There is scientific and political controversy regarding the continued inclusion of sex-related diagnoses such as the<unk> s in the DSM, due to the stigma of being classified as a mental illness. Some groups, seeking greater understanding and acceptance of sexual diversity, have lobbied for changes to the legal and medical status of unusual sexual interests and practices. Charles Allen Moser, a physician and advocate for sexual minorities, has argued that the diagnoses should be eliminated from diagnostic manuals. Typical versus atypical interests Albert Eulenburg (1914) noted a commonality across the<unk> s, using the terminology of his time, "All the forms of sexual perversion...have one thing in common: their roots reach down into the matrix of natural and normal sex life; there they are somehow closely connected with the feelings and expressions of our physiological erotism. They are...hyperbolic intensifications, distortions, monstrous fruits of certain partial and secondary expressions of this erotism which is considered 'normal' or at least within the limits of healthy sex feeling." The clinical literature contains reports of many<unk> s, only some of which receive their own entries in the diagnostic taxonomies of the American Psychiatric Association or the World Health Organization. There is disagreement regarding which sexual interests should be deemed<unk>  disorders versus normal variants of sexual interest. For example, as of May 2000, per DSM-IV-TR, "Because some cases of Sexual Sadism may not involve harm to a victim (e.g., inflicting humiliation on a consenting partner), the wording for sexual sadism involves a hybrid of the DSM-III-R and DSM-IV wording (i.e., "the person has acted on these urges with a non-consenting person, or the urges, sexual fantasies, or behaviors cause marked distress or interpersonal difficulty")". The DSM-IV-TR also acknowledges that the diagnosis and classification of<unk> s across cultures or religions "is complicated by the fact that what is considered deviant in one cultural setting may be more acceptable in another setting”. Some argue that cultural relativism is important to consider when discussing<unk> s, because there is wide variance concerning what is sexually acceptable across cultures. Consensual adult activities and adult entertainment involving sexual roleplay, novel, superficial, or trivial aspects of sexual fetishism, or incorporating the use of sex toys are not necessarily<unk> .<unk> l psychopathology is not the same as psychologically normative adult human sexual behaviors, sexual fantasy, and sex play. Intensity and specificity Clinicians distinguish between optional, preferred and exclusive<unk> s, although the terminology is not completely standardized. An "optional"<unk>  is an alternative route to sexual arousal. In preferred<unk> s, a person prefers the<unk>  to conventional sexual activities, but also engages in conventional sexual activities. The literature includes single-case studies of very rare and idiosyncratic<unk> s. These include an adolescent male who had a strong fetishistic interest in the exhaust pipes of cars, a young man with a similar interest in a specific type of car, and a man who had a<unk>  interest in sneezing (both his own and the sneezing of others). Diagnostic and Statistical Manual of Mental Disorders DSM-I and DSM-II In American psychiatry, prior to the publication of the DSM-I,<unk> s were classified as cases of "psychopathic personality with pathologic sexuality". The DSM-I (1952) included sexual deviation as a personality disorder of sociopathic subtype. The only diagnostic guidance was that sexual deviation should have been "reserved for deviant sexuality which was not symptomatic of more extensive syndromes, such as schizophrenic or obsessional reactions". The specifics of the disorder were to be provided by the clinician as a "supplementary term" to the sexual deviation diagnosis; there were no restrictions in the DSM-I on what this supplementary term could be. Researcher Anil Aggrawal writes that the now-obsolete DSM-I listed examples of supplementary terms for pathological behavior to include "homosexuality, transvestism, pedophilia, fetishism, and sexual sadism, including rape, sexual assault, mutilation." The DSM-II (1968) continued to use the term sexual deviations, but no longer ascribed them under personality disorders, but rather alongside them in a broad category titled "personality disorders and certain other nonpsychotic mental disorders". The types of sexual deviations listed in the DSM-II were: sexual orientation disturbance (homosexuality), fetishism, pedophilia, transvestitism (sic), exhibitionism, voyeurism, sadism, masochism, and "other sexual deviation". No definition or examples were provided for "other sexual deviation", but the general category of sexual deviation was meant to describe the sexual preference of individuals that was "directed primarily toward objects other than people of opposite sex, toward sexual acts not usually associated with coitus, or toward coitus performed under bizarre circumstances, as in necrophilia, pedophilia, sexual sadism, and fetishism." Except for the removal of homosexuality from the DSM-III onwards, this definition provided a general standard that has guided specific definitions of<unk> s in subsequent DSM editions, up to DSM-IV-TR. DSM-III through DSM-IV The term<unk>  was introduced in the DSM-III (1980) as a subset of the new category of "psychosexual disorders." The DSM-III-R (1987) renamed the broad category to sexual disorders, renamed atypical<unk>  to<unk>  NOS (not otherwise specified), renamed transvestism as transvestic fetishism, added frotteurism, and moved zoophilia to the NOS category. It also provided seven nonexhaustive examples of NOS<unk> s, which besides zoophilia included exhibitionism, necrophilia, partialism, coprophilia, klismaphilia, and urophilia. The DSM-IV (1994) retained the sexual disorders classification for<unk> s, but added an even broader category, "sexual and gender identity disorders," which includes them. The DSM-IV retained the same types of<unk> s listed in DSM-III-R, including the NOS examples, but introduced some changes to the definitions of some specific types. DSM-IV-TR The DSM-IV-TR describes<unk> s as "recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving nonhuman objects, the suffering or humiliation of oneself or one's partner, or children or other nonconsenting persons that occur over a period of six months" (criterion A), which "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" (criterion B). DSM-IV-TR names eight specific<unk>  disorders (exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, voyeurism, and transvestic fetishism, plus a residual category,<unk> —not otherwise specified). Criterion B differs for exhibitionism, frotteurism, and pedophilia to include acting on these urges, and for sadism, acting on these urges with a nonconsenting person. Sexual arousal in association with objects that were designed for sexual purposes is not diagnosable. Some<unk> s may interfere with the capacity for sexual activity with consenting adult partners. In the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a<unk>  is not diagnosable as a psychiatric disorder unless it causes distress to the individual or harm to others. DSM-5 The DSM-5 adds a distinction between<unk> s and<unk>  disorders, stating that<unk> s do not require or justify psychiatric treatment in themselves, and defining<unk>  disorder as "a<unk>  that is currently causing distress or impairment to the individual or a<unk>  whose satisfaction has entailed personal harm, or risk of harm, to others". The DSM-5<unk> s Subworkgroup reached a "consensus that<unk> s are not ipso facto psychiatric disorders", and proposed "that the DSM-V make a distinction between<unk> s and<unk>  disorders. ... One would ascertain a<unk>  (according to the nature of the urges, fantasies, or behaviors) but diagnose a<unk>  disorder (on the basis of distress and impairment). In this conception, having a<unk>  would be a necessary but not a sufficient condition for having a<unk>  disorder." The 'Rationale' page of any<unk>  in the electronic DSM-5 draft continues: "This approach leaves intact the distinction between normative and non-normative sexual behavior, which could be important to researchers, but without automatically labeling non-normative sexual behavior as psychopathological. It also eliminates certain logical absurdities in the DSM-IV-TR. In that version, for example, a man cannot be classified as a transvestite—however much he cross-dresses and however sexually exciting that is to him—unless he is unhappy about this activity or impaired by it. This change in viewpoint would be reflected in the diagnostic criteria sets by the addition of the word 'Disorder' to all the<unk> s. Thus, Sexual Sadism would become Sexual Sadism Disorder; Sexual Masochism would become Sexual Masochism Disorder, and so on." Bioethics professor Alice Dreger interpreted these changes as "a subtle way of saying sexual kinks are basically okay – so okay, the sub-work group doesn't actually bother to define<unk> . But a<unk>  disorder is defined: that's when an atypical sexual interest causes distress or impairment to the individual or harm to others." Interviewed by Dreger, Ray Blanchard, the Chair of the<unk> s Sub-Work Group, stated, "We tried to go as far as we could in depathologizing mild and harmless<unk> s, while recognizing that severe<unk> s that distress or impair people or cause them to do harm to others are validly regarded as disorders." Charles Allen Moser stated that this change is not really substantive, as the DSM-IV already acknowledged a difference between<unk> s and non-pathological but unusual sexual interests, a distinction that is virtually identical to what was being proposed for DSM-5, and it is a distinction that, in practice, has often been ignored. Linguist Andrew Clinton Hinderliter argued that "including some sexual interests—but
Paraphilia
Hypersexuality
Musical anhedonia
Alexithymia
Dysgraphia
Gender dysphoria
Acrophobia
Hyperreligiosity