Paraphilia and Related Crime: a Neurological Perspective
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The DSM Diagnostic Criteria for Paraphilia Not Otherwise Specified
Arch Sex Behav DOI 10.1007/s10508-009-9552-0 ORIGINAL PAPER The DSM Diagnostic Criteria for Paraphilia Not Otherwise Specified Martin P. Kafka Ó American Psychiatric Association 2009 Abstract The category of ‘‘Not Otherwise Specified’’ (NOS) Introduction for DSM-based psychiatric diagnosis has typically retained diag- noses whose rarity, empirical criterion validation or symptomatic Prior to an informed discussion of the residual category for expression has been insufficient to be codified. This article re- paraphilic disorders, Paraphilia Not Otherwise Specified (PA- views the literature on Telephone Scatologia, Necrophilia, Zoo- NOS), it is important to briefly review the diagnostic criteria philia, Urophilia, Coprophilia, and Partialism. Based on extant for a categorical diagnosis of paraphilic disorders as well as the data, no changes are suggested except for the status of Partialism. types of conditions reserved for the NOS designation. Partialism, sexual arousal characterized by ‘‘an exclusive focus The diagnostic criteria for paraphilic disorders have been mod- on part of the body,’’ had historically been subsumed as a type of ified during the publication of the Diagnostic and Statistical Man- Fetishism until the advent of DSM-III-R. The rationale for con- uals of the American Psychiatric Association. In the latest edition, sidering the removal of Partialism from Paraphilia NOS and its DSM-IV-TR (American Psychiatric Association, 2000), a para- reintegration as a specifier for Fetishism is discussed here and in a philic disorder must meet two essential criteria. The essential companion review on the DSM diagnostic criteria for fetishism features of a Paraphilia are recurrent, intense sexually arousing (Kafka, 2009). -
Use of DSM Paraphilia Diagnoses in Sexually Violent Predator Commitment Cases
SPECIAL ARTICLE Use of DSM Paraphilia Diagnoses in Sexually Violent Predator Commitment Cases Michael B. First, MD, and Robert L. Halon, PhD There is legitimate concern in the psychiatric community about the constitutionality of sexually violent predator (SVP) commitment statutes. Such constitutionality depends on the requirement that a sexual offender have a mental abnormality that makes him commit violent predatory sex offenses and reflects almost exclusively a concern for public safety, with little regard for notions of clinical sensibility or diagnostic accuracy. However, given that mental health experts’ diagnostic opinions are, and will continue to be, important to the triers of fact in regard to the application of the SVP statutes, we describe valid means of making a DSM-IV-TR paraphilic diagnosis. We also provide a three-step approach for the judicious application of the diagnosis in the context of SVP commitment evaluations that emphasizes the importance of not making a paraphilia diagnosis based solely on the sexual offenses themselves. Finally, we discuss the appropriate use of a paraphilia NOS diagnosis in SVP cases. J Am Acad Psychiatry Law 36:443–54, 2008 In 1990, the state of Washington passed the first Despite several challenges to the constitutionality sexually violent predator (SVP) involuntary commit- of SVP statutes, the U.S. Supreme Court in two sep- ment statute, which was designed to allow for the arate rulings (Kansas v. Hendricks3 and Kansas v. civil commitment of sex offenders to mental hospi- Crane4) upheld the constitutionality of the Kansas tals after they complete mandatory prison sentences. State Sexually Violent Predator laws, essentially mak- According to the Washington SVP statute, the of- ing similar laws with analogous proof requirements fender must be found to be “a person who has been constitutional in all states. -
Mental Health Diagnosis Codes
Mental Health Diagnosis Codes Code Description Code System 10007009 Coffin-Siris syndrome (disorder) SNOMEDCT 10278007 Factitious purpura (disorder) SNOMEDCT 10327003 Cocaine-induced mood disorder (disorder) SNOMEDCT 10349009 Multi-infarct dementia with delirium (disorder) SNOMEDCT 10532003 Primary degenerative dementia of the Alzheimer type, presenile onset, with SNOMEDCT depression (disorder) 10586006 Occupation-related stress disorder (disorder) SNOMEDCT 106013002 Mental disorder of infancy, childhood or adolescence (disorder) SNOMEDCT 106014008 Organic mental disorder of unknown etiology (disorder) SNOMEDCT 106015009 Mental disorder AND/OR culture bound syndrome (disorder) SNOMEDCT 109006 Anxiety disorder of childhood OR adolescence (disorder) SNOMEDCT 109478007 Kohlschutter's syndrome (disorder) SNOMEDCT 109805003 Factitious cheilitis (disorder) SNOMEDCT 109896009 Indication for modification of patient status (disorder) SNOMEDCT 109897000 Indication for modification of patient behavior status (disorder) SNOMEDCT 109898005 Indication for modification of patient cognitive status (disorder) SNOMEDCT 109899002 Indication for modification of patient emotional status (disorder) SNOMEDCT 109900007 Indication for modification of patient physical status (disorder) SNOMEDCT 109901006 Indication for modification of patient psychological status (disorder) SNOMEDCT 11061003 Psychoactive substance use disorder (disorder) SNOMEDCT 111475002 Neurosis (disorder) SNOMEDCT 111476001 Mental disorder usually first evident in infancy, childhood AND/OR -
Zoophilia and Hypersexuality in an Adult Male with Schizophrenia A
Neurology, Psychiatry and Brain Research 34 (2019) 41–43 Contents lists available at ScienceDirect Neurology, Psychiatry and Brain Research journal homepage: www.elsevier.com/locate/npbr Zoophilia and hypersexuality in an adult male with schizophrenia: A case report T Sujita Kumar Kar, Sankalp Dixit King George’s Medical University, Lucknow, India ARTICLE INFO ABSTRACT Keywords: Background: Paraphilias can be seen in the context of schizophrenia. Among the paraphilias, zoophilia is less Paraphilia commonly reported. Paraphilias are often associated with hypersexuality and psychiatric comorbidities. Zoophilia Paraphilias like zoophilia may result in development of sexually transmitted diseases. Schizophrenia Method: After obtaining informed consent, details of history were obtained. Mental status of the patient was Sexually transmitted diseases done at regular intervals. General physical examination, appropriate blood investigations and neuroimaging were done. Result: We have described here the case of an adult male suffering from schizophrenia with co-morbid alcohol and cannabis use disorder with hypersexuality, who had zoophilia and developed hepatitis B infection. Conclusion: Paraphilias like zoophilia can lead to development of sexually transmitted disease in patients with schizophrenia. 1. Introduction of paraphilia. Earlier reports suggest the prevalence of zoophilia to be significantly higher among psychiatric inpatients than those in medical Schizophrenia is a severe mental disorder. Altered sexual behaviour inpatients (Alvarez & Freinhar, 1991). Presence of comorbid paraphilia may be seen more frequently in patients with schizophrenia. Zoophilia in schizophrenia is associated with increased rate of suicides as well as (Bestiality) is a form of sexual perversion (paraphilia), which involves longer duration of hospitalization (Marsh et al., 2010). This case report sexual fantasies and acts with animals. -
Icd-9-Cm Mental Disorders Diagnosis Codes And
ATTACHMENT A ICD-9-CM MENTAL DISORDERS DIAGNOSIS CODES AND DESCRIPTIONS Subject to Certification of Admission/Concurrent/Continued Stay Review Revised Effective May 1, 2005 Effective Dates of New Codes Are Noted in Bold After Their Description This list contains principal diagnosis codes for psychiatric services Category of Service 21. General care hospitals that are not enrolled for COS 21 will continue to bill for a maximum of three days of emergency psychiatric care using COS 20. Schizophrenic disorders 295.00 Unspecified 295.01 Subchronic 295.02 Chronic 295.03 Subchronic with acute exacerbation 295.04 Chronic with acute exacerbation 295.05 In remission 295.10 Disorganized type unspecified 295.11 Disorganized type subchronic 295.12 Disorganized type chronic 295.13 Disorganized type subchronic with acute exacerbation 295.14 Disorganized type chronic with acute exacerbation 295.15 Disorganized type in remission 295.20 Catatonic type unspecified 295.21 Catatonic type subchronic 295.22 Catatonic type chronic 295.23 Catatonic type subchronic with acute exacerbation 295.24 Catatonic type chronic with acute exacerbation 295.25 Catatonic type in remission 295.30 Paranoid type unspecified 295.31 Paranoid type subchronic 295.32 Paranoid type chronic 295.33 Paranoid type subchronic with acute exacerbation 295.34 Paranoid type chronic with acute exacerbation 295.35 Paranoid type in remission 295.40 Schizophreniform disorder, unspecified 295.41 Schizophreniform disorder, subchronic 295.42 Schizophreniform disorder, chronic 295.43 Schizophreniform -
The Addictive Potential of Sexual Behavior (Impulse) Review2
Page 1 of 9 Impulse: The Premier Journal for Undergraduate Publications in the Neurosciences Submitted for Publication January, 2018 The Addictive Potential of Sexual Behavior Heather Bool D’Youville College, Buffalo, New York This paper examines the addictive potential of sexual behavior through behavioral and neurophysiological mechanisms analogous to other formalized addictions. Sexual behavior refers to any action or thought preformed with the intention of sexual gratification, such as the consumption of explicit material, masturbation, fantasizing of sexual scenarios, and sexual intercourse. Addiction is defined by the presence of tolerance, preoccupation, withdrawal, dependence, and the continuation of behavior despite risk and/or harm. Sexual addiction demonstrates high relapse potential due to the frequency of reward-associated cues encountered in daily life, and the low effort and risk required for sexual pleasure. Currently, sexual addiction lacks a formal diagnosis despite behavioral, psychological, and physiological evidence. An official diagnosis recognized by a governing authority, such as the American Psychological Association, would offer greater access to treatment, funding for research, and exposure and education for the general public about this disorder. Abbreviations: None Keywords: Sexual Behavior; Addiction; Sexual Addiction; Neurophysiology; Behavioral Neuroscience Introduction “Sexual addiction” is an umbrella term Confusion remains regarding the for sexual impulsivity, sexual compulsivity, out- etiology and nosology of sexual addiction, of-control sexual behavior, hypersexual which has led to the lack of a universally behavior or disorder, sexually excessive accepted criterion and, more importantly, the behavior or disorder, Don Jaunism, satyriasis, absence of a formal diagnosis. A lack of and obsessive-compulsive sexual behavior operationalization of the disorder has severe (Beech et al., 2009; Karila et al., 2014; effects on research; due to the use of Rosenberg et al., 2014). -
Paraphilic Disorders
Commentary PARAPHILIC DISORDERS Paraphilic disorders: A better understanding Patients with these disorders are a significantly misunderstood and underserved population n my role as the Director of The Johns Hopkins Sex and Gender Clinic, I have had the opportunity to provide care Ito 3 broad categories of patients: patients with sexual dysfunctions, patients experiencing gender dysphoria, and patients manifesting a paraphilic disorder. This article will not address sexual dysfunctions or gender dysphoria, but these terms are defined in the Box1-3 (page 23) to clearly dis- tinguish them from paraphilic disorders. Persons with paraphilic disorders (predominantly males) experience recurrent atypical sexual fantasies and urges that cause clinically significant impairment or distress.1 Those atypical fantasies and urges may be directed towards unac- ceptable partners such as animals or children, or towards PHOTGRAPHEE.EU unacceptable behaviors such as public exhibitionism. Table 11 Fred S. Berlin, MD, PhD (page 24) lists the paraphilic disorders identified in DSM-5. Associate Professor of Psychiatry and Behavioral Sciences This article focuses primarily, though not exclusively, upon The Johns Hopkins University School of Medicine pedophilic disorder, and its pharmacologic treatment. Founder, The Johns Hopkins Sexual Disorders Clinic Director, The Johns Hopkins Sex and Gender Clinic However, the rationale underlying such treatment is appli- Director, National Institute for the Study, Prevention, cable across the paraphilic spectrum. Before providing such and Treatment of Sexual Trauma treatment, it is important for clinicians to have a clear con- Baltimore, Maryland ceptual understanding of paraphilic disorders. When is a difference a disorder? Cancer and respiration are 2 different biologic phenom- enon. Cancer causes suffering and impairment, and as a consequence, we label it a disorder. -
Paraphilia NOS, Nonconsent: Not Ready for the Courtroom
ANALYSIS AND COMMENTARY Paraphilia NOS, Nonconsent: Not Ready for the Courtroom Allen Frances, MD, and Michael B. First, MD Sexually violent predators (SVP) constitute a serious potential risk to public safety, especially when they are released after too short a prison sentence. Twenty states and the federal government have developed a seemingly convenient way to reduce this risk. They have passed statutes that allow for the involuntary (often lifetime) psychiatric commitment of mentally disordered sexual offenders after prison time is up. In three separate cases, the Supreme Court has accepted the constitutionality of this procedure, but only if the offender’s dangerousness is caused by a mental disorder and is not a manifestation of simple criminality. The idea that paraphilic rape should be an official category in the psychiatric diagnostic manual has been explicitly rejected by Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, DSM-III-R, DSM-IV, and, recently, DSM-5. Despite this, paraphilia NOS, nonconsent, is still frequently used by mental health evaluators in SVP cases to provide a mental disorder diagnosis that legitimizes psychiatric commitment and makes it appear constitutional. This commentary will show how the diagnosis paraphilia NOS, nonconsent, is based on a fundamental misreading of the original intent of the DSM-IV Paraphilia Workgroup and represents a misuse of psychiatry, all in the admittedly good cause of protecting public safety. J Am Acad Psychiatry Law 39:555–61, 2011 The legal system unwittingly created a dilemma for rage when recently released offenders reoffended, itself 30 years ago when it adopted fixed sentencing as sometimes in the most horrible ways imaginable. -
Clinical Considerations in Treating BDSM Practitioners: a Review
JOURNAL OF SEX & MARITAL THERAPY , VOL. , NO. , – https://doi.org/./X.. Clinical Considerations in Treating BDSM Practitioners: A Review Cara R. Dunkleya andLoriA.Brottob aDepartment of Psychology, University of British Columbia, Vancouver, British Columbia, Canada; bDepartment of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada ABSTRACT BDSM is an overlapping acronym referring to the practices of bondage and discipline, dominance and submission, and sadism and masochism. This arti- cle reviews the psychological literature on BDSM practitioners and discusses issues concerning BDSM that are relevant to clinicians and sexual health-care providers. The literature concerning the psychological health of BDSM prac- titioners and clinical issues in treating BDSM practitioners was exhaustively reviewed. BDSM practitioners differ minimally from the general population in terms of psychopathology. Six clinical considerations emerged: ignoring versus considering BDSM; countertransference; nondisclosure; cultural competence; closer relationship dynamics; BDSM, abuse, and pathology. Sexual sadism and sexual masochism describe behaviors that fall under the paraphilia umbrella and are often accepted as variations of “typical” sexual behaviors. Given the proliferation of sadomasochistic themes in sexually explicit media (Weiss, 2006a), sadomasochism may represent a more common sex- ual expression among individuals than was previously assumed (e.g., Moser & Levitt, 1987; Richters, de Visser, Rissel, Grulich, & Smith, 2008), with an estimated 10% of adults in the general population having engagedinsomeformofBDSMactivity(Moser&Kleinplatz,2006a). Light forms of sadomasochistic sexual activity, such as spanking, biting, and hair pulling, are not uncommon among individuals with more conventional sexual proclivities, with a minority of the population reporting engagement in more intense forms of sadomasochism, such as whipping, paddling, and bondage (Moser & Kleinplatz, 2006b). -
451 Sexual Response and Behavior
341770_ch_11_448-53 6/17/02 10:56 AM Page 451 mac48 Mac 48:Desktop Folder:spw/456: MODULE 11.2 451 CONCEPT CHART 11.2 Sexual Response and Behavior Concept Description Additional Comments Sexual response cycle The characteristic pattern of bodily re- According to Masters and Johnson, the sexual response cycle sponses to sexual stimulation consists of four phases: excitement, plateau, orgasm, and resolution. Sexual orientation The direction of sexual attraction to The roots of sexual orientation remain obscure, but interest one’s own gender, to the opposite gen- among investigators and theorists has focused on biological der, or to both genders factors (genetics, prenatal sex hormones) and psychosocial factors (self-perceptions in childhood of differentness, relation- ship patterns with parents). Sexual behavior Includes masturbation, sexual inter- Though the human body can respond to many forms of sexual course, oral sex, and anal sex stimulation, sexual behavior is strongly influenced by cultural learning, personal values, and individual experiences, not sim- ply by biological drives or capacities for sexual response. Paraphilias Atypical or deviant patterns of sexual Some forms of paraphilia are associated with behaviors that attraction are illegal because of the harm these behaviors cause to others. had experiences dating back to infancy in which erections were associated with contact with rubber pants or diapers (Reinisch, 1990). Such experiences might then have led to a conditioned response (sexual arousal) connected with touch- ing the object. Concept Chart 11.2 reviews key concepts relating to sexual response and behavior. Sexual Behavior and STDs: Are You at Risk? Concept 11.20 Many STDs, not just HIV/AIDS, pose AIDS (acquired immune deficiency syndrome) has become one of history’s worst serious threats to our health. -
Zoophilia As an Early Sign of Psychosis
Original paper Alcoholism and Psychiatry Research 2017;53:27-32 DOI: 10.20471/apr.2017.53.01.03 Received February 13, 2017, accepted after revision April 20, 2017. Zoophilia as an Early Sign of Psychosis Vinka Lesandrić¹*, Ivona Orlović ²*, Vjekoslav Peitl³, Dalibor Karlović³ ¹Department of psychiatry, County General Hospital Vinkovci, Vinkovci, Croatia, ²Institute of Public Health, Međimurje County, Čakovec, Croatia, ³Department of psychiatry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia *Both authors have contributed equally to this work. Abstract – Zoophilia is a disorder of sexual preference that is characterised by sexual fantasies or behav- iours that include animals. Zoophilia is more common in comorbidity with other paraphilias. When reviewing scholarly publications, a small number of articles has been found that connect zoophilia, and other psychi- atric disorders, and they are shown here. Out of the seventeen known to us isolated cases of patients with zoophilia in comorbity with other psychiatric disorders, nine are noted with zoophilia and psychosis. Precisely in those patients, and also in the case of our patient that we described here, we can speak of zoophilic be- haviour as one of the signs of psychosis, although keeping in mind the small sample and the unreliability of data, it is hard to state that zoophilia is an early, or any other sign of psychosis. Considering that in our case zoophilia presented as an early sign of the psychotic process, it is for us to conclude how during noticing of such sexually deviant behaviour it is important to pay attention to all the other psychopathology as to get an insight into the possible start or exacerbation of the psychotic process in order for the treatment to be more directional. -
ICD-9-CM MENTAL DISORDERS DIAGNOSIS CODES and DESCRIPTIONS Subject to Certification of Admission/Concurrent/Continued Stay Review Revised Effective May 1, 2005
ATTACHMENT A ICD-9-CM MENTAL DISORDERS DIAGNOSIS CODES AND DESCRIPTIONS Subject to Certification of Admission/Concurrent/Continued Stay Review Revised Effective May 1, 2005 This list contains principal diagnosis codes for psychiatric services Category of Service 21. General care hospitals that are not enrolled for COS 21 will continue to bill for a maximum of three days of emergency psychiatric care using COS 20. Schizophrenic disorders 295.00 Unspecified 295.01 Subchronic 295.02 Chronic 295.03 Subchronic with acute exacerbation 295.04 Chronic with acute exacerbation 295.05 In remission 295.10 Disorganized type unspecified 295.11 Disorganized type subchronic 295.12 Disorganized type chronic 295.13 Disorganized type subchronic with acute exacerbation 295.14 Disorganized type chronic with acute exacerbation 295.15 Disorganized type in remission 295.20 Catatonic type unspecified 295.21 Catatonic type subchronic 295.22 Catatonic type chronic 295.23 Catatonic type subchronic with acute exacerbation 295.24 Catatonic type chronic with acute exacerbation 295.25 Catatonic type in remission 295.30 Paranoid type unspecified 295.31 Paranoid type subchronic 295.32 Paranoid type chronic 295.33 Paranoid type subchronic with acute exacerbation 295.34 Paranoid type chronic with acute exacerbation 295.35 Paranoid type in remission 295.40 Schizophreniform disorder, unspecified 295.41 Schizophreniform disorder, subchronic 295.42 Schizophreniform disorder, chronic 295.43 Schizophreniform disorder, subchronic with acute exacerbation 295.44 Schizophreniform