apa 7th Post: Respond to your colleague by comparing the differential diagnostic features of erectile disorder to the diagnostic features of sexual pain disorder Paraphilic Disorder I chose to discuss paraphilic disorder this week. A paraphilic disorder is defined as an atypical sexual interest. The diagnostic criteria for the Paraphilic the disorder is as followed: feel personal distress about their interest, not merely distress resulting from societys disapproval; or have a sexual desire or behavior that involves another persons psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent (APA, 2013). The names of these disorders have been revised to differentiate between the behaviors itself and the disorder stemming from that behavior which further defines the line between an atypical sexual interest and disorder. For example, Sexual Masochism in DSM-IV will be titled Sexual Masochism Disorder in DSM-5(APA, 2013). By making this possible the difference it makes, makes it possible for an individual to engage in consensual atypical sexual behavior without being inappropriately labeled with a mental disorder. The DSM-5 revision clearly distinguishes between atypical sexual interests and mental disorders involving these desires or behaviors. Paraphilic disorders include eight different conditions: exhibitionistic disorder which is exposing ones genitals to an unsuspecting person or performing sexual acts that can be watched by others, fetishistic the disorder is the use of inanimate objects to gain sexual excitement, frotteurism disorder is touching or rubbing against a non-consenting person, the pedophilic disorder is where sexual preference for prepubescent children, sexual masochism disorder is wanting to be humiliated, beaten, bound or otherwise made to suffer for sexual pleasure, sexual sadism disorder is in which pain or the humiliation of a person is sexually pleasing, the transvestic disorder is Arousal from clothing associated with members of the opposite sex and voyeuristic disorder is when one has urges to observe an unsuspecting person who is naked, undressing or engaging in sexual activities, or in activities deemed to be of a private nature. Psychopharmacologic Treatment According to Thibaut (2010) in his 40 years of evaluation of treatment, his research found despite some case reports of a reduction of some sexual behaviors, psychotropic drugs showed very poor evidence of effective treatment for paraphilic behaviors. The same was found for anti-androgens, also associated with many side effects. Gonadotropin-releasing hormone treatment showed high efficacy which works in a similar way to physical castration. Gonadotropin-releasing hormone receptors rapidly desensitize resulting in a reduction of luteinizing hormone. Unfortunately, the effectiveness of treatments for these paraphilias presented is inconclusive according to the research. The research into all treatments of paraphilia is blighted due to the small sample sizes; short duration of follow-up; open and retrospective studies; lack of controls and biases; and its associated co-morbidity with other disorders (McManus & Hargreaves et al, 2013). Psychotherapy I have found in my readings the research into the treatment of non-criminal paraphilics is negligible due to reliant on voluntary disclosure. The voluntary disclosure of Paraphilia is rare and justification for treatment is still debatable. According to Thibaut (2010), the use of Cognitive Behavioral Therapy (CBT had reports of a moderate decrease in sexual offending recidivism. Other types of therapy that are suggested are aversion or reconditioning but have shown little evidence of effectiveness. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Mathiesen, A. M. M. S. (2017). Gender dysphoria. Magills Medical Guide (Online Edition). McManus, M. A., Hargreaves, P., Rainbow, L., & Alison, L. J. (2013). Paraphilias: definition, diagnosis, and treatment. F1000prime reports, 5, 36. doi:10.12703/P5-36 Thibaut F, De La Barra F, Gordon H, Cosyns P, Bradford JM, WFSBP Task Force on Sexual Disorders. World J Biol Psychiatry. 2010 Jun; 11(4):604-55.
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