Fast Five Quiz: Sexual Disorders

Steve Soreff, MD; Bradley Schwartz, DO; Michel E. Rivlin, MD


August 11, 2020

Generally, for each of the specific paraphilic disorders listed in DSM-5, the first diagnostic criterion specifies the qualitative nature of the paraphilia, whereas the second criterion specifies the negative consequences of the paraphilia. Both criteria must be satisfied to establish a diagnosis of a paraphilic disorder. An individual who meets the first criterion but not the second is considered to have a paraphilia but not a paraphilic disorder. A paraphilia by itself, without distress, impairment, or potential or actual harm, does not necessarily require clinical intervention.

The duration of symptoms for paraphilic disorders must be at least 6 months. In addition to the diagnostic criteria, each of the paraphilic disorders in DSM-5 has "further specifiers." For most of these disorders, these further specifiers include considerations about whether or not the individual is in a controlled environment and whether the disorder is in full remission. The concept of full remission is not only an important designation but it also can be controversial. At a minimum, treatment for paraphilic disorders must be provided on a long-term basis.

The DSM-5 diagnostic criteria for fetishistic disorder specifies that the fetishes are not limited to devices designed for genital stimulation (eg, vibrators). The criteria for sexual masochism disorder specifies that the patient experiences recurrent and intense sexual arousal (manifested by fantasies, urges, or behaviors) involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer.

Read more about paraphilic disorders.