Am I a ‘pervert’ or simply enjoying the extraordinary? The answer to this question has seen remarkable changes over the times. Many sexual practices that might have resulted in getting burned at the stake for being possessed by ‘demons’ or being locked up in a mental ward during the last centuries are considered as nothing else than normal nowadays. However, there are indeed forms of sexual behavior that are considered as psychopathological even if moral issues are left aside. Today, sexual behavior is considered a disorder (or paraphilia) if it causes distress or impairment to the individual or harm to others. This is an important distinction to avoid pejorative positions towards more uncommon sexual interests and practices like a sexual attraction to the same sex which was still part of the diagnostic manuals until 1973.

Upcoming versions of  diagnostic manuals will further make a distinction between paraphilias and paraphilic disorders. A paraphilia by itself would not automatically justify or require therapeutic intervention. A paraphilic disorder will be the aforementioned paraphilia that causes distress or impairment to the individual or harm to others. In other words, non-normative sexual behavior will not automatically be labeled as psychopathological anymore. Cross-dressing, for example, will not automatically be classified as transvestitism anymore – unless the person is unhappy about this activity or impaired by it. Only then it would be diagnosed as ‘disorder’.
While the new generation of classifications will definitely bring improvements compared to diagnoses that were given in a pejorative way before, it will also link diagnoses closer to cultural values again, so in a society with tighter cultural norms like here in Asia, we will probably see more people diagnosed with sexual disorders once the new classifications have become standard, as these person’s behavior patterns are more prone to ‘harm’ or ‘distress’ others…

The most common paraphilias that are considered as disorders are exhibitionism, fetishism (certain objects are required to gain sexual excitement), frotteurism (urges to touch or rub against a nonconsenting person), pedophilia, sexual masochism and sadism, transvestic fetishism, urophilia (sexual excitement with the sight or thought of urination) and voyeurism. These forms of sexual deviance usually become a problem if non-consenting persons are involved, local laws are violated or if sexual arousal can only be reached by acting on the urge of the paraphilia.
Can paraphilias be cured? Many experts claim they can’t, at least not with standard methods of sex therapy. However, often enough, persons suffering from the restrictions their paraphilias impose on them can learn to manage their sexual behavior more efficiently and flexibly – at least to an extent that prevents them from breaking laws or destroying their relationships.

More articles and literature:

• Andrea Beckmann, “The Social Construction of Sexuality and Perversion: Deconstructing Sadomasochism” (engl.)
• Sexualstörungen und Sexualtherapie (german lang.)
• Diagnoseschema ICD-10 (german)

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)