Specific Disorders II

Masochism and Sexual Sadism

Sexual masochism disorder involves arousal derived from being humiliated, beaten, tied up or subjected to suffering.

To be diagnosed as a disorder, these urges must cause significant discomfort or functional impairment, or, if acted upon, must cause actual physical harm or risk of death.

A critical specifier is "asphyxiophilia," where arousal depends on restriction of breathing, a lethal high-risk practice.

Sexual sadism, on the other hand, involves deriving pleasure from the physical or psychological suffering of another person.

The diagnosis is established if the individual has acted on these urges with a non-consenting person, or if the urges are intense and cause distress to the subject himself.

It is vital to distinguish between consensual and safe BDSM practices, and pathology involving lack of consent or non-negotiated harm.

Pedophilia: Age Criteria and Difference

Pedophilia is defined by sexual fantasies or behaviors directed toward prepubescent children (usually under the age of 13).

The diagnostic criteria are strict: the perpetrator must be at least 16 years old and at least 5 years older than the victim.

This age difference is crucial in order not to pathologize sexual exploration between adolescents of similar ages.

The manual specifies that a late adolescent in a relationship with a 12- or 13-year-old is not included if the age difference is small.

Diagnosis also requires specifying whether the attraction is exclusive to boys (which aggravates the prognosis) or nonexclusive, and whether it is directed at males, females, or both. It is one of the disorders with major legal and social implications.

Fetishism and Transvestism

Fetishism disorder involves the use of inanimate objects (such as shoes or gloves) or a very specific interest in non-genital body parts (such as feet) for arousal.

It is diagnosed as a disorder only if there is clinical distress or if the objects are necessary for sexual function (exclusivity).

Objects designed for direct genital stimulation (vibrators) and clothing used for cross-dressing are excluded.

Transvestism disorder refers to recurrent sexual arousal derived from dressing in clothing of the opposite sex.

Unlike gender dysphoria, where the goal is identity, here the primary goal is erotic arousal.

Diagnosis requires that