Diagnostic Considerations

In diagnosing paraphilic disorders, it must be kept in mind that nonparaphilic individuals may describe nonpathologic use of sexual fantasies, behaviors, or objects as stimuli for sexual excitement. In patients with mental retardation, paraphilia should be distinguished from dementia, personality change due to a general medical condition, substance intoxication, manic episode, or schizophrenia in which judgment, social skills, or impulse control are compromised. When appropriate, public urination should be distinguished from exhibitionism.

Other problems to be considered (as alternative explanations of symptoms or comorbidities) are as follows:

Experimentation
Hormone dysregulation
Seizures
Chromosome abnormality
Social phobia
Conduct disorder
Multiple sclerosis
Conversion disorder
Frontoparietal traumatic brain injury
Abnormal amygdala activation^[16]
Sexsomnia^[17]
Autoerotic asphyxiation^[18]
Paraphilic coercive disorder

Workup

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th ed. Washington, DC: American Psychiatric Association; 2013. 685-705.
World Health Organization. The International Statistical Classification of Diseases and Health Related Problems, Tenth Revision. 2nd ed. World Health Organization; 2004.
McManus MA, Hargreaves P, Rainbow L, Alison LJ. Paraphilias: definition, diagnosis and treatment. F1000Prime Rep. 2013 Sep 2. 5:36. [QxMD MEDLINE Link]. [Full Text].
Konrad N, Welke J, Opitz-Welke A. Paraphilias. Curr Opin Psychiatry. 2015 Nov. 28 (6):440-4. [QxMD MEDLINE Link].
Campbell MM, Artz L, Stein DJ. Sexual disorders in DSM-5 and ICD-11: a conceptual framework. Curr Opin Psychiatry. 2015 Nov. 28 (6):435-9. [QxMD MEDLINE Link].
Berner W, Briken P. Pleasure seeking and the aspect of longing for an object in perversion. A neuropsychoanalytical perspective. Am J Psychother. 2012. 66(2):129-50. [QxMD MEDLINE Link].
Gardner RA. A theory about the variety of human sexual behavior. Issues in Child Abuse Accusations. 1993. 5(2):[Full Text].
Quinsey VL. Pragmatic and Darwinian views of the paraphilias. Arch Sex Behav. 2012 Feb. 41(1):217-20. [QxMD MEDLINE Link].
Rooth FG. Indecent exposure and exhibitionism. Br J Psychiatry. 1975. Spec No 9:212-22. [QxMD MEDLINE Link].
Eber M. Exhibitionism or narcissism?. Am J Psychiatry. 1977 Sep. 134(9):1053. [QxMD MEDLINE Link].
Kohut M. Forms and transformations of narcissism. Ornstein P, ed. The Search for the Self. New York: International Universities Press; 1978.
Bluglass R. Indecent exposure in the West Midlands. West D, ed. Sex Offenders in the Criminal Justice System. New York: Cambridge University Press; 1980.
Kruger TH, Schiffer B. Neurocognitive and personality factors in homo- and heterosexual pedophiles and controls. J Sex Med. 2011 Jun. 8(6):1650-9. [QxMD MEDLINE Link].
Greenacre P. Fetishism. Rosen I, ed. Sexual Deviations. 3rd ed. New York: Oxford University Press; 1996. 88-110.
Chivers ML, Seto MC, Lalumière ML, Laan E, Grimbos T. Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis. Arch Sex Behav. 2010 Feb. 39(1):5-56. [QxMD MEDLINE Link]. [Full Text].
Sartorius A, Ruf M, Kief C, Demirakca T, Bailer J, Ende G. Abnormal amygdala activation profile in pedophilia. Eur Arch Psychiatry Clin Neurosci. 2008 Aug. 258(5):271-7. [QxMD MEDLINE Link].
Andersen ML, Poyares D, Alves RS, Skomro R, Tufik S. Sexsomnia: abnormal sexual behavior during sleep. Brain Res Rev. 2007 Dec. 56(2):271-82. [QxMD MEDLINE Link].
Cowell DD. Autoerotic asphyxiation: secret pleasure--lethal outcome?. Pediatrics. 2009 Nov. 124(5):1319-24. [QxMD MEDLINE Link].
Taborda JG, Michalski-Jaeger CA. Sexual disorders and crime. Curr Opin Psychiatry. 2012 Sep. 25(5):370-4. [QxMD MEDLINE Link].

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Author

Claudia L Reardon, MD Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health; Staff Psychiatrist and Consulting Sports Psychiatrist for University of Wisconsin Intercollegiate Athletics, University Health Services, University of Wisconsin; Medical Staff, University of Wisconsin Hospital and Clinics

Claudia L Reardon, MD is a member of the following medical societies: American College of Psychiatrists, American Medical Association, American Psychiatric Association, Association for Academic Psychiatry, Dane County Medical Society, International Society for Sports Psychiatry, Wisconsin Medical Society, Wisconsin Medical Society Foundation, Wisconsin Psychiatric Association, World Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Additional Contributors

Guy E Brannon, MD Associate Clinical Professor of Psychiatry, Louisiana State University Health Sciences Center; Director, Adult Psychiatry Unit, Chemical Dependency Unit, Clinical Research, Brentwood Behavior Health Company

Disclosure: Received income in an amount equal to or greater than $250 from: Sunovion; Forest.

Acknowledgements

Robert Levey, PhD, MPH Associate Professor, Department of Medicine, Section of Psychiatry, University of Tennessee Graduate School of Medicine

Robert Levey, PhD, MPH is a member of the following medical societies: American Public Health Association, Association for Hospital Medical Education, and Sigma Xi

Disclosure: Nothing to disclose.

Mohammed A Memon, MD Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Paraphilic Disorders Differential Diagnoses

Diagnostic Considerations

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