Purpose The purpose of this paper is to explain the controversy that surrounds paraphilic disorders (PD), explain my professional belief and the strategies to maintain a relationship with patients presenting with the disorder, and explain ethical and legal considerations related to the disorder. Controversy Surrounding Paraphilic Disorders According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM– 5; American Psychiatric Association, 2013), PD is an emotional disorder characterized by sexually arousing fantasies, urges, or behaviors that are recurrent, intense, occur over a period of at least 6 months, and cause significant distress or interfere with the sufferer’s work, social function, or other important areas of functioning. The term paraphilia is a combination of two creek words, “para,” which means beside, and “philia,” which means love or friendship. The term was first introduced into DSM-III to replace the DSM-II term sexual deviation “because it correctly emphasizes that the deviation (para-) lies in that to which the person is attracted (philia) (Mann, Hanson, Thornton, 2017). In the DSM-5, the diagnosis was further changed to paraphilia disorders. The intent for the change was to reduce stigma by clarifying that atypical sexual arousal patterns are not evidence of psychopathology. To a judge or jury who might not be well versed with the subtitles of DSM, the technical difference might be blur and a diagnosis of paraphilic disorder would, for instance, be damaging to somebody fighting for child custody. There is a great deal of controversy concerning the diagnosis and defining what normal versus deviant or disordered behavior is, can be challenging. Sexual norm is maladaptive and dynamic across time and cultures, which creates problems in defining and diagnosing paraphilia. Homosexuality, for instance, was classified as a paraphilic disorder in the DSM up until 1973
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