Paraphilic Disorders Research Articles

Child-like sex dolls: legal, empirical, and ethical perspectives.

The review deals with the controversy surrounding the use of highly realistic dolls with a child-like appearance. It summarizes recent empirical findings and provides an overview of the different legal and ethical perspectives on this issue. Countries use different legal approaches to regulate the use or sale of child-like sex dolls. Although a causal link is assumed by some legislators between the prohibition of such dolls and the protection of children from sexual abuse, empirical studies do not support this causality. The imposition of bans will hinder empirical research on the potential use of alternative sexual outputs for people with paraphilic disorders.

Assessment Survey and evaluation of LGBT-Psychology in Nigeria: current state and recommendations

There is no gainsaying that individuals with diverse sexual orientations and gender identities are faced with serious socio-legal, and medical discrimination following the enactment of anti-homosexuality law in Nigeria. However, not much is known of the effort of an organized body of psychology in the country to ensure adequate knowledge and competence among Nigerian psychologists. This article, therefore, appraises the stance of Lesbian, Gay, Bisexual, and Transgender (LGBT) psychology in Nigeria in relation to the cardinal quadrants: Advocacy, Education, Research, and Practice. A multi-method design was adopted to sort for both primary and secondary data. Purposive sampling was adopted to involve 124 practicing psychologists. Findings revealed that the Nigerian psychology curriculum limits its scope to sexual and gender disorders (sexual dysfunction, gender dysphoria, and paraphilic disorders) while missing out on sexual and gender diversity content. Furthermore, the outcome shows that not much is documented on the contribution of the field of psychology to the knowledge of LGBT. Many of the participants had a history (and still) working with LGBT clients and did not have formal LGBT-affirmative training. The study concluded that the integration of LGBT psychology is essential for significant achievement in the space of advocacy, education, research, and professional practices.

An Examination of the Psychometric Properties of the Paraphilic Interests and Disorders Scale

ABSTRACT The Paraphilic Interests and Disorders Scale (PIDS) is a self-report measure of DSM-5-TR paraphilic interests and disorders. This study further examined the psychometric properties of the PIDS. In Study 1, using a sample of 2,292 adults in the U.S., we examined comorbidity between paraphilic interests to explore internal consistency, which showed those who reported an interest in one paraphilic interest were significantly more likely to report another paraphilic interest. Convergent validity was assessed by comparing PIDS to another measure (Paraphilia Scale), which showed support for convergent validity for the PIDS interests, as well as most behavioral items. In Study 2, a sample of 91 undergraduate students completed the PIDS at two time points. There was at least substantial test-retest reliability for the interest items except sexual sadism. These findings provide psychometric support for the PIDS which may serve as a useful tool for population-based data on paraphilic interests and disorders.

Other Specified Paraphilic Disorder: Patterns of Use in Sexually Violent Predator Evaluations.

"Sexually violent predator" (SVP) legislation requires, in part, that an individual has a mental abnormality that causes difficulty in controlling sexual behavior. Previous research has found paraphilia not otherwise specified (NOS) as one of the most prevalent diagnoses proffered in SVP evaluations. However, the fifth edition of the Diagnostic and Statistical Manual (DSM-5) modified paraphilia NOS diagnosis in two ways. First, this diagnosis was divided into two new diagnostic categories: other specified paraphilic disorder (OSPD) and unspecified paraphilic disorder. Second, OSPD required an added specifier to indicate the individual's source of sexual arousal. To date, no study has systematically explored how the revision to paraphilia NOS has affected diagnoses within SVP evaluations. The current study explored the frequency and diagnostic reliability of paraphilic disorders in a sample of 190 adult men evaluated for SVP civil commitment using the DSM-5. Results indicated that OSPD was the second most common paraphilic disorder, next to pedophilic disorder. However, there was poor to fair agreement (kappa= 0.21,p< .01) between independent evaluators in providing this diagnosis. Additionally, the two most common OSPD specifiers were non-consent and hebephilia, despite recent debate and rejection of these constructs from the DSM-5. While these constructs were the most prevalent, the specifiers contained quite varied terminology, suggesting vague diagnostic tendencies within these evaluations. Given that the presence of a mental abnormality is the cornerstone to the constitutionality of SVP commitment, diagnostic practices should be based in reliable and valid techniques.

An Evolutionary Psychological Approach Toward BDSM Interest and Behavior

Bondage/discipline, Dominance/submission, and Sadism/Masochism (BDSM) have gained increased attention and discussion in recent years. This prevalence is accompanied by a shift in perceptions of BDSM, including the declassification of sadomasochism as a paraphilic disorder. Evolutionary psychology offers a unique perspective of why some individuals are interested in BDSM and why some prefer certain elements of BDSM over others (e.g., dominance versus submission). In this paper, we examine BDSM from an evolutionary standpoint, examining biopsychosocial factors that underlie the BDSM interests and practice. We articulate this perspective via an exploration of: proximate processes, such as the role of childhood experiences, sexual conditioning, and physiological factors; as well as ultimate explanations for power play and pain play dimensions of BDSM, highlighting the potential adaptive advantages of each. While BDSM may not be adaptive in itself, we examine the literature of sex differences in BDSM role preferences and argue that these preferences may stem from the extreme forms of behaviors which enhance reproductive success. In the realm of pain play, we explore the intersection of pain and pleasure from both physiological and psychological perspectives, highlighting the crucial role of psychological and play partner factors in modulating the experience of pain. Finally, we encourage future research in social sciences to utilize evolutionary frameworks to further explore the subject and help alleviate the mystification surrounding BDSM. This multifaceted exploration of BDSM provides valuable insights for clinicians, kink-identified individuals, and scholars seeking to understand the evolutionary perspectives of human sexual behavior and preferences.

An exploration of racial and ethnic differences in paraphilic interests and behaviours among a nonoffending sample

ABSTRACT Paraphilic interests are often associated with sexual offending and recidivism, and therefore, accurately identifying paraphilias is crucial. Recently, there has been increased recognition of diversity as it relates to sexual offending; however, few studies have examined race/ethnicity as it pertains to paraphilias, and those that have are often limited to forensic samples. Given that important decisions such as post-incarceration civil confinement are, in part, based upon paraphilia diagnoses, information concerning population base rates of paraphilic interests and behaviours, and how they may vary by race/ethnicity, is needed. The current study explored racial/ethnic differences in paraphilic interests/behaviour among a non-offending U.S. sample of 2,292 participants over age 18, using a measure adherent to the DSM-5-TR paraphilia criteria. The findings revealed group differences, highlighting the need for further research examining these differences. PRACTICE IMPACT STATEMENT The results provide information regarding potential racial/ethnic differences in self-reported paraphilic interests and behaviour among a general population, non-offending sample. This information will assist clinicians who evaluate and diagnose paraphilic interests and disorders and represents a contribution to the larger goal of informing best practices for culturally competent risk assessment and evaluation, treatment, and prevention of sexual abuse.

(PM-22) THE UTILIZATION OF SOCIAL MEDIA AS A PSYCHOPEDAGOGICAL TOOL IN SEXUAL HEALTH WITH A FOCUS ON PARAPHILIAS

Abstract Introduction Social media provides a favorable space for health education. Among the available digital resources, WhatsApp message groups can serve as a source of information and a platform for discussions. Recent studies on sexual education through social media are more concentrated on interventions targeting STI prevention, sexual abuse mitigation, and contraception education. However, there are no reports of utilization of WhatsApp for education about paraphilias. The Brazilian Association for Studies in Medicine and Sexual Health (ABEMSS) utilizes WhatsApp as a tool to promote discussions of this often neglected topic. Nevertheless, more studies are needed to substantiate the validity of this resource. Objective To review the literature and to share the experience of using WhatsApp to facilitate discussions and knowledge sharing about paraphilias. Methods Narrative Review on the Use of Social Media in Sexual Education and an experience report on the Utilization of WhatsApp as an Educational Instrument for the study of paraphilias. Results The WhatsApp paraphilia study group was created in 2020 and comprises 222 healthcare professionals (54% urologists, 9% endocrinologists, 8% psychiatrists, 18% psychologists, 7% physiotherapists). Its activities primarily occur in a scheduled manner, but they can also arise spontaneously. They include discussions of clinical cases, scientific studies and lay media. In the first half of 2023, there were 12 scheduled activities and 8 spontaneous ones. To mitigate the risk of stigmatizing comments, department members act as moderators. Conclusions WhatsApp seems to be a valuable tool for disseminating information about neglected health topics, such as paraphilias. The use of specific groups with scheduled and spontaneous activities promotes the provision of scientific information while promotes a attitude towards the topic. Keywords Paraphilias; Paraphilic disorders; Medical education; Social media Financing No conflict.

Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective.

The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior." To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them. A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues. CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed. Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

Pharmacological Interventions in Paraphilic Disorders: Systematic Review and Insights.

(1) Background: Paraphilic disorders, marked by intense sexual fantasies and behaviors, present formidable challenges. This review addresses concerns fueled by scandals and child abuse. Emphasizing paraphilias' complexity, it systematically reviews the pharmacotherapy literature, aiming to enhance understanding and guide future research. (2) Methods: A comprehensive search from 1990 to 2023 across major databases identified 28 relevant English-language studies. Inclusion criteria focused on adult pharmacotherapy for paraphilias, and results were evaluated using the Newcastle-Ottawa Scale. (3) Results: Synthesizing data from selected studies, diverse treatments such as SSRIs and antiandrogens were analyzed, revealing variable effectiveness and side effect profiles. Poor quality of the current literature has been reported. (4) Conclusions: Highlighting the pivotal role of the serotonergic system, this review underscores the efficacy of SSRIs and androgen deprivation therapy. GnRH analog-associated side effects and the importance of a combined assessment approach are discussed. Critical insights contribute to understanding and ethical considerations in paraphilic disorders.

(086) The Capacity to Form Stable Intimate Relationships in People with Paraphilic Interests

Abstract Introduction The yearning for intimate connection with another human being lies at the core of the human experience (Mashek &amp; Aron, 2004). Thus, the ability to form stable and close bonds serves as a crucial indicator of psychological well-being (Burman &amp; Margolin, 1992). However, for some individuals with problematic sexual interests, which may lead to sexually offensive behaviors (Chan, 2020, 2021), their capacity to form such connections may be compromised (Marshal, 1993; Ward et al., 1995). In particular, sex offenders diagnosed with paraphilic disorders often experience challenges with intimacy (Stefanska et al., 2022). Objective This study aimed to investigate emotional closeness, exclusivity, and co-dependency as components of intimacy within the general population, including individuals with sexually aggressive, minors-oriented, and combined paraphilic interests. Methods The study involved a sample of 100 men randomly selected from four groups: control men without any paraphilic interests (n = 100), men with minors-oriented interests (n = 17), men interested in sexual violence (n = 27), and a combined group of men with both sexual violence and minors-oriented interests (n = 15). We collected questionnaire data as part of an online representative survey (n = 800 men) conducted in the Czech Republic, focusing on topics like love, romance, sexual relationships, and pubertal development. Specific survey items related to emotional closeness, sexual non-exclusivity/promiscuity, and co-dependency underwent confirmatory analysis to eliminate redundancy and enhance explained variance. We defined the constructs of interest based on a literature search on sexual intimacy. Subsequently, we compared the groups on these constructs using a 1-way ANOVA with four levels of grouping variables (controls, violence, minors, combined), followed by post hoc Tukey multiple comparisons tests. Results Statistical tests revealed significant group differences in emotional closeness (F(3,150) = 6.31, p = 0.0005). Post hoc comparisons indicated that the aggression group (Δ = 1.132, p = 0.0003) and the combined group (Δ = 1.117, p = 0.0254) reported significantly lower levels of perceived emotional closeness in their sexual relationships compared to the control group. However, there were no other significant group differences found. Regarding measures of sexual non-exclusivity/promiscuity, ANOVA did not show significant differences (F(3,147) = 2.37, p = 0.073, not significant). Yet, post hoc Tukey comparisons revealed that the combined group exhibited significantly higher promiscuity compared to the control group (Δ = -1.033, p = 0.039). There were no statistically significant differences between groups in the co-dependency variable. Conclusions Our findings suggest that individuals with an interest in sexual violence, and especially those with a combined interest in sexual violence and minors, perceive significantly lower levels of emotional closeness in their sexual relationships compared to individuals without any paraphilic interests. This indicates that they may struggle to feel connected and loved in their relationships. This study was funded by the grant nr. 21-31490S of the Czech Science Foundation. Disclosure No.

A brief unstructured literature review on the history of paraphilias.

This unstructured review is based on a comprehensive literature search leading to a variety of selected studies that summarize the historical development of paraphilias. Firstly, paraphilias in ancient times are discussed. Secondly, the development of paraphilia diagnoses, including current critical aspects, is outlined. Finally, a short description of the development of treatment approaches for individuals with paraphilic disorders and those who commit sexual offenses, including medical and psychotherapeutic approaches as well as online intervention programs, is presented. The destigmatization of people with deviant sexual interest is deemed necessary. However, it is also recommended to always strive for a balance between protecting paraphilic individuals' rights and protecting vulnerable groups to whom paraphilic people can pose a danger.

Understanding Pedophilic Disorder: Clinical Features, Diagnostic Challenges, and Therapeutic Interventions

Pedophilic disorder is a paraphilic disorder, characterized by anomalous target preferences particularly intense or preferential sexually arousing fantasies or urges involving prepubescent children. According to the DSM-5-TR, a diagnosis is warranted if these urges are acted upon or cause significant distress or interpersonal difficulties (American Psychiatric Association, 2022). Pedophilic disorder is estimated to affect approximately 3%–5% of the male population, while its prevalence in females is likely a small fraction of that in males and remains uncertain. The current case reports the case of an adult male who has acted on his pedophilic impulses and who fits the diagnostic criteria for pedophilia. It discusses the case's significant clinical and historical aspects, therapeutic initiatives, and risk factors. It also discusses the application of clinical science and empirically supported practices to the client's assessment, treatment, and risk management.

Paraphilic disorders, psychopathy, and those who sexually offend: a narrative review of treatment modalities.

Despite its critical importance, the treatment of paraphilic disorders remains an often-overlooked domain both in clinical research and practice. Challenges have arisen in the morphing understanding of paraphilias and paraphilic disorders, now considered separate concepts, and efforts at developing a more nuanced understanding of these conditions is ongoing, resulting in a muddled history that can frustrate efforts at study and treatment. These populations are by nature more heterogeneous than may first be obvious-particularly among those with comorbid psychopathic traits-and may require a more nuanced and individualized approach based on risk, needs, and responsivity to treatment. Until recently, there were few guidelines to assist clinicians when confronted with these complicated clinical pictures and a sea of discrete studies investigating various biological and non-biological interventions. Treatments range from several variations of psychotherapy and behavioral therapies to SSRIs, anti-androgenic medications, to orchiectomy, all displaying varying degrees of effectiveness and evidence across decades of research. Fortunately, recent efforts to collate these studies supported by a task force of the World Federation of Societies of Biological Psychiatry (WFSBP) have helped form a better-focused and better-evidenced picture of effective treatments and the unique challenges faced by (and with) these populations.

Treatment of Paraphilic Disorder Using Medroxyprogesterone Acetate.

Treatment of Paraphilic Disorder Using Medroxyprogesterone Acetate.

Elemental psychopathology: distilling constituent symptoms and patterns of repetition in the diagnostic criteria of the DSM-5.

The DSM-5 features hundreds of diagnoses comprising a multitude of symptoms, and there is considerable repetition in the symptoms among diagnoses. This repetition undermines what we can learn from studying individual diagnostic constructs because it can obscure both disorder- and symptom-specific signals. However, these lost opportunities are currently veiled because symptom repetition in the DSM-5 has not been quantified. This descriptive study mapped the repetition among the 1419 symptoms described in 202 diagnoses of adult psychopathology in section II of the DSM-5. Over a million possible symptom comparisons needed to be conducted, for which we used both qualitative content coding and natural language processing. In total, we identified 628 distinct symptoms: 397 symptoms (63.2%) were unique to a single diagnosis, whereas 231 symptoms (36.8%) repeated across multiple diagnoses a total of 1022 times (median 3 times per symptom; range 2-22). Some chapters had more repetition than others: For example, every symptom of every diagnosis in the bipolar and related disorders chapter was repeated in other chapters, but there was no repetition for any symptoms of any diagnoses in the elimination disorders, gender dysphoria or paraphilic disorders. The most frequently repeated symptoms included insomnia, difficulty concentrating, and irritability - listed in 22, 17 and 16 diagnoses, respectively. Notably, the top 15 most frequently repeating diagnostic criteria were dominated by symptoms of major depressive disorder. Overall, our findings lay the foundation for a better understanding of the extent and potential consequences of symptom overlap.

Paraphilias: an update on nosology and diagnostic challenges

ABSTRACT Ever since the inception of paraphilias in the psychiatric nosological system, it has been in several controversies ranging from determining normal sexual behaviour from abnormal, role of culture, diagnosing paraphilia as deviant sexual behaviour and various medico-legal issues related to sexual offenders and predators. Over the years, several landmark changes have been made in the subsection of paraphilias in both DSM and ICD nosological system. The evolutionary journey of paraphilias to paraphilic disorder is remarkable, yet there are various unresolved issues related to its nosological status and diagnosis. To review some fundamental concepts of paraphilias related to its evolution in nosological systems and discuss its various diagnostic and medico-legal/forensic issues. A comprehensive literature search was conducted on paraphilias in PubMed and Google Scholar and through the cross-references of relevant articles till June 2022. Keywords included ‘paraphilias,’ ‘nosology,’ ‘critique’ ‘issues’ and ‘diagnosis’ in various combinations. Only original articles (abstract and full text), review articles, viewpoint articles and recommendations published in English, till June 2022, were reviewed and checked thoroughly. Articles published in non-English languages were excluded. 34 articles related to the topic were found, including those relevant to paraphilias’ nosology and diagnostic issues. We discuss in detail the nosological journey of paraphilias and various controversies related to it. Additionally, we discuss the various diagnostic and forensic issues. From our review, we conclude that the most valid indicators of true paraphilic disorders i.e. exclusiveness, fixation and compulsiveness, which are the most complex entities to establish in a forensic context, are not adequately addressed even by the new criteria of DSM-5 and ICD-11 of paraphilic disorders. Hence, even after so many modifications, paraphilic disorders still present challenges to our conceptualization of mental disorders.

(442) The Importance of Understanding Paraphilias and Paraphilic Disorders (PD) for General Health and Sexology

Abstract Introduction Sexual fantasies and behaviors are crucial dimensions of the human experience. Paraphilias and paraphilic disorders (PD), categorized by modern sexology as corresponding to the unconventional sexual experiences of a given society at a given time, are complex and still affected by stigma and uncertainty concerning epidemiology, etiology, and clinical management. These topics are rarely addressed in health professionals’ training, including in the field of sexology, which can significantly impact the quality of care. Objective To identify inherent problems in the study and dissemination of knowledge on paraphilias and PD; to indicate solutions aiming to reduce stigma and to offer better care. Methods Narrative review and experience report of the committee for paraphilias and PD from a Brazilian association of sexology. Results Even though the quality of sexology training in health providers’ education might be varied, it is frequently claimed that it is insufficient for the identification and management of sexual health issues. According to a Austrian medical university’ study, the topic of human sexuality is almost exclusively addressed in the curricula of gynecology, endocrinology, and psychiatry, often focusing on contents such as anatomy, STIs, sexual dysfunctions, pregnancy, and infertility. On the other hand, topics such as pornography and paraphilias are rarely addressed. Dealing with paraphilic individuals is challenging, both for general practitioners and specialist sexologists, and poor training can lead to stigmatizing attitudes, such as pathologizing of unconventional sexual experiences and moral judgment. The knowledge and skills acquired through supervised training on the field of paraphilias and PD proved to be useful in conducting a careful sexual interview, a complete psychiatric anamnesis and establishing a positive therapeutic relation. For example, patients with these characteristics may initially report complaints related to sexual dysfunctions, such as reduced desire or difficulty in getting an erection. However, once their sexuality is approached holistically, the dysfunction might be better explained by the displacement of the sexual object, a defining condition of the paraphilic experience. In such an occasion, the veiled conception that the study of paraphilias and PD is exclusive to psychiatrists and psychologists can relegate it to a blind spot, resulting in negligence on the part of other health professionals, including sexologists. This situation can lead to misdiagnosis, underdiagnosis and inadequate treatment of PD. Ignoring the possibility that a patient may have a PD might shield the professional from dealing with its ethical difficulties, but it addresses neither the patients’ nor social problems – given the risk of criminal sexual behavior. Conclusions To match their complexity, the approach to paraphilias and PD requires high levels of clinical, ethical, and academic understanding. Educational programs capable of tackling these issues would improve sexual health care. It is of fundamental importance that understanding and practice in paraphilias and PD is improved, and it is up to institutions, such as universities and expert associations, to promote discussion of these topics, despite any moral discomfort or tendency to avoid ethical implications of knowing a patient may engage in criminal behavior. Disclosure No

Outcome Evaluation of a Treatment Program for Men with Paraphilic Disorders Convicted of Sexual Offenses: 10-Year Community Follow-up.

Evidence concerning specific paraphilia treatment effectiveness is limited. We present observation data of 127 men convicted of paraphilic sexual offenses who attended inpatient and outpatient follow-up treatment in Czechia. We collected participants' sociodemographic and treatment-related information, including STATIC-99R scores, and used proportional hazards models to analyze variables' effect on recidivism risk. Within the observation period, the general recidivism and sexual recidivism rates were 33.1% and 16.5%, respectively, and the sexual contact recidivism rate was 4.7%. The total STATIC-99 score for those who re-offended was 5.65 (SD = 2.11) and for those who did not was 3.98 (SD = 2.02). Recidivism risk was 7.52 times higher for those diagnosed with exhibitionism than with pedophilia, sadomasochism, or antisocial personality disorder. General recidivism is comparable to others' findings. We attribute the lower sexual contact recidivism rate to the combined effects of psychological and pharmacological treatment, and higher numbers of non-contact offenses to limited antidepressant use.

The prevalence of mental disorders among incarcerated adult men convicted of child sexual exploitation material offences.

Despite the growing body of research on individuals convicted of child sexual exploitation material (CSEM), relatively little is known about the prevalence of mental disorders in this population. The aim of the present study was to describe the prevalence of mental disorders among individuals convicted of CSEM offenses. This cross-sectional study examined data from 66 individuals serving a sentence for CSEM offenses in the Austrian prison system who underwent a clinical assessment between 2002 and 2020. Diagnoses were based on the German version of the Structured Clinical Interview for Axis I and Axis II disorders. In the total sample, n=53 individuals (80.3%) were diagnosed with a mental disorder. Twenty-seven individuals (40.9%) had an Axis I disorder and n=47 (71.2%) had an Axis II disorder. More than two-thirds of the sample, n=47 (71.2%), had a personality disorder diagnosis, with cluster B personality disorders being the most frequent mental disorders. More than half of the sample, n=43 (65.2%), had a diagnosis of pedophilic disorder, of which n=9 (13.6%) were of the exclusive type. Twenty-eight persons (42.4%) showed evidence of a hypersexual disorder. In line with previous research, the present sample of convicted CSEM offenders showed a comparatively high prevalence of personality disorders and paraphilic disorders, particularly pedophilic disorders. Additionally, the rate of hypersexual disorder symptoms was considerably high. These findings should be considered for the development of successful risk management strategies for this population.

Between submission and pain. Shades of BDSM practices.

Many people are interested in BDSM practices. Some people practice and others fantasize about participating in these practices. Several elements are related to BDSM practices that are usually unaccepted in a close relationship, such as a strong dependence of one partner on the other or inflicting pain. BDSM practitioners create various relationships, and in a broader context, their communities. From a clinical perspective, an important issue is whether BDSM relation is consensual and serves the personal and relationship development or it can be a premise for the diagnosis of a paraphilic disorder, or recognizing abuse or mechanism of trauma repetition Adequate understanding of the behaviors that may be described by a patient practicing BDSM requires, however, getting to know the specifics of such relationships. The mental and sexual health professional would be able then to evaluate them adequately, without referring to a subjective norm or bias on stereotype or prejudice.