198 - 6D35 Other paraphilic disorder involving non

6D35 Other paraphilic disorder involving non-consenting individuals

585 Paraphilic disorders disorder may use substances with the intention of engaging in frotteuristic behaviour that does reflect an underlying paraphilic arousal pattern. A diagnosis of frotteuristic disorder may be assigned together with a disorder due to substance use if the diagnostic requirements for both are met. Boundary with other mental disorders The occurrence or a history of behaviours involving sexual touching or rubbing against nonconsenting individuals is not sufficient to establish a diagnosis of frotteuristic disorder. Rather, these behaviours must reflect a sustained, focused and intense pattern of sexual arousal. When this is not the case, other causes of the behaviour need to be considered. For example, inappropriate touching or rubbing against others that does not reflect an underlying, persistent pattern of sexual arousal may occur in the context of some mental disorders, such as bipolar type I disorder during manic or mixed episodes, or dementia. Boundary with sexual crimes that do not involve a paraphilic disorder Sexual crimes involving frotteuristic behaviour may consist of actions or behaviours that are not associated with a sustained underlying paraphilic arousal pattern. Rather, these behaviours may be transient and occur impulsively or opportunistically. The diagnosis of frotteuristic disorder requires sexual touching or rubbing behaviours to be a manifestation of a sustained, focused and intense pattern of sexual arousal. Other paraphilic disorder involving non-consenting individuals Essential (required) features • A sustained, focused and intense pattern of atypical sexual arousal – as manifested in sexual thoughts, fantasies, urges or behaviours – in which the focus of the arousal pattern involves others who are unwilling or unable to consent is required for diagnosis. • The arousal pattern is not specifically described by any of the other named paraphilic disorders categories (e.g. arousal patterns involving corpses or animals). • The presentation does not fulfil the diagnostic requirements of coercive sexual sadism disorder, paedophilic disorder, voyeuristic disorder, exhibitionistic disorder or frotteuristic disorder. • The individual must have acted on these thoughts, fantasies or urges, or be markedly distressed by them. Additional clinical features • Other paraphilic disorder involving non-consenting individuals should not be diagnosed among children, and should be diagnosed only with the utmost caution among adolescents. Sexual experimentation is typical during adolescence, and sexual acts may occur impulsively or opportunistically rather than representing a recurrent pattern of sexual arousal. 6D35 Paraphilic disorders | Other paraphilic disorder involving non-consenting individuals

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders • A diagnosis of other paraphilic disorder involving non-consenting individuals is generally not adequately supported when the evidence indicating a sustained, focused and intense pattern of sexual arousal consists solely of a single or very limited number of instances of specific forms of sexual behaviour, as there may be other explanations for specific occurrences (e.g. intoxication, opportunity). In the absence of a report of the individual’s sexual thoughts, fantasies or urges, examples of other forms of evidence supporting the presence of a paraphilic arousal pattern include a preference for specific types of pornography; preference over other forms of sexual behaviour; or planning and repeatedly seeking out opportunities to engage in the relevant paraphilic sexual behaviour. Boundary with normality (threshold) • Other paraphilic disorder involving non-consenting individuals specifically excludes sexual behaviours that occur with the consent of the person or people involved, as long as they are deemed to have the capacity to provide such consent. Course features • Individuals with paraphilic disorders often report the onset of paraphilic sexual interest during adolescence. • Paraphilic disorders are relatively stable after young adulthood, but sexual thoughts, fantasies, urges and behaviours may change over time, such that an individual who was assigned a diagnosis of a paraphilic disorder no longer meets the diagnostic requirements. Developmental presentations • Advancing age may be associated with decreasing paraphilic sexual arousal and decreasing behavioural manifestations of paraphilic disorders due to increased impulse control and decreased sexual drive. Sex- and/or gender-related features • Paraphilic disorders are much more prevalent among men. Paraphilic disorders | Other paraphilic disorder involving non-consenting individuals

587 Paraphilic disorders Boundaries with other disorders and conditions (differential diagnosis) Boundary with compulsive sexual behaviour disorder Both other paraphilic disorder involving non-consenting individuals and compulsive sexual behaviour disorder may involve repetitive sexual impulses, urges or behaviours that result in marked distress or impairment. Other paraphilic disorder involving non-consenting individuals is characterized by sexual impulses, urges or behaviours that are manifestations of a sustained, focused and intense pattern of sexual arousal, in which the focus of the arousal pattern involves others who are unwilling or unable to consent, that is not specifically described in any of the other named paraphilic disorders categories. In contrast, compulsive sexual behaviour disorder is characterized by a persistent pattern of failure to control sexual impulses, urges or behaviours, regardless of the focus of sexual arousal. If an individual with other paraphilic disorder involving non-consenting individuals is able to exercise some degree of control over the behavioural expressions of the arousal pattern, an additional diagnosis of compulsive sexual behavioural disorder is generally not warranted. Boundary with disorders due to substance use Episodes of sexual behaviour involving others whose age or status renders them unwilling or unable to consent may occur during substance intoxication. Such episodes may not be a manifestation of a sustained, focused and intense sexual arousal pattern. At the same time, some individuals with paraphilic disorders may use substances with the intention of engaging in sexual behaviour involving others whose age or status renders them unwilling or unable to consent that does reflect an underlying paraphilic arousal pattern. A diagnosis of other paraphilic disorder involving non-consenting individuals may be assigned together with a disorder due to substance use if the diagnostic requirements for both are met. Boundary with other mental disorders The occurrence or a history of sexual behaviours involving others whose age or status renders them unwilling or unable to consent is not sufficient to establish a diagnosis of other paraphilic disorder involving non-consenting individuals. Rather, these sexual behaviours must reflect a sustained, focused and intense pattern of sexual arousal. When this is not the case, other causes of the sexual behaviour need to be considered. For example, sexual behaviours involving nonconsenting individuals that do not reflect an underlying, persistent pattern of sexual arousal may occur in the context of some mental disorders, such as bipolar type I disorder during manic or mixed episodes, or dementia. Boundary with sexual crimes that do not involve a paraphilic disorder Sexual crimes involving non-consenting individuals may consist of actions or behaviours that are not associated with a sustained underlying paraphilic arousal pattern. Rather, these behaviours may be transient and occur impulsively or opportunistically. The diagnosis of other paraphilic disorder involving non-consenting individuals requires these behaviours to be a manifestation of a sustained, focused and intense pattern of paraphilic sexual arousal. Paraphilic disorders | Other paraphilic disorder involving non-consenting individuals