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For further information, see CMDT Part 25-09: Psychosexual Disorders

Key Features

  • Atypical objects or orientations for sexual excitement

  • Stimuli can vary from common objects such as a woman's shoe, a child, animals, instruments of torture, or aggressive acts

  • Disorders are differentiated by the object or activity used to achieve arousal

  • When paraphilias are associated with distress, impairment, or risk of harm, they become paraphilic disorders

  • Some paraphilias or paraphilic disorders include exhibitionism, transvestism, voyeurism, pedophilia, incest, sexual sadism, and sexual masochism

Clinical Findings

  • Exhibitionism is the achievement of arousal by exposing genitalia to strangers

  • Transvestism consists of recurrent cross-dressing in a heterosexual man often in masturbation foreplay

  • Voyeurism involves attaining arousal watching sexual activities or disrobing of an unknowing person

  • Pedophilia is the use of a child to achieve sexual arousal and often gratification

  • Incest involves a sexual relationship with a person—usually a child—in the immediate family

  • Sexual sadism involves inflicting pain upon the sexual object as a means of arousal

  • Sexual masochism is erotic pleasure being achieved by being humiliated, enslaved, or physically bound or restrained


  • Clinical history, often including court-ordered evaluations


  • Behavioral therapy

  • Gonadotropin antagonists

  • Medroxyprogesterone acetate

  • Selective serotonin reuptake inhibitors

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