Magazine article Clinical Psychiatry News

Debate Continues over Categorizing Paraphilias

Magazine article Clinical Psychiatry News

Debate Continues over Categorizing Paraphilias

Article excerpt

SCOTTSDALE, ARIZ. -- Paraphilias should be thought of more as sexual disorders, rather than as anxiety disorders, H. Martin Malin, Ph.D., said in a poster presentation at the annual meeting of the American Academy of Psychiatry and the Law.

Although the DSM-IV Text Revision currently classifies paraphilias as sexual disorders, it has not always been so. "Beginning with the first DSM published in 1952, so-called sexual deviation was classified under the broad rubric of 'personality disorders,' specifically 'sociopathic personality disturbance,'" said Dr. Malin of the National Institute for the Study, Prevention, and Treatment of Sexual Trauma, Baltimore.

The term paraphilia did not enter the DSM until 1980, with the DSM-III. "Since that time, 'paraphilia' has come to mean different things to different people," Dr. Malin noted. Often, people use the term pejoratively. "It is not uncommon for even well-educated professionals who have heard the term 'paraphile' or 'paraphiliac' to confuse it with 'pedophile,' arguably the most pejorative label society can currently attach to a human being," he said.

The debate over how to classify paraphilias is more than academic "An exhibitionist who acts on his paraphilia, [such as] by exposing his genitals to a nonconsenting individual, is typically considered to be a sociopath, rather than an individual suffering from a medical or psychiatric disorder. His behavior is considered to be entirely volitional and will usually elicit little sympathy," according to the researcher.

On the other hand, someone who uses legal or illegal substances is more likely to be viewed as "ill, volitionally impaired, or addicted," Dr. Malin said. Because of some similarities between paraphilic sexual behavior and inappropriate drug use, the terms sexual addiction and sexual compulsion have recently become more popular, but they haven't made it into the DSM-IV.

Those two terms "carry with them the notion of hypersexuality as measured by total sexual outlet above some defined level," and some people have attempted to classify hypersexual arousal patterns into two subcategories: paraphilias, which are behavior patterns that are illegal and highly socially stigmatized, and paraphilia-related disorders, which are legal and less socially stigmatized. …

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