Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11)
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The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH's proposals for Paraphilic Disorders in ICD-11 are based on the WHO's role as a global public health agency and the ICD's function as a public health reporting tool.
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These ICD-10 categories were not carried over to the ICD-11 as named diagnostic entities because they were seen as contributing unnecessarily to stigmatization of variations in sexual arousal that are not in themselves associated with distress, functional impairment, harm, or violation of the rights of others.
“These ICD-10 categories were not carried over to the ICD-11 as named diagnostic entities, because they were seen as contributing unnecessarily to stigmatization of variations in sexual arousal that are not in themselves associated with distress, functional impairment, harm, or violation of the rights of others 87 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [87]
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Experimental — accuracy not yet measuredThe ICD-11 does not include functional impairment in Paraphilic Disorders because of concerns about the subjectivity and potential misuse of this element to stigmatize and even criminalize atypical sexual behaviours.
“The ICD-11 makes the same allowance for distress, but does not include functional impairment in the diagnostic requirements for any of the Paraphilic Disorders, because of concerns about the subjectivity and potential misuse of this element to stigmatize and even criminalize atypical sexual behaviours 87 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [87]
The Comparison of ICD-11 Recommendations with DSM-5 section says interference with social roles was not included as a diagnostic requirement in the proposed ICD-11 guidelines. The Considerations section discusses stigma, criminalization, and misuse of diagnoses, but does not identify the subjectivity or potential misuse of functional impairment as the reason for omitting that requirement. The paper describes proposals, rather than the finalized ICD-11. (LLM, conf=0.85)
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Self-citation
- Authors
- Krueger, R. B., Reed, G. M., First, M. B., Marais, A., Kismodi, E., & Briken, P.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- Columbia University Irving Medical Center (US)
- New York State Psychiatric Institute (US)
- University Medical Center Hamburg-Eppendorf (DE)
- Corresponding author
- Krueger, Richard B.
- Venue
- Archives of Sexual Behavior
- Published
- 2017-02-16
- Volume
- 46
- Issue
- 5
- Pages
- 1529-1545
- ISSN
- 0004-0002 (ISSN-L)
- 1573-2800
- PMC
- PMC5487931
- OpenAlex
- W2588281431
- Cited by
- 129
- References
- 55
- Citations by year
- 2026: 14 · 2025: 11 · 2024: 25 · 2023: 11 · 2022: 11 · 2021: 11 · 2020: 22 · 2019: 13 · 2018: 7 · 2017: 3 · 2016: 1
- FWCI
- 15.26
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Archives of Sexual Behavior (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- The International Union of Psychological Science
- The National Institute of Mental Health (USA)
- The World Psychiatric Association
- The Royal College of Psychiatry (UK)
- The Spanish Foundation of Psychiatry and Mental Health (Spain)
- The Department of Psychiatry, Universidad Autonoma de Madrid
- The Department of Psychiatry Universidad Nacional Autonoma de Mexico
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- paraphilic disorders, ICD-11, ICD-10, DSM-5, sexual sadism, fetishism, sadomasochism, sexual health, diagnostic criteria
- MeSH terms
- Fetishism, Psychiatric, Humans, Masochism, Paraphilic Disorders, Sexual Behavior, Transvestism, Sexuality, International Classification of Diseases
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