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Posted by on Nov 15, 2013 in Mental Health, Outreach, Psychology | 7 comments

Paraphilias to Paraphilic Disorders: Changes in the DSM-5

This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare three 1,000ish word posts on a particular class of mental disorders, with one of those focusing on changes made from the DSM-IV to the DSM-5.

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Paraphilias to Paraphilic Disorders: Changes in the DSM-5 by Derrick Meyers

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) was released in May of 2013.  The DSM-5 release brings numerous changes to several categories of mental disorders.  The task at hand is to determine what is different from the DSM-IV-TR and what is the same for the paraphilic disorders.  Overall, the paraphilic disorders did not get a major overhaul, but there are some subtle changes.  The three major category changes in the DSM-5 are a) the distinction between paraphilias and paraphilic disorders and slight changes to the criteria, b) addition of new specifiers, and c) some wording changes.

The DSM-5 keeps the basic diagnostic criteria and structure from the DSM-IV-TR.  A diagnosis requires two general criteria for the seven major disorders (those being voyeuristic, exhibitionistic, frotteuristic, sexual masochism, sexual sadism, pedophilic, and fetishistic disorders) both criterion must be met for diagnosis.  The first criterion (criterion A) is that over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors are experienced.  The second criteria (criterion B) consists of  an individual acting on those sexual urges with a non-consenting person, or that the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.  The two main themes are that the person experiences an intense sexual arousing fantasies, urges, etc., and that the person experiences distress due to this.  This is an improvement over the DSM-IV-TR in that it requires additional criteria to be diagnosed aside from just Criterion A.  This brings us the distinction made between paraphilias and paraphilic disorders.  If you only meet criterion A then you may have a paraphilia, but that’s no longer considered a “disorder.” But, if your paraphilia causes distress then it could be appropriate to be diagnosed with a disorder.  This is a major improvement to the old DSM criteria, in the fact that those with unusual or uncommon sexual interests / urges aren’t unfairly diagnosed and labeled.

The DSM-5 also added two new general specifiers:  “in a controlled environment” and “in full remission.”  In a controlled environment refers to an individual who is currently in a mental institution or prison.  In full remission refers to people who have not experienced distress or impairment in social, occupational, or other areas of function, for at least five years in a normal environment.  These seem to have been added to help clear up diagnosis and help to specify level of potential concern about a person’s symptomology. There is not, however, a clear and unanimous opinion if a paraphilic disorder can remit since most are chronic, even with treatment.

Next, several specific changes were made to individual disorders. A note was added to the diagnostic criteria for pedophilic disorder. that states, “Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12 or 13 year old.”  This is probably a good addition because it may eliminate unnecessary and potentially damaging diagnoses, and prevents someone from receive a severe stigma.  A note for voyeuristic disorder was added removing people who are under 18, and the specifier that the person has to be heterosexual to meet criteria for transvestic disorder has been removed.  These are both positive additions and may clear up any confusion.

Finally, most of the name changes have been to the names of the disorders, and for the most part the DSM-V swapped out the suffix “-ilia” for “-illic,” and “-ism” for “-istic.” Specifically, paraphilia disorders were renamed as paraphillic disorders, frotterurism was renamed as frotteuristic disorder, fetishism was renamed as fetishistic disorder, voyeurism has been renamed as voyeuristic disorder, exhibitionism was renamed as exhibitionistic disorder, transvestic fetishism has been renamed as transvestic disorder, and pedophilia has been changed to pedophilic disorder.

The new DSM-5 was released only a few short months ago, and brought about several changes to paraphillic disorders.  The distinction between a paraphilia and a paraphillic distinction has been made.  Two general specifiers were added, and a note for voyeurism and transvestic fetishism was added.  The names of the disorders also got a slight overhaul. Overall, these changes seem to have well-based on research and clinical opinion, and should prove useful for the psychological community.

  • Distance Left

    Isn’t the single biggest issue with psychology that much of it isn’t empirical and therefore is pretty susceptible to well good old fashioned making things up or ideology and belief, unlikes say medicine.
    I am aware there some empirical studies, but as a discipline it doesn’t qualify as a science, it has no central thesis to falsify, just conjectures.

    • http://www.caleblack.com/ Caleb W. Lack

      I can only assume that you are trolling, asking a psychologist if psychology is a science. Seriously?

      • Distance Left

        No, not at all. Unless it’s changed a lot since I read about how it operates or many empirically falsifiable studies have been done in it (which I’m happy to read) I view the whole discipline in an odd light, as well as psychoanalysis, psychiatry etc. I am aware there is more to Psychology than there is to Economics, which seems to be basically be Pure Maths put to bad use by fools who haven’t the first clue about human behavior.

        This is due to my benchmark for science being Physics however, and being a Biologist, I have a bit of an ingrained ‘o really’ view to ‘Social Sciences’.
        More than happy to have my prejudices erased by decent papers, however, despite the shocking state of peer review.

        • http://www.caleblack.com/ Caleb W. Lack

          Well, then I shall be happy to show you the light that is scientific psychology!

          For a start, you could check out any of the journals published by the Association for Psychological Science (which focuses more on experimental and basic research); Two of the best are Psychological Science (http://pss.sagepub.com) and Psychological Science in the Public Interest (http://www.psychologicalscience.org/index.php/publications/journals/pspi).

          For more clinically-oriented science, I’d recommend Cognitive & Behavioral Practice (http://www.journals.elsevier.com/cognitive-and-behavioral-practice/).

          Now, i will be the first to admit that most psychologists are not scientists, or even trained in scientific methodology, but that doesn’t mean that the field itself is unscientific. That would be like saying the Discovery Institute and “intelligent design” proponents represent the best biology has to offer in the way of scientific finds.

          Psychoanalysis, which you alluded to, is pure bunk, as were the “theories” that it grew out of (Freud, Jung, Adler, et al.). Much of what is done in practice by therapists doesn’t have empirical support, but what scientific, evidence-based psychologists (like myself) use certainly does (often exceeding the efficacy standards for new medications and medical interventions).

          • Distance Left

            Thanks for your time. I will read through that with pleasure in my spare time.

            In the same way The Templeton Prize, is not a good indicator for Nobel placements…or something similar.

            I’m glad you debunked that. Yes there is a hell of a lot of positive publication bias in medicine, Ben Goldacre deals with that well.

            Good to hear, there might well be some good stuff on PLoS One as well which I didn’t think to check.

          • http://www.caleblack.com/ Caleb W. Lack

            PLOS One is a good place to check as well. Here’s a direct link to their Psychology section – http://www.plosone.org/browse/psychology

  • Distance Left

    Then there’s the false memory thing and the rise of neuroscience.