How anomalous are paraphilic interests?

The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) addressed important issues related to the definition and diagnostic criteria of paraphilic disorders. Among them is the distinctionbetweenparaphilic interestsandparaphilicdisorders, which clearly acknowledge that paraphilias are not necessarily pathological. However, many problems remain with the category of Paraphilic Disorders in the DSM-5. Issues related to the diagnoses of paraphilic disorders were previously stressed by others (e.g., vagueness of terms, lack of validity, unoperationalized terminology, mixed medical and criminal criteria) (e.g., Balon, 2013; Fedoroff, 2011; Hinderliter, 2011; Moser, 2011; Singy, 2010). This commentary will raise more basic, yet rarely addressed, questions concerning the category of paraphilic disorders: the fundamental definition of paraphilia (Criterion A). According to the DSM-5, paraphilia are anomalous sexual activity preferences or anomalous sexual target preferences (the DSM-IV-TR employed the term atypical). Paraphilias are further defined in the DSM-5 as any intense and persistent sexual interests (fantasies, urges or behaviors) not comprised in a definition of so-called‘‘normophilic’’sexual interests, i.e., ‘‘genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners’’ (American Psychiatric Association, 2013, p. 685). To be paraphilic, these interests must be greater or equal to ‘‘normophilic’’ sexual interests. Examples of paraphilic interests are given, separated by erotic activities (e.g., spanking, whipping, binding) or erotic targets (e.g., children, animals, shoes, rubber). ThefirstcommenthereconcernstheDSM-5attempttodefine normal sexual behaviors. As stressed by others, this type of definition (‘‘normophilic sexuality’’) depends heavily on historical, political, and sociocultural factors, much more than medical or scientific evidence (Balon, 2013; Laws & O’Donohue,2008).Homosexuality, forexample,was listedasamental disorder until 1973, when it was deleted from the DSM-II (American Psychiatric Association, 1968). Given its relative rarity (3–5 % prevalence) and its counter-evolutionary (non-procreative) nature, should exclusive homosexuality be a paraphilia (Cantor, 2012)? At the time of the first Kinsey report (Kinsey, Pomeroy, & Martin, 1948), oral sex, anal sex, and homosexual intercoursewereconsideredascriminalacts inmanyU.S. states. Masturbation was banned by many religions not so long ago. In the future, what will be said about the paraphilias of the DSM-5? A second concern about the DSM-5 definition of paraphilic interests is their label as ‘‘non-normophilic’’ and ‘‘anomalous’’ sexual interests although no information is provided about the evidence on which these labels are based (in the DSM-IV-TR, the term used was‘‘atypical,’’with no additional bases). There is a general consensus that a paraphilia can be defined as sexual interests that are atypical for one’s species (Cantor, 2012). What is less clear, however, is what an atypical sexual interest is. One can wonder when an atypical sexual interest becomes a mental disorder (Moser, 2009) but, again, what exactly is an atypical sexual interest? Finally, such important terms as ‘‘intense’’ and ‘‘persistent’’ are still not defined in the DSM-5 descriptions of paraphilias. Given that mere sexual fantasies can be paraphilic if they are intense and recurrent, and that sexual fantasies are known to be rather intense and recurrent, at least in subgroups of non-clinical populations (e.g., college students) (Leitenberg & Henning, 1995), one can wonder which sexual fantasies fit this definition. C. C. Joyal (&) Department of Psychology, Université du Québec à Trois-Rivières, 3351, Boul. des Forges, C.P. 500, Trois-Rivières, QC G9A 5H7, Canada e-mail: [email protected]