Paraphilias and paraphilic disorders: diagnosis, assessment and management

Abstract

SummaryWe outline the difficulties in classifying paraphilias as mental disorder and summarise the changes to this diagnostic category in DSM-5. We review the research on the epidemiology and aetiology of paraphilias, and provide guidance on assessment and referral options for general psychiatrists when they encounter patients who may meet diagnostic criteria for a paraphilic disorder. Empirical evidence for effective treatments for paraphilias is limited, and specific treatment services are scarce, particularly for individuals presenting with legal paraphilias or those who are committing paraphilic sexual offences but who have not been convicted.LEARNING OBJECTIVESBe able to diagnose a paraphilic disorder according to DSM-5 criteria.Understand the epidemiology, comorbidity and theories of aetiology of paraphilic disorders.Know how to assess the need for disclosure if the patient presents with illegal paraphilias.