> is the touching of or rubbing against a nonconsenting person. <strong>Sexual masochism<\/strong> is the derivation of sexual arousal from being the recipient of physical or mental abuse and\/or humiliation. <strong>Sexual sadism<\/strong> is when sexual arousal is gained from inflicting mental or physical suffering on a nonconsenting person. <strong>Pedophilia<\/strong> is any sexual activity with or sexual fantasies about a prepubescent child, where the offender is at least sixteen years of age.\u00a0<\/span><\/p>\n<h2>Etiology<\/h2>\n<p>The exact etiology of paraphilia and paraphilic disorders is unknown. However, it is thought that a combination of neurobiological, interpersonal, and cognitive processes all play a role. Literature also points towards various genetic factors contributing to the development of pedophilia and pedophilic disorder, with recent evidence displaying a positive correlation of the COMT Val158Met (rs4680) polymorphism in paraphilic child sexual offenders. A recent study focusing on neurotransmission of paraphilic disorders found evidence to suggest that central dopamine plays a key role in the pathogenesis of paraphilic disorders as well as the general disturbance of the conscious regulation of behavior. The results of this study revealed increased levels of serotonin and norepinephrine, with a decreased concentration of DOPAC (3,4-dihydroxyphenylacetic acid) in urine samples of the test population diagnosed with paraphilic disorders. A correlation was made between serotonin and norepinephrine with obsessive disturbances and an association of DOPAC with affective and dissociative disorders.<\/p>\n<h2>Epidemiology<\/h2>\n<p>Literature is lacking with information pertaining to the epidemiology of paraphilia and paraphilic disorders. Literature is also limited from an epidemiological standpoint, with paraphilia typically studied in a general sense rather than pertaining to specific paraphilia or paraphilic disorders. Paraphilias, in general, are more common in men, with reasons unknown. A recent study conducted looked specifically at the desire for and experience of paraphilic behaviors of a sample population demographically representative of the general population. The sample size contained a total of 1,040 persons classified according to gender, age, education, ethnicity, religion, and location of residency. It was found that almost half of the study population expressed interest in one or more paraphilic categories, with approximately one-third of this population actually acting on this interest at least once. Specifically, fetishism, frotteurism, voyeurism, and masochism held a prevalence of 15.9% (value considered to be statistically unusual), with interest in both males and females. Interest levels in fetishism and masochism revealed no statistically significant difference amongst males and females. It was also found that the most common paraphilic interest amongst men is often voyeurism and fetishism.<\/p>\n<p>Let&#8217;s learn a little bit more about the types of paraphillic disorders.<\/p>\n<h2>Fetishistic Disorder<\/h2>\n<div id=\"attachment_4133\" style=\"width: 279px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4133\" class=\"wp-image-4133\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/04191016\/35755503564_ed818d4bae_k-300x200.jpg\" alt=\"A foot with toenails painted purple wearing a sandal.\" width=\"269\" height=\"179\" \/><\/p>\n<p id=\"caption-attachment-4133\" class=\"wp-caption-text\"><strong>Figure 2<\/strong>. Foot fetishes are more common than you think.<\/p>\n<\/div>\n<p><b>Sexual fetishism<\/b>\u00a0or\u00a0<b>erotic fetishism<\/b>\u00a0is a sexual fixation on a nonliving object or nongenital body part.\u00a0The object of interest is called the\u00a0<b>fetish<\/b>; the person who has\u00a0<i>a fetish<\/i>\u00a0for that object is a\u00a0<b>fetishist<\/b>.\u00a0Sexual arousal\u00a0from a particular body part can be further classified as\u00a0<strong>partialism<\/strong>, or\u00a0sexual interest\u00a0with an exclusive focus on a specific part of the body other than the genitals.<sup id=\"cite_ref-DSM-5_1-0\" class=\"reference\"><\/sup><sup id=\"cite_ref-h_2-0\" class=\"reference\"><\/sup>\u00a0Partialism is categorized as a\u00a0fetishistic disorder\u00a0in the\u00a0DSM-5\u00a0only if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life. Fetishism is diagnosed by\u00a0recurrent 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 that occur for at least six months. It must cause significant stress or impairment and not be related to clothing used in cross-dressing (transvestic disorder) or objects used for genital stimulation, like a vibrator.<\/p>\n<p>Individuals who exhibit partialism sometimes describe the anatomy of interest to them as having an equal or greater\u00a0erotic attraction\u00a0for them as do the genitals.\u00a0Partialism occurs in\u00a0heterosexual,\u00a0bisexual, and\u00a0homosexual\u00a0individuals.\u00a0The\u00a0foot\u00a0is considered one of the most common partialisms.<\/p>\n<div class=\"textbox exercises\">\n<h3>Partialisms<\/h3>\n<p>The following are some of the partialisms commonly found among those with fetishes:<\/p>\n<table class=\"wikitable\">\n<tbody>\n<tr>\n<th>Formal name<\/th>\n<th>Common name<\/th>\n<th>Source of arousal<\/th>\n<\/tr>\n<tr>\n<td>Podophilia<\/td>\n<td>Foot fetish<\/td>\n<td>Foot<\/td>\n<\/tr>\n<tr>\n<td>Oculophilia<\/td>\n<td>Eye fetish<\/td>\n<td>Eye<\/td>\n<\/tr>\n<tr>\n<td>Maschalagnia<\/td>\n<td>Armpit fetish<\/td>\n<td>Armpits<\/td>\n<\/tr>\n<tr>\n<td>Mazophilia<\/td>\n<td>Breast fetish<\/td>\n<td>Breasts<\/td>\n<\/tr>\n<tr>\n<td>Pygophilia<\/td>\n<td>Buttocks fetish<\/td>\n<td>Buttocks<\/td>\n<\/tr>\n<tr>\n<td>Nasophilia<\/td>\n<td>Nose fetish<\/td>\n<td>Nose<\/td>\n<\/tr>\n<tr>\n<td>Trichophilia<\/td>\n<td>Hair fetish<\/td>\n<td>Hair<\/td>\n<\/tr>\n<tr>\n<td>Alvinophilia<\/td>\n<td>Navel\/Belly button fetish<\/td>\n<td>Navel<\/td>\n<\/tr>\n<tr>\n<td>Alvinolagnia<\/td>\n<td>Belly\/Stomach fetish<\/td>\n<td>Belly<\/td>\n<\/tr>\n<tr>\n<td>Cheirophilia<\/td>\n<td>Hand fetish<\/td>\n<td>Hands<\/td>\n<\/tr>\n<tr>\n<td>Crurophilia<\/td>\n<td>Leg fetish<\/td>\n<td>Legs<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<p>While medical definitions restrict the term\u00a0<i>sexual fetishism<\/i>\u00a0to objects or body parts,\u00a0<i>fetish<\/i>\u00a0can, in common discourse, also refer to sexual interest in specific activities.\u00a0This broader usage of\u00a0<i>fetish<\/i>\u00a0covers parts or features of the body (including obesity and body modifications), objects, situations and activities (such as\u00a0<strong>BDSM<\/strong>\u2014a variety of often\u00a0erotic\u00a0practices or\u00a0roleplaying\u00a0involving\u00a0bondage,\u00a0discipline,\u00a0dominance and submission,\u00a0sadomasochism, and other related interpersonal dynamics).\u00a0Paraphilias\u00a0such as\u00a0urophilia,\u00a0necrophilia, and\u00a0coprophilia\u00a0have been described as fetishes.<\/p>\n<p><strong>Erotic<\/strong> <strong>asphyxiation<\/strong>\u00a0is 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 that can result in strangulation when there is no one to help if the device gets too tight and strangles the user.<\/p>\n<h2>Transvestic Disorder<\/h2>\n<p><b>Transvestism\u00a0<\/b>is the practice of\u00a0cross-dressing<b>, <\/b>which\u00a0is the act of wearing items of clothing and other\u00a0accoutrements\u00a0commonly associated with the opposite sex within a particular society.\u00a0The term\u00a0<i>cross-dressing<\/i>\u00a0refers 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\u00a0transgender. A transvestic disorder is characterized by intense sexual arousal from cross-dressing that has occurred for at least six months, which also causes significant distress or impairment. It should be specified if it occurs with fetishism, meaning arousal by materials related to cross-dressing, or with autogynephilia, which includes arousal by thoughts of oneself as a female.<\/p>\n<p>A\u00a0transvestic fetishist\u00a0is a person who cross-dresses as part of a\u00a0sexual fetish. According to the DSM-4, this fetishism was limited to\u00a0heterosexual\u00a0men; however, DSM-5 does not have this restriction, and opens it to women and men, regardless of their\u00a0sexual orientation.<\/p>\n<p>Transvestic fetishism,\u00a0<i>fetishistic transvestism<\/i>,\u00a0and sometimes\u00a0<i>transvestism<\/i>\u00a0are also often used to describe\u00a0<i>any<\/i>\u00a0sexual\u00a0behavior or\u00a0arousal\u00a0that is in any way triggered by the\u00a0clothes\u00a0of the other\u00a0gender. Especially the latter is problematic because transvestism and cross-dressing are neither a\u00a0sexual\u00a0fetish nor do they necessarily have anything to do with sexual behavior or arousal.<\/p>\n<p>Also, not every sexual behavior where clothes of the opposite gender are involved is\u00a0<i>transvestic fetishism<\/i>; they are also often used in sexual\u00a0roleplay\u00a0without being a\u00a0fetish. Also, many\u00a0transgendered\u00a0people, mostly\u00a0transwomen, also cross-dress before\u00a0coming out\u00a0in sexual contexts to relieve their cross-gender feelings. This behavior is likewise not considered\u00a0<i>transvestic fetishism<\/i>, as it is not cross-dressing for sexual\u00a0pleasure, rather it is simply their self-gender expression.<\/p>\n<p>Some male transvestic fetishists collect women&#8217;s\u00a0clothing, e.g., nightgowns,\u00a0babydolls,\u00a0slips, other types of\u00a0nightwear,\u00a0lingerie\u00a0stockings, 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\u00a0silk\u00a0or\u00a0nylon\u00a0and adore the\u00a0silky\u00a0fabric of women&#8217;s nightwear, lingerie, and nylons.<\/p>\n<p>Most transvestic fetishists are said to be\u00a0heterosexual\u00a0men, although there are no studies that accurately represent either their\u00a0sexual orientation\u00a0or\u00a0gender, 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\u00a0women, and desire surgical or hormonal gender-affirming services. In such cases the diagnosis should be changed to\u00a0transsexualism (or gender dysphoria).<\/p>\n<h2>Exhibitionist Disorder<\/h2>\n<div id=\"attachment_4134\" style=\"width: 310px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4134\" class=\"wp-image-4134 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/04191552\/exhibitionism-3066668_1920-300x214.jpg\" alt=\"Two figurines. One has its coat open and is exposing itself to the the other.\" width=\"300\" height=\"214\" \/><\/p>\n<p id=\"caption-attachment-4134\" class=\"wp-caption-text\"><strong>Figure 3.<\/strong> Exposing oneself to only an intimate partner may not be considered exhibitionism.<\/p>\n<\/div>\n<p><b>Exhibitionism<\/b>\u00a0is the act of exposing in a public or semi-public context those parts of one&#8217;s body that are not normally exposed\u2014for example, the\u00a0breasts,\u00a0genitals, or\u00a0buttocks. 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.\u00a0Exposing oneself only to an\u00a0intimate partner\u00a0is normally not regarded as exhibitionism. In law, the act of exhibitionism may be called\u00a0indecent exposure, &#8220;exposing one&#8217;s person,&#8221; or other expressions.<\/p>\n<p>When exhibitionistic sexual interest is acted on with a non-consenting person or interferes with a person&#8217;s quality of life or\u00a0normal\u00a0functioning, it can be diagnosed as\u00a0<strong>exhibitionistic disorder<\/strong>\u00a0in the\u00a0DSM-5. The DSM states that the highest possible prevalence for exhibitionistic disorder in men is 2%-4%. It is thought to be much less common in women.<\/p>\n<p>Exhibitionists in some cases masturbate while exposing themselves (or while fantasizing that they are exposing themselves) 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.<\/p>\n<h3>Child versus Adult Presentation<\/h3>\n<p>Generally, society accepts exhibitionism in children as a natural curiosity, not a disorder; however, if the behaviors continue, a paraphilia is probable. The disorder appears to develop before the age of 18 and rarely is found in people over the age of 50.<\/p>\n<h3>Gender and Cultural Differences in Presentation<\/h3>\n<p>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 outfits 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 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.<\/p>\n<h4>Epidemiology<\/h4>\n<p>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.\u00a0<span id=\"Risk_Factors\" class=\"mw-headline\">Risk factors appear to be a<\/span>ntisocial history, antisocial personality disorder, a<span style=\"font-size: 1em;\">lcohol misuse, and p<\/span><span style=\"font-size: 1em;\">edophilic sexual preference.<\/span><\/p>\n<h2 id=\"firstHeading\" class=\"firstHeading\" lang=\"en\">Voyeuristic Disorder<\/h2>\n<p>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.\u00a0The term comes from the French\u00a0<i>voir<\/i>\u00a0which means &#8220;to see.&#8221; A male voyeur is commonly labelled as &#8220;Peeping Tom&#8221; or a &#8220;Jags,&#8221; a term which originates from the\u00a0Lady Godiva\u00a0legend.\u00a0However, that term is usually applied to a male who observes somebody secretly and, generally, not in a\u00a0public space.<\/p>\n<p>It is diagnosed by recurrent and intense sexual arousal stemming from observing an unsuspecting person who is naked, undressing, or engaging in sexual activity. It should cause significant distress and the person must be at least 18 years old.<\/p>\n<p>Research found voyeurism to be the most common sexual law-breaking behavior in both clinical and general populations.<a class=\"footnote\" title=\"&quot;The DSM Diagnostic Criteria for Exhibitionism, Voyeurism, and Frotteurism&quot; (PDF). Niklas Langstrom. Retrieved 2013-04-04.\" id=\"return-footnote-819-2\" href=\"#footnote-819-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a> In the same study, it was found that 42% of college males who had never been convicted of a crime had watched others in sexual situations. An earlier study indicates that 54% of men have voyeuristic fantasies, and that 42% have tried voyeurism. In a national study of Sweden, it was found that 7.7% of the population (both men and women) had engaged in voyeurism at some point.<a class=\"footnote\" title=\"L\u00e5ngstr\u00f6m, Niklas; Seto, Michael C. (2006). &quot;Exhibitionistic and Voyeuristic Behavior in a Swedish National Population Survey&quot;. Archives of Sexual Behavior. 35 (4): 427\u201335. doi:10.1007\/s10508-006-9042-6. PMID 16900414\" id=\"return-footnote-819-3\" href=\"#footnote-819-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a> It is also believed that voyeurism occurs up to 150 times more frequently than police reports indicate. This same study also indicates that there are high levels of co-occurrence between voyeurism and exhibitionism, finding that 63% of voyeurs also report exhibitionist behavior.<\/p>\n<h2 id=\"firstHeading\" class=\"firstHeading\" lang=\"en\">Frotteuristic Disorder<\/h2>\n<p>Frotteurism\u00a0is a\u00a0paraphilic\u00a0interest in rubbing, usually one&#8217;s\u00a0pelvic\u00a0area or erect\u00a0penis, against a non-consenting person for\u00a0sexual pleasure. It may involve touching any part of the body, including the genital area.\u00a0<strong>Frotteuristic disorder<\/strong> is a sexual dysfunction disorder characterized by sexual arousal from rubbing against or touching a non-consenting person.<\/p>\n<p>The DSM-5 lists the following diagnostic criteria for frotteuristic disorder:<\/p>\n<ul>\n<li>Over a period of at least six months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors.<\/li>\n<li>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.<\/li>\n<\/ul>\n<p>If the individual has not acted on their interest and experiences no distress or impairment, they are considered to have a frotteuristic sexual interest, but not frotteuristic disorder. Some sexologists distinguish between frotteurism (as pelvic rubbing) and toucherism (as groping with hands), but the DSM does not.<\/p>\n<p>The prevalence of frotteurism is unknown. The DSM estimates that 10\u201314% 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.<\/p>\n<p>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.<\/p>\n<h2 class=\"firstHeading\" lang=\"en\">Sexual Masochism and Sexual Sadism Disorders<\/h2>\n<p><b>Sexual masochism disorder<\/b>\u00a0<strong>(SMD)<\/strong> is the condition of experiencing recurring and intense\u00a0sexual arousal\u00a0in response to enduring moderate or extreme pain, suffering, or\u00a0humiliation. Conversely, <strong>s<\/strong><b>exual sadism disorder<\/b>\u00a0is the condition of experiencing\u00a0sexual arousal\u00a0in response to the extreme pain, suffering, or\u00a0humiliation\u00a0of others.\u00a0The words\u00a0<em>sadism<\/em>\u00a0and\u00a0<i>sadist<\/i>\u00a0are derived from\u00a0Marquis de Sade.\u00a0Many of\u00a0Marquis de Sade&#8217;s books, including\u00a0<i>Justine<\/i>\u00a0(1791),\u00a0<i>Juliette<\/i>\u00a0(1797) and\u00a0<i>The 120 Days of Sodom<\/i>\u00a0(published posthumously in 1905), are written from a cruelly sadistic viewpoint.<\/p>\n<p><strong>BDSM<\/strong>\u00a0(bondage, domination, sadomasochism) is a colloquial term relating to individuals who willingly engage in consenting forms of pain or humiliation, typically for sexual purposes.\u00a0The term\u00a0BDSM\u00a0describes the activities between consenting partners that contain sadistic and masochistic elements. Many behaviors such as\u00a0erotic spanking,\u00a0tickling, and\u00a0love-bites\u00a0that many people think of only as &#8220;rough&#8221; sex also contain elements of sado-masochism. BDSM is not currently a diagnosable condition in either the DSM or ICD system.<\/p>\n<h3>Sexual Masochism<\/h3>\n<p>The formal diagnosis of sexual masochism disorder according to the DSM-5 involves &#8220;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.&#8221; It applies only if the individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning.<\/p>\n<p>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.<\/p>\n<p>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).\u00a0Behaviors sometimes include being forced to cross-dress or being treated like an infant.<\/p>\n<p>Following a phenomenological study of individuals 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.\u00a0A behavioral spin is described as a process one goes through that is characterized by a behavior growing in frequency and magnitude. 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.<\/p>\n<h3>Sexual Sadism Disorder<\/h3>\n<p>Sexual sadism disorder refers to the &#8220;recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors.&#8221; The formal diagnosis of sexual sadism disorder would apply if the individual has acted on these urges with a nonconsenting person or if the urges cause significant distress to the individual.<\/p>\n<p><strong>Paraphilic coercive disorder\u00a0<\/strong>refers to the preference for non-consenting over consenting sexual partners.\u00a0It 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\u00a0Biastophilia,\u00a0Coercive Paraphilic Disorder,\u00a0and\u00a0Preferential Rape.<\/p>\n<p>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,\u00a0but 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.\u00a0In 40% of cases, the offender kept a personal item of the victim as a souvenir.<\/p>\n<p>On personality testing, sadistic rapists apprehended by law enforcement have shown elevated traits of impulsivity, hypersexuality, callousness, and psychopathy.\u00a0Although there appears to be a continuum of severity from mild (<i>hyperdominance<\/i>\u00a0or\u00a0<i>BDSM<\/i>) to moderate (<i>paraphilic coercive disorder<\/i>) to severe (<i>sexual sadism disorder<\/i>), it is not clear if they are genuinely related or only appear related superficially.<\/p>\n<p>Very little is known about how sexual sadism disorder develops.\u00a0Most of the people diagnosed with sexual sadism disorder come to the attention of authorities by committing sexually motivated crimes.\u00a0Surveys have also been conducted to include people who are interested in only mild and consensual forms of sexual pain\/humiliation (BDSM).<\/p>\n<p>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.\u00a0<sup id=\"cite_ref-20\" class=\"reference\"><\/sup><sup id=\"cite_ref-21\" class=\"reference\"><\/sup><sup id=\"cite_ref-22\" class=\"reference\"><\/sup>People with sexual sadism disorder are at an elevated likelihood of having other paraphilic sexual interests.<\/p>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_52ee333a-6040-4ef3-8bed-5d1066bbfbe2\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/52ee333a-6040-4ef3-8bed-5d1066bbfbe2?iframe_resize_id=assessment_practice_id_52ee333a-6040-4ef3-8bed-5d1066bbfbe2\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_448fe4d3-9c25-4c0e-a349-5699b0d56e70\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/448fe4d3-9c25-4c0e-a349-5699b0d56e70?iframe_resize_id=assessment_practice_id_448fe4d3-9c25-4c0e-a349-5699b0d56e70\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>Watch this video to review the main components of each of the paraphilic disorders in the DSM-5.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=5576161&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=YOV61lKxqxY&amp;video_target=tpm-plugin-3hikt5b6-YOV61lKxqxY\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/WhatAreParaphilicDisorders_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;What are Paraphilic Disorders?&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>Key Takeaways: Paraphilic Disorders<\/h3>\n<table style=\"height: 218px; width: 847px;\">\n<caption>\u00a0<\/caption>\n<thead>\n<tr style=\"height: 11px;\">\n<th style=\"width: 834.097px; height: 11px;\" colspan=\"3\">Table 1. Paraphilic Disorders as Described in the\u00a0DSM-5<\/th>\n<\/tr>\n<tr style=\"height: 11px;\">\n<th style=\"width: 137.431px; height: 11px;\">Disorder<\/th>\n<th style=\"width: 385.208px; height: 11px;\">Description<\/th>\n<th style=\"width: 288.542px; height: 11px;\">Prevalence<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"height: 23px;\">\n<td style=\"width: 137.431px; height: 23px;\">Voyeuristic Disorder<\/td>\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from watching another person who is naked, undressing, or engaged in sexual activities.<\/td>\n<td style=\"width: 288.542px; height: 23px;\">Lifetime prevalence is estimated at the high end to be up to 12% in males and 4% in females.<\/td>\n<\/tr>\n<tr style=\"height: 23px;\">\n<td style=\"width: 137.431px; height: 23px;\">Exhibitionistic Disorder<\/td>\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from showing genitals to an unsuspecting person.<\/td>\n<td style=\"width: 288.542px; height: 23px;\">Highest prevalence predicted to be 2%-4% of males, and unknown for females.<\/td>\n<\/tr>\n<tr style=\"height: 23px;\">\n<td style=\"width: 137.431px; height: 23px;\">Frotteuristic Disorder<\/td>\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person.<\/td>\n<td style=\"width: 288.542px; height: 23px;\">Unknown<\/td>\n<\/tr>\n<tr style=\"height: 35px;\">\n<td style=\"width: 137.431px; height: 35px;\">Sexual Masochism Disorder<\/td>\n<td style=\"width: 385.208px; height: 35px;\">Recurrent and intense sexual arousal from being bound, beaten, or made to suffer in some way.<\/td>\n<td style=\"width: 288.542px; height: 35px;\">Unknown; Australia estimates show that 2.2% of males and 1.3% of females were involved in sadomasochistic behaviors in the past 12 months.<\/td>\n<\/tr>\n<tr style=\"height: 23px;\">\n<td style=\"width: 137.431px; height: 23px;\">Sexual Sadism Disorder<\/td>\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from the physical or psychological suffering of another person.<\/td>\n<td style=\"width: 288.542px; height: 23px;\">Unknown, estimates vary between 2% and 20%. Of sex offenders in the United States, 10% have sexual sadism.<\/td>\n<\/tr>\n<tr style=\"height: 23px;\">\n<td style=\"width: 137.431px; height: 23px;\">Pedophilic Disorder<\/td>\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal and fantasies related to sexual activity with a prepubescent child or children under age 13.<\/td>\n<td style=\"width: 288.542px; height: 23px;\">Unknown; highest prevalence approximately 3%-5%.<\/td>\n<\/tr>\n<tr style=\"height: 23px;\">\n<td style=\"width: 137.431px; height: 23px;\">Fetishistic Disorder<\/td>\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from either nonliving objects, or on nongenital body parts.<\/td>\n<td style=\"width: 288.542px; height: 23px;\">Unknown<\/td>\n<\/tr>\n<tr style=\"height: 23px;\">\n<td style=\"width: 137.431px; height: 23px;\">Transvestic Disorder<\/td>\n<td style=\"width: 385.208px; height: 23px;\">Recurrent and intense sexual arousal from cross-dressing.<\/td>\n<td style=\"width: 288.542px; height: 23px;\">Unknown; fewer than 3% of men report ever being aroused by cross-dressing.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>BDSM<\/strong>\u00a0<strong>(bondage, domination, sadomasochism):<\/strong> a\u00a0colloquial term relating to individuals who willingly engage in consenting forms of pain or humiliation, typically for sexual purposes<\/p>\n<p><strong>exhibitionism:\u00a0<\/strong>the exposure of an individual\u2019s genitalia to unsuspecting strangers for sexual satisfaction<\/p>\n<p><strong>frotteurism:\u00a0<\/strong>the touching of or rubbing against a nonconsenting person<\/p>\n<p><strong>paraphilias:\u00a0<\/strong>persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature<\/p>\n<p><strong>paraphilic coercive disorder: <\/strong>the preference for non-consenting over consenting sexual partners<\/p>\n<p><strong>Partialism: <\/strong>sexual interest\u00a0with an exclusive focus on a specific part of the body other than the genitals<\/p>\n<p><strong>pedophilia:<\/strong> any sexual activity with a prepubescent child, where the offender\/patient is at least sixteen years of age, and the victim is at least five years younger<\/p>\n<p><strong>sexual fetishism<\/strong>\u00a0or\u00a0<strong>erotic fetishism:<\/strong>\u00a0sexual fixation on a nonliving object or nongenital body part<\/p>\n<p><strong>sexual masochism:<\/strong>\u00a0the derivation of sexual arousal from being the recipient of physical or mental abuse and\/or humiliation<\/p>\n<p><strong>sexual sadism:<\/strong>\u00a0when sexual arousal is gained from inflicting mental or physical suffering on a nonconsenting person<\/p>\n<p><strong>toucherism: <\/strong>sexual arousal\u00a0based on grabbing or rubbing one\u2019s hands against an unexpecting (and non-consenting) person<\/p>\n<p><strong>transvestic fetishism:<\/strong>\u00a0the derivation of sexual arousal from cross-dressing or dressing in clothes of the opposite sex<\/p>\n<p><strong>voyeurism:\u00a0<\/strong>the viewing of an unsuspecting person engaging in disrobing or sexual activity<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-819\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Sonja Ann Miller for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Paraphilia. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Paraphilia#DSM-5\">https:\/\/en.wikipedia.org\/wiki\/Paraphilia#DSM-5<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Paraphilia. <strong>Authored by<\/strong>: Kristy A. Fisher; Raman Marwaha.. <strong>Provided by<\/strong>: StatPearls. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK554425\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK554425\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Sexual fetishism. <strong>Provided by<\/strong>: Wikpedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_fetishism\">https:\/\/en.wikipedia.org\/wiki\/Sexual_fetishism<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Partialism. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Partialism\">https:\/\/en.wikipedia.org\/wiki\/Partialism<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Transvestic fetishism. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.wikidoc.org\/index.php\/Transvestic_fetishism\">https:\/\/www.wikidoc.org\/index.php\/Transvestic_fetishism<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Exhibitionism. <strong>Authored by<\/strong>: Dr. Caleb Lack. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/abnormalpsych.wikispaces.com\/\">http:\/\/abnormalpsych.wikispaces.com\/<\/a>. <strong>Project<\/strong>: Abnormal Psychology: An e-text!. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/\">CC BY-NC-SA: Attribution-NonCommercial-ShareAlike<\/a><\/em><\/li><li>Voyeurism. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Voyeurism\">https:\/\/en.wikipedia.org\/wiki\/Voyeurism<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Frotteurism. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Frotteurism\">https:\/\/en.wikipedia.org\/wiki\/Frotteurism<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Sexual masochism disorder. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_masochism_disorder\">https:\/\/en.wikipedia.org\/wiki\/Sexual_masochism_disorder<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Sexual sadism disorder. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_sadism_disorder\">https:\/\/en.wikipedia.org\/wiki\/Sexual_sadism_disorder<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Crossdressing boy. <strong>Authored by<\/strong>: Dws101. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Crossdressing_boy.jpg\">https:\/\/commons.wikimedia.org\/wiki\/File:Crossdressing_boy.jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Foot. <strong>Authored by<\/strong>: Mario A. P.. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.flickr.com\/photos\/99058495@N00\/35755503564\">https:\/\/www.flickr.com\/photos\/99058495@N00\/35755503564<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Figurines. <strong>Authored by<\/strong>: Capri23auto. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/pixabay.com\/photos\/exhibitionism-flitzer-3066668\/\">https:\/\/pixabay.com\/photos\/exhibitionism-flitzer-3066668\/<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Pixabay License<\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>What are Paraphilic Disorders?. <strong>Authored by<\/strong>: Dr. Todd Grande. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?time_continue=1&#038;v=YOV61lKxqxY&#038;feature=emb_logo\">https:\/\/www.youtube.com\/watch?time_continue=1&#038;v=YOV61lKxqxY&#038;feature=emb_logo<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-819-1\">\"Paraphilic Disorders\". <em>Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.)<\/em>. Philadelphia, Pennsylvania: American Psychiatric Publishing. 2013. pp. 685\u2013686. <a href=\"#return-footnote-819-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-819-2\">\"The DSM Diagnostic Criteria for Exhibitionism, Voyeurism, and Frotteurism\" (PDF). Niklas Langstrom. Retrieved 2013-04-04. <a href=\"#return-footnote-819-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-819-3\">L\u00e5ngstr\u00f6m, Niklas; Seto, Michael C. (2006). \"Exhibitionistic and Voyeuristic Behavior in a Swedish National Population Survey\". Archives of Sexual Behavior. 35 (4): 427\u201335. doi:10.1007\/s10508-006-9042-6. PMID 16900414 <a href=\"#return-footnote-819-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":11,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Paraphilia\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Paraphilia#DSM-5\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Paraphilia\",\"author\":\"Kristy A. 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