Abnormal Psychology

Gender and Sexual Disorders 483

that involve objects or consenting adults. Paraphilic disorders are almost exclusively

diagnosed in men; the only paraphilia observed in a signifi cant percentage of women

issexual masochism. Because of the extremely high prevalence of the other paraphilias

Disorder

Specifi c Sexual Fantasies,

Urges, or Activities to

Enhance Sexual Arousal DSM-IV-TR Diagnostic Criteria

Exhibitionism Exposing genitals to an

unsuspecting stranger

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or

behaviors involving exposing one’s genitals to an unsuspecting stranger.

B. The person has acted on these urges, or the sexual urges or fantasies cause marked distress or

interpersonal diffi culty.

Voyeurism Observing an unsuspecting

person who is disrobing or

having sex

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges,

or behaviors involving the act of observing an unsuspecting person who is naked, in the process of

disrobing, or engaging in sexual activity.

B. The person has acted on these urges, or the sexual urges or fantasies cause marked distress or

interpersonal diffi culty.

Frotteurism Touching or rubbing against

a nonconsenting person

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or

behaviors involving touching and rubbing against a nonconsenting person.

B. The person has acted on these urges, or the sexual urges or fantasies cause marked distress or

interpersonal diffi culty.

Pedophilia Sexual activity with a

prepubescent child

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or

behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or

younger).

B. The person has acted on these urges, or the sexual urges or fantasies cause marked distress or

interpersonal diffi culty.

C. The person is at least age 16 years and at least 5 years older than the child or children in Criterion A.

Sexual Sadism Infl icting psychological or

physical pain on another

person

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or

behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including

humiliation) of the victim is sexually exciting to the person.

B. The person has acted on these urges with a nonconsenting person, or the sexual urges or fantasies

cause marked distress or interpersonal diffi culty.

Sexual

Masochism

Being humiliated, bound, or

made to suffer in other ways

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or

behaviors involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made

to suffer.

B. The fantasies, sexual urges, or behaviors cause clinically signifi cant distress or impairment in

functioning.

Fetishism Using a nonliving object to

become aroused

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or

behaviors involving the use of nonliving objects (such as female undergarments).

B. The fantasies, sexual urges, or behaviors cause clinically signifi cant distress or impairment in

functioning.

C. The fetish objects are not limited to articles of female clothing used in cross-dressing (as in Transvestic

Fetishism, below) or devices designed for the purpose of tactile genital stimulation (such as a vibrator).

Transvestic

Fetishism

Cross-dressing (dressing in

clothes of the other gender

for sexual arousal)

A. Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing

fantasies, sexual urges, or behaviors that involve cross-dressing.

B. The fantasies, sexual urges, or behaviors cause clinically signifi cant distress or impair functioning.

Paraphilias include deviant sexual fantasies, urges, and activities that can be classifi ed into three types: Those that involve nonconsenting partners or

children (in purple); those that involve suffering or humiliating oneself or a partner (in gray); and those that involve nonhuman animals or objects (in

yellow). Note that sexual sadism involves nonconsenting people. Nonetheless, DSM-IV-TR groups sexual sadism with sexual masochism, rather than

with the other paraphilias that involve nonconsenting people. Note also that the specifi cs of Criterion B—distress, impaired functioning, interpersonal

problems, or acting on the sexual fantasies and urges—vary across the paraphilic disorders, depending in part on the whether the disorder involves

nonconsenting individuals.

Source: Adapted from American Psychiatric Association, 2000; McAnulty, Adams, & Dillon, 2001, p. 751. For more information see the Permissions section.

Table 11.3 • Paraphilias: An Overview and the DSM-IV-TR Diagnostic Criteria