Paraphilic Disorders are characterized by those paraphilias that result in distress or impairment to the individual, or, for the satisfaction of the individual, entail harm, or risk of harm, themselves or to others. Simply having a paraphilia does not meet the requirements for a diagnosis of a paraphilic disorder. 

Paraphilia

Section II of the DSM-5-TR covers the bulk of the manual by including the descriptive text and criteria for each diagnosis. This section also references relevant context and research for the diagnoses and other conditions, medication-related adverse effects and -induced disorders, and corresponding ICD-10 codes. This section is broken down into the following chapters: 

-	Neurodevelopmental Disorders
-	Schizophrenia Spectrum and Other Psychotic Disorders
-	Bipolar and Related Disorders
-	Depressive Disorders
-	Anxiety Disorders
-	Obsessive-Compulsive and Related Disorders
-	Trauma- and Stressor-Related Disorders
-	Dissociative Disorders
-	Somatic Symptom and Related Disorders
-	Feeding and Eating Disorders
-	Elimination Disorders
-	Sleep-Wake Disorders
-	Sexual Dysfunctions
-	Gender Dysphoria 
-	Disruptive, Impulse-Control, and Conduct Disorders
-	Substance-Related and Addictive Disorders
-	Neurocognitive Disorders
-	Personality Disorders
-	Paraphilic Disorder
-	Other Mental Disorders and Additional Codes
-	Medication-Induced Movement Disorders and Other Adverse Effects of Medication
-	Other Conditions that May Be a Focus of Clinical Attention


[DSM-5-TR] Section II: Diagnostic Criteria and Codes

Wiederman, M. W. (2003). Paraphilia and fetishism. The Family Journal, 11(3), 315–321. https://doi.org/10.1177/1066480703252663 

Paraphilia and fetishism

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text revision). https://doi.org/10.1176/appi.books.9780890425596

DSM-5-TR

- Fetishism: involves sexual acts with nonhuman objects (clothing, shoes, etc.)
- Exhibitionism: Exposing one’s genitals to a non-consenting individual 
- Voyeurism: Watching an unsuspecting person or stranger while they are engaged sexually.
- Frotteurism: Rubbing one’s genitals against a non-suspecting individual.
- Pedophilia: Is sexual interest in underage/prepubescent children
- Sadism: Pleasure from inflicting harm on others
- Masochism: Pleasure from being harmed/in pain/humiliated 

Different Kinds of Paraphilia

All races/socioeconomic groups can develop paraphilias. Paraphilias develop in early childhood or adolescence, and the nature of their sexual interest/urges become more intense and elaborate when entering early adulthood.

The Development of Paraphilias

Paraphilic Disorders

Disorder Class: Disruptive, Impulse-Control, and Conduct Disorders

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:
1. Aggression to people and  animals
2. Destruction of property
3. Deceitfulness or theft
4. Serious violations of rules
 
The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
 
If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder
 
Specify age onset:  Individuals show at least one symptom characteristic of conduct disorder prior to age 10 years

[DSM-5] Conduct Disorder Criteria

Borderline personality disorder (BPD) is a mental disorder characterized by unstable interpersonal relationships and extreme emotional reactions to affective stimuli. These emotional reactions include, but are not limited to, impulsivity, aggression, self-injurious behaviors, etc., and are usually at their peak during an episode brought about via a singular crisis, whether it is imagined or real.

Borderline Personality Disorder

Personality Disorders are characterized by a pervasive, inflexible, and enduring pattern of inner experiences and behaviors that significantly deviate from the expectations in the individual’s culture. These patterns are first recognized in adolescence or early adulthood and remain consistent over time, resulting in distress and impairment for the individual. 

Personality Disorders

Neurodevelopmental Disorders are conditions with onset in the developmental period, particularly, early development, often being recognized before the child enters grade school. These conditions are characterized due to developmental deficits or delays that result in impairment in areas of personal, social, academic, or occupational functioning. These impairments vary from very specific limitations, such as learning or control of executive functioning, to global impairments encompassing social skills or intelligence. These conditions are also noted for their frequency to co-occur amongst themselves. 

Neurodevelopmental Disorders

Feeding and Eating Disorders are characterized by persistent changes to eating or eating-related behaviors that result in altered consumption or absorption of food, significantly impairing an individual’s physical health and/or psychosocial functioning. 

Feeding and Eating Disorders

Neurocognitive Disorders are a group of disorders characterized by the primary clinical deficit of the individual being in cognitive functioning that is acquired, not developmental. These disorders have a strongly recognized and researched disease etiology to them making them a unique intersection between psychiatry and pathology. 

Neurocognitive Disorders

Substance-Related and Addictive Disorders are characterized by abusing the activation of the brain reward system through certain behaviors or the use of pharmacological substances. This often results in a sense of increased pleasure, or a “high”, encouraging reinforcement of behaviors and actions that are detrimental to or neglectful of daily activities. Due to insufficient research, repetitive behaviors that have been coined as behavioral addictions (e.g., sex addiction, exercise addiction, or shopping addiction) are excluded from this chapter.

Substance-Related and Addictive Disorders

Depressive Disorders are recognized through the presence of common features such as sad, empty, or irritable moods that are coupled with somatic and cognitive changes affecting an individual’s ability to function. 

Depressive Disorders

Sleep-Wake Disorders are defined using a multidimensional approach due to the expectations for co-existing or comorbid diagnosis in both mental and neurological health. They are largely characterized by individual’s interpretation of having dissatisfying sleep quality, timing, or amount of sleep. These complaints are often expressed alongside issues of distress or impairment during expected daytime activities. 

Sleep-Wake Disorders

Sexual Dysfunctions are characterized by clinically significant disturbances related to an individual’s ability to respond sexually or experience sexual pleasure. This requires a multidimensional approach to diagnoses by considering the biological, sociological, and psychological factors that influence the ways in which individuals experience sex. However, these disorders, do not include sexual dysfunctions that are a result of inadequate or a lack of stimulation or knowledge which may still be treated, but are not diagnosed.

Sexual Dysfunctions

Gender Dysphoria is characterized by the subjectively experienced distress that arises from the mismatch between gender identity, or internally felt sense of gender, and assigned sex at birth.

Gender Dysphoria

Obsessive-Compulsive and Related Disorders are characterized by the presence of obsessions (e.g., thoughts, urges, images), compulsions (e.g., mental or behavioral acts), or both. Characteristics that are not indicative of these disorders include developmentally normative preoccupations and rituals that may be considered excessive or persisting beyond the developmentally appropriate period. 

Obsessive-Compulsive and Related Disorders

Bipolar and Related Disorders are recognized by unusual shifts in mood, energy, activity levels, and concentration, affecting the ability to carry out day-to-day tasks. The presence of mania is a defining trait of bipolar disorder. These shifts range from periods of manic episodes (being extremely “up”, elated, irritable, or energized) and depressive episodes (being very “down”, indifferent, or hopeless).

Bipolar and Related Disorders

Elimination Disorders are characterized by inappropriate elimination of either urine or feces. These disorders are typically diagnosed in childhood or adolescence but are based on developmental age rather than chronological age.

Elimination Disorders

A node to help create and move other nodes around

TEMP Node for DSM 

Dissociative Disorders are characterized by the disruption and/or discontinuity in the integration of consciousness, memory, motor control, perception, body representation, emotion, identity, and behavior. These symptoms can be applicable to all areas of psychological functioning and are typically experienced as unbidden intrusions into one’s awareness and behavior. This coincides with a loss of continuity in the subjective experience of the individual and/or the inability to access information or to control mental functions. 

Dissociative Disorders

Anxiety disorders are characterized by features of excessive fear and anxiety, as well as related behavioral disturbances. These symptoms are often not temporary and linger beyond typical expectations. Excessiveness of these symptoms is clinician diagnosed with cultural contexts taken into consideration.

Anxiety Disorders

Trauma- and Stressor-Related Disorders are characterized by exposure to a traumatic or stressful event. Symptoms and reactions vary for each case and while they may be understood in an anxiety- or fear-based context, individuals often instead prominently display anhedonic, dysphoric, dissociative, and/or aggressive symptoms. This variability in the display of symptoms imposes a distinction from other similar disorders, which then also requires that for one to be diagnosed with a trauma- and stressor-disorder, they specifically must have had explicit exposure to a traumatic or stressful event.

Trauma- and Stressor-Related Disorders

Disruptive, Impulse-Control, and Conduct Disorders are a group of conditions characterized by problems related to the self-control of emotions and behaviors. These disorders are distinct from other disorders with emotional or behavioral regulation due to the nature that these problems result in violations of the rights of others and/or significant conflict with societal norms or authority figures. These disorders and their presentation can greatly vary within the category, as well as between individuals. 


Disruptive, Impulse-Control, and Conduct Disorders

Schizophrenia Spectrum and Other Psychotic Disorders are recognized through abnormalities occurring within at least one of five domains. These domains include delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms.

Schizophrenia Spectrum and Other Psychotic Disorders

Somatic Symptom and Related Disorders are characterized by the presence of prominent somatic symptoms as well as the abnormal thoughts, feelings, and/or behaviors in response to the somatic symptoms. These symptoms and the response to them result in significant distress and impairment to the individual. The symptoms themselves may sometimes be less important than the way individuals will present and interpret them.

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