In DSM-II, this category is called Sexual deviations

This category is for individuals whose sexual interests are directed primarily toward objects other than people of the 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. Even though many find their practices distasteful, they remain unable to substitute normal sexual behavior for them. This diagnosis is not appropriate for individuals who perform deviant sexual acts because normal sexual objects are not available to them.


  1. Homosexuality
  2. Fetishism
  3. Pedophilia
  4. Transvestitism
  5. Exhibitionism
  6. Voyeurism
  7. Sadism
  8. Masochism
  9. Other sexual deviation


In DSM-III, this category is called Paraphilias


  1. Fetishism
  2. Transvestism
  3. Zoophilia
  4. Pedophilia
  5. Exhibitionism
  6. Voyeurism
  7. Sexual Masochism
  8. Sexual Sadism
  9. Atypical Paraphilia


In DSM-IV, this category is called Paraphilias


  1. Exhibitionism
  2. Fetishism
  3. Frotteurism
  4. Pedophilia
  5. Sexual Masochism
  6. Sexual Sadism
  7. Transvestic Fetishism
  8. Voyeurism
  9. Paraphilia NOS

Differential Diagnosis

Nonpathological use of sexual fantasies, behaviors, or objects as a stimulus for sexual excitement

A Paraphilia must be distinguished from the nonpathological use of sexual fantasies, behaviors, or objects as a stimulus for sexual excitement in individuals without a Paraphilia. Fantasies, behaviors, or objects are paraphiliac only when they lead to clinically significant distress or impairment (e.g., are obligatory, result in sexual dysfunction, require participation of nonconsenting individuals, lead to legal complications, interfere with social relationships).

Other mental disorders

In Mental Retardation, Dementia, Personality Change Due to a General Medical Condition, Substance Intoxication, a Manic Episode or Schizophrenia, there may be a decrease in judgment, social skills, or impulse control that, in rare instances, leads to unusual sexual behavior. This can be distinguished from a Paraphilia by the fact that the unusual sexual behavior is not the individual's preferred or obligatory pattern, the sexual symptoms occur exclusively during the course of these mental disorders, and the unusual sexual acts tend to be isolated rather than recurrent and usually have a later age at onset.

Other Paraphilias

The individual Paraphilias can be distinguished based on differences in the characteristic paraphiliac focus. However, if the individual's sexual preferences meet criteria for more than one Paraphilia, all can be diagnosed. Exhibitionism must be distinguished from public urination, which is sometimes offered as an explanation for the behavior. Fetishism and Transvestic Fetishism both often involve articles of feminine clothing. In Fetishism, the focus of sexual arousal is on the article of clothing itself (e.g., panties), whereas in Transvestic Fetishism the sexual arousal comes from the act of cross-dressing. Cross-dressing, which is present in Transvestic Fetishism, may also be present in Sexual Masochism. In Sexual Masochism, it is the humiliation of being forced to cross-dress, not the garments themselves, that is sexually exciting.

Gender Identity Disorder

Cross-dressing may be associated with gender dysphoria. If some gender dysphoria is present but the full criteria for Gender Identity Disorder are not met, the diagnosis is Transvestic Fetishism, With Gender Dysphoria. Individuals should receive the additional diagnosis of Gender Identity Disorder if their presentation meets the full criteria for Gender Identity Disorder.



  1. Voyeuristic Disorder
  2. Exhibitionistic Disorder
  3. Frotteuristic Disorder
  4. Sexual Masochism Disorder
  5. Sexual Sadism Disorder
  6. Pedophilic Disorder
  7. Fetishistic Disorder
  8. Transvestic Disorder
  9. Other Specified Paraphilic Disorder
  10. Unspecified Paraphilic Disorder
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