An overarching change from DSM-IV-TR is the addition of the course specifiers “in a controlled environment” and “in remission” to the diagnostic criteria sets for all the paraphilic disorders. These specifiers are added to indicate important changes in an individual’s status. There is no expert consensus about whether a longstanding paraphilia can entirely remit. In DSM-5, paraphilias are not ipso facto mental disorders. There is a distinction between paraphilias and paraphilic disorders. A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm or risk of harm to others. A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not automatically justify or require clinical intervention. The distinction between paraphilias and paraphilic disorders was implemented without making any changes to the basic structure of the diagnostic criteria as they had existed since DSM-III-R.
The questions below are from DSM-5 Self-Exam Questions: Test Questions for the Diagnostic Criteria, which may be preordered from American Psychiatric Publishing at http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62467. The answers and rationales are posted at http://www.psychnews.org/pdfs/DSM-5_Self_Examination_QandA_16.pdf. The book, available in February 2014, contains 500 questions for all the categories of psychiatric disorders and includes Section III. The questions were developed under the leadership of Philip Muskin, M.D., a professor of clinical psychiatry at Columbia University College of Physicians and Surgeons. APA members may purchase the book at a discount.
1. What change had been made in DSM-5 to the diagnosis of paraphilia/paraphilic disorder?
a) Paraphilia has been distinguished from paraphilic disorder so as to distinguish between those who have benign interests/behavior and those whose interest/behavior is associated with distress or impairment
b) The “benign” specifier has been added to paraphilic disorder
c) Transvestic disorder has been eliminated from DSM-5
d) To be diagnosed as a paraphilic disorder, a paraphilia must go beyond fantasy or urge to include behavior
e) Paraphilic disorders are grouped in a chapter with sexual disorders
2. In DSM-5, which of the following is not included among the paraphilic disorders?
a) sexual masochism disorder
b) transvestic disorder
c) transsexual disorder
d) voyeuristic disorder
e) fetishistic disorder
3. Which of the following is true about pedophilic disorder?
a) The extensive use of pornography depicting prepubescent or early pubescent children is not a useful diagnostic indicator of pedophilic disorder
b) Pedophilic disorder is stable over the course of a lifetime
c) There is an association between pedophilic disorder and antisocial personality disorder
d) While normophilic sexual interest declines with age, pedophilic sexual interest remains constant
e) Vaginal plethysmography is a less reliable diagnostic instrument for pedophilia in women than is penile plethysmography for pedophilia in men ■