Paraphilia Not Otherwise Specified

When the defining characteristics of a nonnormative pattern of erotic interest meet the DSM-IV-TR general criteria for paraphilia but fall outside the diagnostic criteria for the eight listed paraphilias, the interest is categorized as a paraphilia not otherwise specified. Presumably because the number of possible paraphilias and fetishes is virtually limitless, the DSM-IV-TR lists as specific paraphilias those most commonly observed and reported in clinical and forensic practice. The para-philia NOS category includes the many other nonstandard sexual interests, and lists seven as examples: telephone scatologia (obscene phone calls), necrophilia (corpses), partialism (exclusive focus on part of the body), zoophilia (animals), coprophilia (feces), klismaphilia (enemas), and urophilia (urine).

Definitional problems regarding the paraphilias become particularly apparent in the NOS category. There are dozens of paraphilias described in the literature, including some listed in the DSM-IV-TR as examples of paraphilia NOS, that fail to meet any of the three subtype criteria for paraphilia: erotic focus on nonhuman objects, suffering or humiliation of self or partner, or children or other nonconsenting persons (64). Partialism, coprophilia, urophilia, and numerous other atypical interests described in the literature involve a human focus and do not inherently involve suffering, humiliation, or nonconsenting persons.

Kafka proposed that some problematic sexual behaviors, while they meet DSM-IV-TR criteria for paraphilia NOS, are more accurately conceptualized as a distinct disorder, for which he proposed the category "paraphilia-related disorders" (65,66). Paraphilia-related disorders involve fantasies, urges, or behaviors that do not meet DSM-IV-TR criterion A for paraphilia because they are normative in content by societal standards but occur with pathological frequency or intensity.

Like the paraphilias, they are repetitive, intrusive, and persist for at least 6 months. Kafka's suggested paraphilia-related disorders include egodystonic compulsive masturbation, protracted promiscuity, and dependence on pornography. This conceptualization has not met with consensus and it remains unclear how such categorical distinctions improve the current classification system. Hopefully, future iterations of the DSM will resolve some of the nosological confusion.

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