# 40 - Paraphilias (Disorders of sexual preference) # Paraphilias (Disorders of sexual preference) © SPMM Course Most adult transsexuals, in fact, have origins of symptoms in childhood itself. Gender identity disorders of childhood can also be present in adolescents and children. A duration criteria of 6 months is appreciated for the pre-pubertal group. It is important to rule out chromosomal and endocrine problems in this group. In children, the large element of management is promoting the young person's tolerance of uncertainty and resisting pressures for quick solutions for the gender dysphoria. Surgical intervention is not justified until adulthood. Rarely some patients may have a form of body dysmorphic disorder where there is a persistent preoccupation with castration or penectomy without a desire to acquire the characteristics of the other sex. This may be classed as Gender identity disorder - NOS (not otherwise specified) or body dysmorphophobia. But this is not transsexualism. A transsexual person need not necessarily be homosexual – In other words, gender identity must be differentiated from sexual orientation. In gender dysphoria of childhood, 1/3rd to 2/3rd boys later appear homosexually oriented but very few persist as adult transsexuals. GIDs, at any age, are more common in males. Cross-dressing behaviour can also be transient in some associated with stressful times. Also, some individuals with mild gender dysphoria (to a degree that does not cause undue distress while in a mentally healthy state) may experience a marked intensification of a low-grade gender dysphoria when experiencing depressive episodes. Paraphilias (Disorders of sexual preference) Paraphilias, impulsive disorders and other habitual problems are coded under F60. In paraphilias, egosyntonic urges of sexual deviancy are seen (except in some cases of exhibitionism where the urges are reported as ego-alien). Klismaphilia is not a separate entity but is related to use of enemas to achieve sexual arousal. Necrophilia is  also  an  ‘other  paraphilia’  in  ICD-10. This refers to achieving sexual arousal by using dead bodies or other death related objects for sexual arousal. Paraphilias described in ICD-10 & DSM-IV Exhibitionism Expose genitals to achieve arousal Fetishism Use of inanimate objects to achieve arousal Paedophilia Sex with prepubescent child (<13) Sexual masochism Real, not simulated act of being humiliated, beaten or bound to achieve arousal Sexual sadism Real, not simulated act of inflicting psychological or physical suffering including humiliation of victim to achieve arousal DSM-5 AND PARAPHILIC DISORDERS All Paraphilic Disorders now include two new specifiers: In a Controlled Environment and In Remission. © SPMM Course Fetishistic transvestism Crossdressing in heterosexual male to achieve arousal Voyeurism ‘Peeping-toms.' Frotteurism Touching and rubbing against non-consenting individual Frotteurism  is  coded  as  ‘other  paraphilias’  in  ICD-10, but separate disorder in DSM-IV. Fetishistic transvestism is termed transvestic fetishism in DSM-IV.