Institute of Forensic Psychiatry, Charité - University Medicine Berlin, Berlin, Germany.
Curr Opin Psychiatry. 2015 Nov;28(6):440-4. doi: 10.1097/YCO.0000000000000202.
The concept of paraphilia still carries an 'unwanted burden' of sexual norms because the pathologization of some sexual practices as paraphilic disorders is still based on the assumption that normal sexuality should be genitally organized with the aim of reproduction. The aim of this review is to give an impression of the ongoing discussion about the changes introduced with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the results of recent research in this area.
The release of DSM-5 in the spring of 2013 introduced a distinction between paraphilias and paraphilic disorders, implying a destigmatization of consenting adults engaging in unusual sexual behaviour. According to DSM-5 diagnostic criteria, paedophilic disorder is the only paraphilic disorder without an 'in remission' and an 'in a controlled environment' specifier. Today, antiandrogen treatment is offered to sex offenders in many countries as an additional treatment strategy alongside psychotherapy.
The introduction of DSM-5 offers the possibility to distinguish between paraphilia and paraphilic disorders. The aetiology of paraphilias is still unknown. Paraphilias are much more common in men than in women, but the reasons for this difference remain unknown. So far there is no clear consent on the best therapeutic approach for a paraphilic disorder.
性僻症的概念仍然带有“不受欢迎的性规范负担”，因为一些性行为被病理化为性僻症，这仍然基于这样一种假设，即正常的性行为应该以生殖为目的与生殖器组织化。本文旨在概述正在进行的关于《精神障碍诊断与统计手册》第五版（DSM-5）引入的变化的讨论，以及该领域的最新研究结果。
2013 年春季发布的 DSM-5 区分了性僻症和性僻障碍，这意味着同意参与不寻常性行为的成年人的污名化得以消除。根据 DSM-5 的诊断标准，恋童癖是唯一一种没有“缓解”和“在控制环境中”特殊说明的性僻障碍。如今，许多国家都将雄激素治疗作为一种额外的治疗策略，与心理治疗一起提供给性犯罪者。
DSM-5 的引入提供了区分性僻症和性僻障碍的可能性。性僻症的病因仍不清楚。性僻症在男性中比女性更为常见，但造成这种差异的原因尚不清楚。到目前为止，对于性僻障碍的最佳治疗方法还没有明确的共识。
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