The DSM-III-R renamed the broad category to sexual disorders , renamed atypical paraphilia to paraphilia NOS not otherwise specified , renamed transvestism as transvestic fetishism , added frotteurism , and moved zoophilia to the NOS category.
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It also provided seven nonexhaustive examples of NOS paraphilias, which besides zoophilia included telephone scatologia , necrophilia, partialism , coprophilia , klismaphilia , and urophilia. The DSM-IV retained the sexual disorders classification for paraphilias, but added an even broader category, "sexual and gender identity disorders ," which includes them. The DSM-IV-TR describes paraphilias as "recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving nonhuman objects, the suffering or humiliation of oneself or one's partner, or children or other nonconsenting persons that occur over a period of six months" criterion A , which "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" criterion B.
DSM-IV-TR names eight specific paraphilic disorders exhibitionism , fetishism , frotteurism , pedophilia , sexual masochism , sexual sadism , voyeurism , and transvestic fetishism , plus a residual category, paraphilia—not otherwise specified. Some paraphilias may interfere with the capacity for sexual activity with consenting adult partners.
The DSM-5 adds a distinction between paraphilias and paraphilic disorders , stating that paraphilias do not require or justify psychiatric treatment in themselves, and defining paraphilic disorder as "a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others". 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.
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In this conception, having a paraphilia would be a necessary but not a sufficient condition for having a paraphilic disorder. 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.
Charles Allen Moser pointed out that this 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.
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The DSM-5 acknowledges that many dozens of paraphilias exist, but only has specific listings for eight that are forensically important and relatively common. These are voyeuristic disorder, exhibitionistic disorder, frotteuristic disorder, sexual masochism disorder, sexual sadism disorder, pedophilic disorder, fetishistic disorder, and transvestic disorder. Most clinicians and researchers believe that paraphilic sexual interests cannot be altered,  although evidence is needed to support this.
Cognitive behavioral therapy , at times, can help people with paraphilias develop strategies to avoid acting on their interests. Pharmacological treatments can help people control their sexual behaviors, but do not change the content of the paraphilia. Selective serotonin reuptake inhibitors SSRIs are used, especially with exhibitionists, non-offending pedophiles, and compulsive masturbators.
They are proposed to work by reducing sexual arousal, compulsivity , and depressive symptoms. Antiandrogens are used in more severe cases. Research has shown that paraphilias are rarely observed in women.
Many acknowledge the scarcity of research on female paraphilias. He states that while a man's sexual arousal can be directly measured from his erection see penile plethysmograph , a woman's sexual arousal cannot be measured as clearly see vaginal photoplethysmograph , and therefore research concerning female sexuality is rarely as conclusive as research on men. In the United States, since a significant number of states have passed Sexually violent predator laws.
Hendricks , and exhibitionism Kansas v. Crane , , with a history of anti-social behavior and related criminal history, can be held indefinitely in civil confinement under various state legislation generically known as sexually violent predator laws   and the federal Adam Walsh Act United States v.
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