Paraphilia
Overview
Historical Perspective
- From biblical times, human societies all across the world, have placed restrictions over many types of sexual behaviors. The level of acceptability is based on cultural variations across the globe.
- There is controversy in what should be called sexual deviation, mainly based on various factors like the degree of consent, age of the involved individuals, degree of distress caused, location of sexual behavior, degree of unacceptable by others, etc. [1]
- Marquis de Sade (1740-1814) gave the term sadism. He was placed in a lunatic asylum multiple times and ultimately, he died there. His mental instability, is considered to heve resulted in his pattern of sexual behavior . [1]
- The term masochism comes from Baron Leopold von Sacher Masoch (1835-1895), who was of European origin.[1]
- At the end of the nineteenth century, sexual deviance was started to be considered a medical condition, with the publication of Psychopathia Sexualis. [1]
Classification
- Earlier the non-reproductive sexual behaviors were considered pathological and criminalized. However, over years the boundaries of pathology has been defined to the absence of sexual consent. [2]
- The inclusion of pathological classification of paraphilias in the DSM and ICD has been criticized for a long time. It is based on the thin line of difference between something that is a normal variation or just unusual, and something that is pathological.
- Till DSM-IV-TR, the diagnostic category of paraphilia was scrutinized for logic, clarity, and consistency. It was criticized for the fulfillment of a clear-cut mental illness.[3]
- There were proposals to remove paraphilias as a diagnostic category from DSM-5. Some considered the concept of paraphilic disorder as more ideological instead of scientific. [4][5]
- Despite the on-going controversies, in DSM-5, the paraphilias have been assigned a separate chapter and are termed Paraphilic disorders. [6]
- It has been found that DSM-5 diagnostic criteria for paraphilias can increase the false-positive diagnoses and attaining this diagnosis can produce many legal consequences. [7]
- ICD-10 does not comprise a clear-cut definition of paraphilia.[8]
Pathophysiology
==Differential Diagnosis
Epidemiology and Demographics
The actual prevalence of Paraphilic disorders is difficult to estimate because of existence of the nonclinical subjects.[9]
Age
Patients of all age groups may develop [disease name].
Gender
- The levels of interest in fetishism and masochism have not been found to be significantly different between women and men.[9]
Race
There is no racial predilection to [disease name].
Risk Factors
Screening
Natural History, Complications, and Prognosis
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Diagnosis
Treatment
Medical Therapy
- ↑ 1.0 1.1 1.2 1.3 Gordon, Harvey (2008). "The treatment of paraphilias: An historical perspective". Criminal Behaviour and Mental Health. 18 (2): 79–87. doi:10.1002/cbm.687. ISSN 0957-9664.
- ↑ Giami, Alain (2015). "Between DSM and ICD: Paraphilias and the Transformation of Sexual Norms". Archives of Sexual Behavior. 44 (5): 1127–1138. doi:10.1007/s10508-015-0549-6. ISSN 0004-0002.
- ↑ Moser, Charles; Kleinplatz, Peggy J. (2006). "DSM-IV-TRand the Paraphilias". Journal of Psychology & Human Sexuality. 17 (3–4): 91–109. doi:10.1300/J056v17n03_05. ISSN 0890-7064.
- ↑ Downing, Lisa (2015). "Heteronormativity and Repronormativity in Sexological "Perversion Theory" and the DSM-5's "Paraphilic Disorder" Diagnoses". Archives of Sexual Behavior. 44 (5): 1139–1145. doi:10.1007/s10508-015-0536-y. ISSN 0004-0002.
- ↑ Spitzer, Robert L. (2006). "Sexual and Gender Identity Disorders". Journal of Psychology & Human Sexuality. 17 (3–4): 111–116. doi:10.1300/J056v17n03_06. ISSN 0890-7064.
- ↑ Krueger RB, Kaplan MS (2012). "Paraphilic diagnoses in DSM-5". Isr J Psychiatry Relat Sci. 49 (4): 248–54. PMID 23585461.
- ↑ First MB (2014). "DSM-5 and paraphilic disorders". J Am Acad Psychiatry Law. 42 (2): 191–201. PMID 24986346.
- ↑ McManus, Michelle A.; Hargreaves, Paul; Rainbow, Lee; Alison, Laurence J. (2013). "Paraphilias: definition, diagnosis and treatment". F1000Prime Reports. 5. doi:10.12703/P5-36. ISSN 2051-7599.
- ↑ 9.0 9.1 Joyal, Christian C.; Carpentier, Julie (2016). "The Prevalence of Paraphilic Interests and Behaviors in the General Population: A Provincial Survey". The Journal of Sex Research. 54 (2): 161–171. doi:10.1080/00224499.2016.1139034. ISSN 0022-4499.