Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11)

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Abstract

The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH’s proposals for Paraphilic Disorders in ICD-11 are based on the WHO’s role as a global public health agency and the ICD’s function as a public health reporting tool.

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Assessing risk for sexual recidivism: some proposals on the nature of psychologically meaningful risk factors.

Brian E. Mann, David Thornton, Maureen R. Hanson (2010)

Risk assessment and treatment for sexual offenders should focus on individual characteristics associated with recidivism risk. Although it is possible to conduct risk assessments based purely on empirical correlates, the most useful evaluations also explain the source of the risk. In this review, the authors propose that the basic requirements for a psychologically meaningful risk factor are (a) a plausible rationale that the factor is a cause of sexual offending and (b) strong evidence that it predicts sexual recidivism. Based on the second of these criteria, the authors categorize potential risk factors according to the strength of the evidence for their relationship with offending. The most strongly supported variables should be emphasized in both assessment and treatment of sexual offenders. Further research is required, however, to establish causal connections between these variables and recidivism and to examine the extent to which changes in these factors leads to reductions in recidivism potential.

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Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis.

Elena Vázquez-Chávez, Lawrence Gostin, Benedetto Saraceno … (2011)

This report reviews the evidence for the types of human rights violations experienced by people with mental and psychosocial disabilities in low-income and middle-income countries as well as strategies to prevent these violations and promote human rights in line with the UN Convention on the Rights of Persons with Disabilities (CRPD). The article draws on the views, expertise, and experience of 51 people with mental and psychosocial disabilities from 18 low-income and middle-income countries as well as a review of English language literature including from UN publications, non-governmental organisation reports, press reports, and the academic literature. Copyright Â© 2011 Elsevier Ltd. All rights reserved.

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Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations.

Geoffrey Reed, Jack Drescher, Richard B Krueger … (2016)

In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings: F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation. Changes have been proposed based on advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards. This paper describes the main recommended changes, the rationale and evidence considered, and important differences from the DSM-5. An integrated classification of sexual dysfunctions has been proposed for a new chapter on Conditions Related to Sexual Health, overcoming the mind/body separation that is inherent in ICD-10. Gender identity disorders in ICD-10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health. The proposed classification of Paraphilic disorders distinguishes between conditions that are relevant to public health and clinical psychopathology and those that merely reflect private behaviour. ICD-10 categories related to sexual orientation have been recommended for deletion from the ICD-11.

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Author and article information

Contributors

Richard B. Krueger: 212-740-7330 , rbk1@cumc.columbia.edu

Journal

Journal ID (nlm-ta): Arch Sex Behav

Journal ID (iso-abbrev): Arch Sex Behav

Title: Archives of Sexual Behavior

Publisher: Springer US (New York )

ISSN (Print): 0004-0002

ISSN (Electronic): 1573-2800

Publication date (Electronic): 16 February 2017

Publication date PMC-release: 16 February 2017

Publication date (Print): 2017

Volume: 46

Issue: 5

Pages: 1529-1545

Affiliations

[1 ]Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University, New York, NY USA

[2 ]ISNI 0000 0000 8499 1112, GRID grid.413734.6, Department of Psychiatry, , New York Presbyterian Hospital, ; New York, NY USA

[3 ]ISNI 0000 0000 8499 1112, GRID grid.413734.6, Sexual Behavior Clinic, , New York State Psychiatric Institute, ; 1051 Riverside Drive, Unit #45, New York, NY 10032 USA

[4 ]ISNI 0000000121633745, GRID grid.3575.4, Department of Mental Health and Substance Abuse, , World Health Organization, ; Geneva, Switzerland

[5 ]ISNI 0000 0001 2285 2675, GRID grid.239585.0, Global Mental Health Program, , Columbia University Medical Center, ; New York, NY USA

[6 ]ISNI 0000 0004 1937 1151, GRID grid.7836.a, Department of Psychiatry and Mental Health, Groote Schur Hospital, , University of Cape Town, ; Observatory, South Africa

[7 ]Geneva, Switzerland

[8 ]ISNI 0000000419368710, GRID grid.47100.32, Global Health Justice Partnership, , Yale Law School, ; New Haven, CT USA

[9 ]ISNI 0000 0001 2180 3484, GRID grid.13648.38, Institute for Sex Research and Forensic Psychiatry, , University Medical Center Hamburg-Eppendorf, ; Hamburg, Germany

Article

Publisher ID: 944

DOI: 10.1007/s10508-017-0944-2

PMC ID: 5487931

PubMed ID: 28210933

SO-VID: 5df0b75a-2026-4671-86ba-6d8e9441a007

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 1 December 2015

Date revision received : 13 January 2017

Date accepted : 16 January 2017

Funding

Funded by: The International Union of Psychological Science

Funded by: The National Institute of Mental Health (USA)

Funded by: The World Psychiatric Association

Funded by: The Royal College of Psychiatry (UK)

Funded by: The Spanish Foundation of Psychiatry and Mental Health (Spain)

Funded by: The Department of Psychiatry, Universidad Autonoma de Madrid

Funded by: The Department of Psychiatry Universidad Nacional Autonoma de Mexico

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ScienceOpen disciplines: Sexual medicine

Keywords: paraphilic disorders,icd-11,paraphilias,icd-10,dsm-5,disorders of sexual preference

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ScienceOpen disciplines: Sexual medicine

Keywords: paraphilic disorders, icd-11, paraphilias, icd-10, dsm-5, disorders of sexual preference

Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11)

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Most cited references 59

Assessing risk for sexual recidivism: some proposals on the nature of psychologically meaningful risk factors.

Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis.

Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations.

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