Paraphilia Classification and external resources MeSH D010262 Paraphilia (in Greek para παρά = beside and -philia φιλία = friendship, having the meaning of love) is a biomedical term used to describe sexual arousal to objects, situations, or individuals that are not part of normative stimulation and that may cause distress or serious problems for the paraphiliac or persons associated with him or her. A paraphilia involves sexual arousal and gratification towards sexual behavior that is atypical and extreme.1 The term was coined by Wilhelm Stekel in the 1920s.2 Controversial sexologist John Money later popularized the term as a nonpejorative designation for unusual sexual interests.3456 He described paraphilia as "a sexuoerotic embellishment of, or alternative to the official, ideological norm."7 In the late 19th century, psychologists and psychiatrists started to categorize various paraphilias as they wanted a more descriptive system than the legal and religious constructs of sodomy8 and perversion.9 Before the introduction of the term paraphilia in the DSM-III (1980), the term sexual deviation was used to refer to paraphilias in the first two editions of the manual.10 American Journal of Psychiatry11 describes paraphilia as "recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving: Non-human objects The suffering or humiliation of oneself or one's partner Children Non-consenting persons12 Up until 1973, attraction to persons of the same sex was included in this list.13 The view of paraphilias as disorders is not universal. Some groups seeking greater understanding and acceptance of sexual diversity have lobbied for changes to the legal and medical status of unusual sexual interests and practices. Charles Allen Moser, a physician and advocate for sexual minorities, has argued that the diagnoses should be eliminated from diagnostic manuals.14 Psychiatrist Glen Gabbard writes that despite efforts by Stekel and Money, "the term paraphilia remains pejorative in most circumstances." 15 In the current version of the DSM (DSM-IV-TR), a paraphilia is not diagnosable as a psychiatric disorder unless it causes distress to the individual or harm to others. The DSM-5 draft adds a terminology distinction between the two cases, stating that "paraphilias are not ipso facto psychiatric disorders", and defining paraphilic disorder as "a paraphilia that causes distress or impairment to the individual or harm to others".16 This will make a clear distinction between a healthy person with a non-normative sexual behavior and a person with a psychopathological non-normative sexual behavior. In the United States, following a series of landmark cases in the US Supreme Court, persons diagnosed with paraphlias and a history of anti-social behavior, particularly pedophilia (Kansas v. Hendricks, 1997) and exhibitionism (Kansas v. Crane, 2002), can be held indefinitely in civil confinement under various state legislation generically known as Sexually violent predator laws1718 and the federal Adam Walsh Act (United States v. Comstock, 2010).1920 Contents 1 General concerns 1.1 Terminological 1.2 Classificational 1.3 Homosexuality 2 Clinical views 2.1 Classifications and theories 2.2 Diagnostic and Statistical Manual of Mental Disorders 2.2.1 DSM-I and DSM-II 2.2.2 DSM-III through DSM-IV-TR 2.2.3 DSM-5 draft 2.3 Intensity and specificity 2.4 Drug treatments 2.4.1 Hormonal 2.4.2 Psychoactive 3 See also 4 References 4.1 Bibliography 5 Further reading 6 External links General concerns Terminological

Paraphilial psychopathology is not the same as psychologically normative adult human sexual behaviors, sexual fantasy, and sex play. These terms have been used in interchangeable ways which can allow for cognitive and clinical diagnostic misjudgment to occur. Consensual adult activities and adult entertainment that may involve some aspects of sexual roleplay, novel, superficial, or trivial aspects of sexual fetishism, or may incorporate the use of sex toys are not necessarily paraphilic.12 Classificational It is not known how many different kinds of paraphilias exist; one source lists as many as 547 paraphilias.21 Because so many paraphilias exist, one needs to classify them in an orderly and meaningful way. It has long been argued that the Diagnostic and Statistical Manual of Mental Disorders (DSM) system of classification makes unjustified categorical distinctions between disorders, and between normal and abnormal. Although the DSM-5 may move away from this categorical approach in some limited areas, some argue that a fully dimensional, spectrum or complaint-oriented approach would better reflect the evidence.22232425 There is scientific and political controversy regarding the continued inclusion of sex-related diagnoses such as the paraphilias in the DSM.2627 Homosexuality Homosexuality was at one time categorized as a form of paraphilia.28 Sigmund Freud and his proponents considered homosexuality and paraphilias to be forms of psychosexual infantilism. In a 1951 symposium discussing psychiatrist Benjamin Karpman's paper "The Sexual Psychopath,"29 psychiatrist Emil Gutheil said, "Looking back upon my own experience with so-called psychopaths, I find one characteristic they all have in common, and that is their infantilism. Take the man who is a homosexual. In his paraphilia he regresses to the time he was bisexual, that is, to his infantile level.30 By the mid-20th century, mental health practitioners began formalizing "deviant sexuality" classifications into categories. Researcher Anil Aggrawal writes that the 1952 first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) specified "the type of the pathological behavior, such as homosexuality, transvestism, pedophilia, fetishism, and sexual sadism, including rape, sexual assault, mutilation)."31 Originally coded as 000-x63, homosexuality was the top of the classification list (Code 302.0) until the American Psychiatric Association removed homosexuality from the DSM in 1973. Other organizations followed suit, including the American Psychological Association in 1975, and the National Association of Social Workers.32 Martin Kafka writes, "Sexual disorders once considered paraphilias (e.g., homosexuality) are now regarded as variants of normal sexuality."33 Clinical views An editor has expressed a concern that this article lends undue weight to certain ideas, incidents, controversies or matters relative to the article subject as a whole. Please help to create a more balanced presentation. Discuss and resolve this issue before removing this message. (October 2010) Classifications and theories Albert Eulenburg (1914) noted a commonality across the paraphilias, using the terminology of his time, "All the forms of sexual perversion...have one thing in common: their roots reach down into the matrix of natural and normal sex life; there they are somehow closely connected with the feelings and expressions of our physiological erotism. They are...hyperbolic intensifications, distortions, monstrous fruits of certain partial and secondary expressions of this erotism which is considered 'normal' or at least within the limits of healthy sex feeling."34

The clinical literature contains reports of many paraphilias, only some of which receive their own entries in the diagnostic taxonomies of the American Psychiatric Association or the World Health Organization.3536 There is disagreement regarding which sexual interests should be deemed paraphilic disorders versus normal variants of sexual interest. For example, as of May 2000, per DSM-IV-TR, "Because some cases of Sexual Sadism may not involve harm to a victim (e.g., inflicting humiliation on a consenting partner), the wording for sexual sadism involves a hybrid of the DSM-III-R and DSM-IV wording (i.e., “the person has acted on these urges with a non-consenting person, or the urges, sexual fantasies, or behaviors cause marked distress or interpersonal difficulty”)".37 Diagnostic and Statistical Manual of Mental Disorders DSM-I and DSM-II In American psychiatry, prior to the publication of the DSM-I, paraphilias were classified as cases of "psychopathic personality with pathologic sexuality". The DSM-I (1952) included sexual deviation as a personality disorder of sociopathic subtype. The only diagnostic guidance was that sexual deviation should have been "reserved for deviant sexuality which [was] not symptomatic of more extensive syndromes, such as schizophrenic or obsessional reactions". The specifics of the disorder were to be provided by the clinician as a "supplementary term" to the sexual deviation diagnosis; examples of this supplementary term provided in the DSM-I included homosexuality, transvestism, pedophilia, fetishism, and sexual sadism, including rape. There were no restrictions in the DSM-I on what this supplementary term could be.38 The DSM-II (1968) continued to use the term "sexual deviations", but no longer ascribed them under personality disorders, but rather them alongside them in a broad category titled "personality disorders and certain other nonpsychotic mental disorders". The types of sexual deviations listed in the DSM-II were: sexual orientation disturbance (homosexuality), fetishism, pedophilia, transvestitism (sic), exhibitionism, voyeurism, sadism, masochism, and "other sexual deviation". No definition or examples were provided for "other sexual deviation", but the general category of sexual deviation was meant to describe the sexual preference of individuals that was "directed primarily toward objects other than people of opposite sex, toward sexual acts not usually associated with coitus, or toward coitus performed under bizarre circumstances, as in necrophilia, pedophilia, sexual sadism, and fetishism."39 Except for the removal of homosexuality from the DSM-III onwards, this definition provided a general standard that has guided specific definitions of paraphilias in subsequent DSM editions, up to DSM-IV-TR.40 DSM-III through DSM-IV-TR The term "paraphilia" was introduced in the DSM-III (1980) as a subset of the new category of "psychosexual disorders". The types of paraphlias listed were: fetishism, transvestism, zoophilia, pedophilia, exhibitionism, voyeurism, sexual masochism, sexual sadism, and "atypical paraphilia". The DSM-III-R (1987) renamed the broad category to sexual disorders, renamed atypical paraphilia to paraphilia NOS (not otherwise specified), finessed transvestism as transvestic fetishism, added frotteurism, and removed zoophilia, relegating it to the NOS category. It also provided seven nonexhaustive examples of NOS paraphilias, which besides zoophilia included telephone scatologia, necrophilia, partialism, corprophilia, klismaphilia, and urophilia.41

The DSM-IV (1994) retained the sexual disorders classification for paraphlias, but added an even broader category, "sexual and gender identity disorders", which includes them. The DSM-IV retained the same types of paraphilias listed in DSM-III-R, including the NOS examples, but introduced some changes to the definitions of some specific types.40 Paraphilias are defined by DSM-IV-TR as sexual disorders characterized by "recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving (1) nonhuman objects, (2) the suffering or humiliation of oneself or one's partner, or (3) children or other nonconsenting persons that occur over a period of 6 months" (Criterion A), which "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" (Criterion B). DSM-IV-TR describes 8 specific disorders of this type (exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, voyeurism, and transvestic fetishism) along with a ninth residual category, paraphilia not otherwise specified (NOS).42 Criterion B differs for exhibitionism, frotteurism, and pedophilia to include acting on these urges, and for sadism, acting on these urges with a nonconsenting person.12 Some paraphilias may interfere with the capacity for sexual activity with consenting adult partners.12 According to the DSM, "Paraphilias are almost never diagnosed in females,"12 but some case studies of females with paraphilias have been published.43 The DSM provides clinical criteria for these paraphilias: Exhibitionism: the recurrent urge or behavior to expose one's genitals to an unsuspecting person, or to perform sexual acts that can be watched by others. Fetishism: the use of inanimate objects to gain sexual excitement. Partialism refers to fetishes specifically involving nonsexual parts of the body. Frotteurism: recurrent urges of behavior of touching or rubbing against a nonconsenting person. Pedophilia: strong sexual attraction to prepubescent children,.44 Sexual Masochism: the recurrent urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made to suffer for sexual pleasure. Sexual Sadism: the recurrent urge or behavior involving acts in which the pain or humiliation of a person is sexually exciting. Transvestic fetishism: arousal from wearing "clothing associated with members of the opposite sex."1245 Voyeurism: the recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing, or engaging in sexual activities, or who is engaging in activities usually considered to be of a private nature.4647 Under Paraphilia NOS, the DSM mentions telephone scatalogia (obscene phone calls), necrophilia (corpses), partialism (exclusive focus on one part of the body), zoophilia (animals), coprophilia (feces), klismaphilia (enemas), urophilia (urine), emetophilia (vomit). The DSM's Paraphilia NOS is equivalent to the ICD-9's Sexual Disorder NOS. Sexual arousal in association with objects that were designed for sexual purposes is not diagnosable in DSM-IV (DSM, p. 570).12 DSM-5 draft The DSM-5 Paraphilias Subworkgroup reached a "consensus that paraphilias are not ipso facto psychiatric disorders", and proposed "that the DSM-V make a distinction between paraphilias and paraphilic disorders. A paraphilia by itself would not automatically justify or require psychiatric intervention. A paraphilic disorder is a paraphilia that causes distress or impairment to the individual or harm to others. One would ascertain a paraphilia (according to the nature of the urges, fantasies, or behaviors) but diagnose a paraphilic disorder (on the basis of distress and impairment). In this conception, having a paraphilia would be a necessary but not a sufficient condition for having a paraphilic disorder." The 'Rationale' page of any paraphilia in the electronic DSM-5 draft continues: "This approach leaves intact the distinction between normative and non-normative sexual behavior, which could be important to researchers, but without automatically labeling non-normative sexual behavior as psychopathological. It also eliminates certain logical absurdities in the DSM-IV-TR. In that version, for example, a man cannot be classified as a transvestite—however much he cross-dresses and however sexually exciting that is to him—unless he is unhappy about this activity or impaired by it. This change in viewpoint would be reflected in the diagnostic criteria sets by the addition of the word “Disorder” to all the paraphilias. Thus, Sexual Sadism would become Sexual Sadism Disorder; Sexual Masochism would become Sexual Masochism Disorder, and so on."16

Bioethics professor Alice Dreger interpreted these changes as "a subtle way of saying sexual kinks are basically okay – so okay, the sub-work group doesn’t actually bother to define paraphilia. But a paraphilic disorder is defined: that’s when an atypical sexual interest causes distress or impairment to the individual or harm to others." Interviewed by Dreger, Ray Blanchard, the Chair of the Paraphilias Sub-Work Group, explained: "We tried to go as far as we could in depathologizing mild and harmless paraphilias, while recognizing that severe paraphilias that distress or impair people or cause them to do harm to others are validly regarded as disorders."48 Charles Allen Moser pointed out that this is change is not really substantive as DSM-IV already acknowledged a difference between paraphilias and non-pathological but unusual sexual interests, a distinction that is virtually identical to what is being proposed for DSM-5, and it is a distinction that, in practice, has often been ignored.49 Linguist A. C. Hinderliter argued that "Including some sexual interests—but not others—in the DSM creates a fundamental asymmetry and communicates a negative value judgment against the sexual interests included," and leaves the paraphilias in a situation similar to ego-dystonic homosexuality, which was removed from the DSM because it did not meet the DSM's definition of mental disorder.50 Historian and philosopher of science Patrick Singy claims that the DSM-5 is about to drastically loosen the criteria for paraphilias and to make them directly dependent on cultural values. The DSM-5 will then be closer to the DSM-I and DSM-II than to their successors, which all were at least trying to separate the concept of "mental disorder" from cultural norms, and which made "harm" or "distress" a necessary condition for having a mental disorder.51 Intensity and specificity Clinicians distinguish between optional, preferred and exclusive paraphilias,12 though the terminology is not completely standardized. An "optional" paraphilia is an alternative route to sexual arousal. For example, a man with otherwise unremarkable sexual interests might sometimes seek or enhance sexual arousal by wearing women's underwear. In preferred paraphilias, a person prefers the paraphilia to conventional sexual activities, but also engages in conventional sexual activities. For example, a man might prefer to wear women's underwear during sexual activity, whenever possible. In exclusive paraphilias, a person is unable to become sexually aroused in the absence of the paraphilia.citation needed The literature includes single-case studies of exceedingly rare and idiosyncratic paraphilias. These include an adolescent male who had a strong fetishistic interest in the exhaust pipes of cars, a young man with a similar interest in a specific type of car, and a man who had a paraphilic interest in sneezing (both his own and the sneezing of others).5253 See also List of paraphilias. Drug treatments The treatment of paraphilias and related disorders has been challenging for patients and clinicians. In the past, surgical castration was advocated as a therapy for men with pedophilia, but has been abandoned for the time being because most governments consider it a cruel punishment where the express willingness and consent of the patient is not objectively indicated. Psychotherapy, self-help groups, and pharmacotherapy (including anti-androgen hormone therapy sometimes referred to as "chemical castration") have all been used. Other drug treatments for these disorders do exist, however.54 Hormonal

Antiandrogenic drugs such as medroxyprogesterone (also known as the long-acting contraceptive Depo Provera) have been widely used as therapy in these men to reduce sex drive. However, their efficacy is limited and they have many side effects, including breast growth, headaches, weight gain, and reduction in bone density. Even if compliance is good, only 60 to 80 percent of men benefit from this type of drug. Long-acting gonadotropin-releasing hormones, such as Triptorelin (Trelstar) which reduces the release of gonadotropin hormones, are also used. This drug is a synthetic hormone which may also lead to reduced sex drive.54 Psychoactive Psychostimulants have been used recently to augment the effects of serotonergic drugs in paraphiliacs. In theory, the prescription of a psychostimulant without pretreatment with an SSRI might further disinhibit sexual behavior, but when taken together, the psychostimulant may actually reduce impulsive tendencies. Methylphenidate (Ritalin) is an amphetamine-like stimulant used primarily to manage the symptoms of attention deficit hyperactivity disorder (ADHD). Recent studies imply that methylphenidate may also act on serotonergic systems; this may be important in explaining the paradoxical calming effect of stimulants on ADHD patients. Amphetamine is also used medically as an adjunct to antidepressants in refractory cases of depression.54 See also Psychology portal Sexuality portal Courtship disorder Developmental psychology Dorian Gray syndrome Human development Human sexuality Labeling theory Linguistic relativity List of paraphilias Lovemap Psychosexual development Richard von Krafft-Ebing for history of classifying sexual object choice as a disease Sex and the law -phil- (list of philias) References ^ Diagnostic and Statistical Manual of Mental Disorders, 1994. ^ Stekel, Wilhelm (1930), Sexual Aberrations: The Phenomenon of Fetishism in Relation to Sex, translated from the 1922 original German edition by S. Parker. Liveright Publishing. ^ Weiderman M (2003). Paraphilia and Fetishism. The Family Journal, July 2003 vol. 11 no. 3 315-321 ^ Bullough VL (1995). Science in the Bedroom: A History of Sex Research, p. 281. Basic Books, ISBN 9780465072590 ^ Moser C (2001). Critiques of conventional models of sex therapy. in Kleinplatz PJ (ed.) New directions in sex therapy: innovations and alternatives. Psychology Press, ISBN 9780876309674 ^ McCammon S, Knox D, Schacht C (2004). Choices in sexuality, p. 476. Atomic Dog Publishing, ISBN 9781592600502 ^ Money, John (1990). Gay, Straight, and In-Between: The Sexology of Erotic Orientation. Oxford University Press ISBN 9780195063318 ^ Dailey, Dennis M. (1989). The Sexually Unusual: Guide to Understanding and Helping. Haworth Press ISBN 9780866567862, pp. 15-16 ^ Purcell, Catherine E. and Bruce A. Arrigo (2006). The psychology of lust murder: paraphilia, sexual killing, and serial homicide. Academic Press ISBN 9780123705105, p. 16 ^ Laws and, O'Donohue (2008) p. 384 ^ 138:210-215. ^ a b c d e f g h American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. ^ Position Statement: Homosexuality and Civil Rights, American Psychiatric Association, December 1973, http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/197310.aspx, retrieved 2011-01-31  ^ Moser C, Kleinplatz PJ (2005). "DSM-IV-TR and the Paraphilias: An argument for removal". Journal of Psychology and Human Sexuality 17 (3/4): 91–109.  ^ Gabbard GO (2007). Gabbard's Treatments of Psychiatric Disorders. American Psychiatric Press. ISBN 9781585622160 ^ a b http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=186 (click 'Rationale' tab). ^ http://www.jaapl.org/cgi/reprint/36/4/443.pdf ^ http://books.google.com/books?id=6MQj-mjHgBIC&pg=PA248 ^ JESSE J. HOLLAND, Court: Sexually dangerous can be kept in prison, Associated Press. Retrieved 5-16-2010. ^ http://capcentral.org/civil/svpa/svpa_article_USsupreme.asp ^ Aggrawal, Anil (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press. ISBN 1420043080.  ^ Spitzer, Robert L, M.D., Williams, Janet B.W, D.S.W., First, Michael B, M.D., Gibbon, Miriam, M.S.W., Biometric Research ^ Maser, JD & Akiskal, HS. et al. (2002) Spectrum concepts in major mental disorders Psychiatric Clinics of North America, Vol. 25, Special issue 4 ^ Krueger, RF., Watson, D., Barlow, DH. et al. (2005) Toward a Dimensionally Based Taxonomy of Psychopathology Journal of Abnormal Psychology Vol 114, Issue 4 ^ Bentall, R. (2006). "Madness explained : Why we must reject the Kraepelinian paradigm and replace it with a 'complaint-orientated' approach to understanding mental illness". Medical hypotheses 66 (2): 220–233. doi:10.1016/j.mehy.2005.09.026. PMID 16300903. http://cat.inist.fr/?aModele=afficheN&cpsidt=17441292.  ^ Alexander, B. (2008) What's ‘normal’ sex? Shrinks seek definition Controversy erupts over creation of psychiatric rule book's new edition MSNBC Today, May. ^ Kleinplatz, P. J., & Moser, C. (2005). Politics versus science: An addendum and response to Drs. Spitzer and Fink. Journal of Psychology and Human Sexuality, 17, 135-139. ^ Hutchinson GE (1959). A speculative consideration of certain possible forms of sexual selection in man. American Naturalist, Vol 93, no. 869 (March/April 1959, pp. 81-91 ^ Karpman B (1951). The sexual psychopath. J Am Med Assoc. 1951 Jun 23;146(8):721-6. PMID 14832048 ^ Karpman B (1951). The sexual psychopath. Discussion. Am J Psychother. 1951 Oct;5(4):584-605. PMID 14878019 ^ Aggrawal, Anil (2008). Forensic and medico-legal aspects of sexual crimes and unusual sexual practices, p. 47. CRC Press, ISBN 9781420043082 ^ Case No. S147999 in the Supreme Court of the State of California, In re Marriage Cases Judicial Council Coordination Proceeding No. 4365(…) ^ Kafka MP (1996). "Therapy for Sexual Impulsivity: The Paraphilias and Paraphilia-Related Disorders". Psychiatric Times 13: 6.  ^ Eulenburg (1914). Ueber sexualle Perversionen. Ztschr. f. Sexualwissenschaft, Vol. I, No. 8. translated in Stekel, Wilhelm. (1940). Sexual aberrations: The phenomena of fetishism in relation to sex. New York: Liveright, p. 4. OCLC 795528 ^ psyweb.com "Axis I. Clinical Disorders, most V-Codes and conditions that need Clinical attention". Retrieved: 23 November, 2007. ^ World Health Organization, International Statistical Classification of Diseases and Related Health Problems, (2007), Chapter V, Block F65; Disorders of sexual preference. Retrieved 2007-11-29. ^ Summary of Practice-Relevant Changes to the DSM-IV-TR from Diagnostic and Statistical Manual of Mental Disorders (DSM) ^ Laws and, O'Donohue (2008) pp. 384-385 citing DSM-I pp. 7, 38-39 ^ Laws and, O'Donohue (2008) p. 385 citing DSM-II p. 44 ^ a b Laws and, O'Donohue (2008) p. 386 ^ Laws and, O'Donohue (2008) p. 385 ^ Paraphilias: Clinical and Forensic Considerations, April 15, 2007 Psychiatric Times. Vol. 24 No. 5 from Psychiatric Times ^ Fedoroff, J. P., Fishell, A., & Fedoroff, B. (). A case series of women evaluated for paraphilic sexual disorders. Canadian Journal of Human Sexuality, 8. ^ World Health Organization, International Statistical Classification of Diseases and Related Health Problems: ICD-10 Section F65.4: Paedophilia (online access via ICD-10 site map table of contents) ^ Hirschfeld, M. (1910). Die tranvestiten [Transvestites]. Berlin: Alfred Pulvermacher. ^ Hirschfeld, M. (1938). Sexual anomalies and perversions: Physical and psychological development, diagnosis and treatment (new and revised edition). London: Encyclopaedic Press. ^ Smith, R. S. (1976). Voyeurism: A review of the literature. Archives of Sexual Behavior, 5, 585-608. ^ Alice Dreger (19 Feb 2010) Of Kinks, Crimes, and Kinds: The Paraphilias Proposal for the DSM-5, Hastings Center ^ Moser, C. (2010). Problems with Ascertainment. Archives of Sexual Behavior, 39, 1225-1227 ^ A. C. Hinderliter. (2010) Defining paraphilia: excluding exclusion. Open Access Journal of Forensic Psychology. 2, 241-271. http://web.me.com/gregdeclue/Site/Volume_2__2010_files/Hinderliter%202010.pdf ^ Singy, P. (2010). What's Wrong With Sex? Archives of Sexual Behavior, 39 (2010), 1231-1233 ^ Padmal de Silva (March 2007). "Sexual disorder and psychosexual therapy". Psychiatry (Elsevier Ltd) 6 (3): 130–134. doi:10.1016/j.mppsy.2006.12.009. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B82Y7-4N0GJN5-6&_user=10&_coverDate=03%2F31%2F2007&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=0e747196d9865801e85db7b1c2942c5b.  ^ King, M.B. (1990). "Sneezing as a fetish object". Sex Marital Therapy 5: 69–72. doi:10.1016/j.mppsy.2006.12.009.  ^ a b c M. Williams. Sexual Compulsivity: Defining Paraphilias and Related Disorders "Psychoactive Drug Treatments". Retrieved 23 November 2007 Bibliography D. Richard Laws, William T. O'Donohue (ed.), Sexual Deviance: Theory, Assessment, and Treatment, 2nd ed., Guilford Press, 2008, ISBN 9781593856052 Further reading Kenneth Plummer, Sexual stigma: an interactionist account, Routledge, 1975, ISBN 0710080603 Elisabeth Roudinesco, Our Dark Side, a History of Perversion, Polity Press, 2009, ISBN 0745645933 External links Wikimedia Commons has media related to: Paraphilias DSM-IV and DSM-IV-TR list of paraphilias Proposed diagnostic criteria for sex and gender section of DSM5 v · d · eParaphilias List of paraphilias Abasiophilia · Acrotomophilia · Agalmatophilia · Algolagnia · Andromimetophilia/Gynemimetophilia · Apotemnophilia · Autassassinophilia · Autoandrophilia/Autogynephilia · Biastophilia · Chremastistophilia · Chronophilia · Coprophilia · Dacryphilia · Dendrophilia · Dippoldism · Emetophilia · Erotic asphyxiation · Erotophonophilia · Exhibitionism · Formicophilia · Frotteurism · Gerontophilia · Hebephilia · Homeovestism · Hybristophilia · Infantophilia · Katoptronophilia · Kleptophilia · Klismaphilia · Lactaphilia · Macrophilia · Narratophilia · Nasophilia · Necrophilia · Object sexuality · Olfactophilia · Omorashi · Paraphilic infantilism · Partialism · Pecattiphilia · Pedophilia · Pictophilia · Pyrophilia · Sadomasochism · Salirophilia · Sexual fetishism · Somnophilia · Sthenolagnia · Symphorophilia · Tamakeri · Telephone scatologia · Transvestic fetishism · Transvestophilia · Trichophilia · Troilism · Urolagnia · Vorarephilia · Voyeurism · Zoophilia · Zoosadism  See also Courtship disorder · Human sexual activity · Sexology · Sexual fetishism v · d · eSex Physiological events Erection · Insemination · Orgasm (Female and Male ejaculation) · Pregnancy · Sexual arousal Health and education Birth control · Condom · Postorgasmic illness syndrome · Reproductive medicine (Andrology · Gynaecology · Urology) · Safe sex · Sex education · Sex therapy (Sex surrogate) · Sexual dysfunction (Erectile dysfunction · Hypersexuality · Hyposexuality) · Sexually transmitted disease · Sexual medicine Identity Gender identity · Sexual identity · Sexual orientation Law Age of consent · Criminal transmission of HIV · Incest · Obscenity · Public indecency · Rape · Sexual abuse · Sexual assault · Sexual harassment · Sexual misconduct · Sexual violence History Feminist Sex Wars · History of erotic depictions · Sexual revolution Relationships and society Anarchism and love/sex · Family planning · Marriage · Paraphilia · Polyamory · Promiscuity · Religion and sexuality · Romance · Sexual abstinence · Sexual attraction · Sexual capital · Sexual ethics · Sexual objectification Sexual activities Anal–oral sex · Anal sex · Ass to mouth · Bareback · BDSM · Cock-and-ball torture · Creampie · Cum shot · Cybersex · Dirty talk · Facial · Felching · Fingering · Fisting · Gang bang · Group sex · Masturbation · Mechanics of sex · Non-penetrative sex (Mammary intercourse · Petting · Handjob · Sumata) · Oral sex · Oral stimulation of nipples · Orgasm control · Pompoir · Quickie · Sex positions · Sexual intercourse (Foreplay) · Sex magic · Sexual sublimation · Snowballing · Tea bag · Venus Butterfly Sex industry Adult video game · Child, Female and Male "sex tourism" · Erotica · Pornography · Prostitution · Sex museum · Sex shop · Sex toy (doll)  · Strip club By country China  · Japan · South Korea Animal sexual behaviour · Human sexuality · Sexology · Sexual slang sexuality portal