For many of us sex therapists, some of the recent changes to the Diagnostic and Statistical Manual 5 (DSM-5), the manual for diagnosing mental disorders, have been a godsend. This new version includes a more up-to-date distinction between what a paraphilia is versus what a paraphilic disorder is. Although both are mentioned it is the latter, the disorder, which is the one that has the negative consequences.
Originally, a paraphilia was defined as an intense or persistent sexual interest in something other than genital stimulation or preparatory foreplay, with a “pheno-typically normal, physically mature, consenting human partner.” These interests can include: Voyeurism — getting turned on by watching sexual activity or observing an unsuspecting person; Exhibitionism — arousal from exposing oneself; Transvestite disorder — cross-dressing; or, sexual Masochism and Sadism — arousal from inflicting or receiving pain.
Historically, these behaviors were regarded as mental illnesses, even when there was no distress or impairment. Individuals who engaged in even mild to moderate intense sexual experiences were often pathologized because the act of having a sadistic or masochistic tendency was frowned upon. Sometimes what many individuals experience as pleasurable only looks like it causes pain.
Although there are still a few nuances within the DSM-5 that are not 100% accurate (from my opinion), the new manual supports what many therapists have recognized for a while. Namely, that there is a wide range of sexual interests that, although may not fall under the normal spectrum, are still non-problematic, and certainly not a symptom of mental illness or a disorder.
These updates have also shed light on that fact that paraphilias can be present but not necessarily involve a paraphilia disorder (something that causes significant distress or impairment in social, occupational, or other areas of functioning; or, with a non-consenting person).
People involved in alternative lifestyles, such as the consensual BDSM (bondage, discipline, sadomasochism) scene, or even just couples in the bedroom, who enjoy engaging in more “extreme sports,” can now express a “Hurrah.” What people consent to within the privacy of “their own home” is not always a cause for distress nor a sign of a mental disorder if they fall a little (or a lot) outside the norm.
Cory Hrushka, M.A, Ph.d candidate, CCS, Diplomate of Sex Therapy, Registered Psychologist
