Transsexualism
A. The individual desires to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormonal treatment.
B. The transsexual identity has been present persistently for at least 2 years.
C. The disorder is not a symptom of another mental disorder, such as schizophrenia, nor is it associated with chromosome abnormality.
Dual-role transvestism
A. The individual wears clothes of the opposite sex in order to experience temporarily membership of the opposite sex.
B. There is no sexual motivation for the cross-dressing.
C. The individual has no desire for a permanent change to the opposite sex.
Gender identity disorder of childhood
For girls:
A. The individual shows persistent and intense distress about being a girl, and has a stated desire to be a boy (not merely a desire for any perceived cultural advantages to being a boy), or insists that she is a boy.
B. Either of the following must be present:
(1) persistent marked aversion to normative feminine clothing and insistence on wearing stereotypical masculine clothing, e.g., boys' underwear and other accessories;
(2) persistent repudiation of female anatomical structures, as evidenced by at least one of the following:
(a) an assertion that she has, or will grow, a penis;
(b) rejection of urinating in a sitting position;
(c) assertion that she does not want to grow breasts or menstruate.
C. The girl has not yet reached puberty.
D. The disorder must have been present for at least 6 months.
For boys:
A. The individual shows persistent and intense distress about being a boy, and has a desire to be a girl or, more rarely, insists that he is a girl.
B. Either of the following must be present:
(1) preoccupation with stereotypic female activities, as shown by a preference for either cross-dressing or simulating female attire, or by an intense desire to participate in the games and pastimes of girls and rejection of stereotypical male toys, games, and activities;
(2) persistent repudiation of male anatomical structures, as indicated by at least one of the following repeated assertions:
(a) that he will grow up to become a woman (not merely in role);
(b) that his penis or testes are disgusting or will disappear;
(c) that it would be better not to have a penis or testes.
C. The boy has not yet reached puberty.
D. The disorder must have been present for at least 6 months.
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Fetishism
A. The general criteria for disorders of sexual preference must be met.
B. The fetish (some nonliving object) is the most important source of sexual stimulation or is essential for satisfactory sexual response.
Fetishistic transvestism
A. The general criteria for disorders of sexual preference must be met.
B. The individual wears articles of clothing of the opposite sex in order to create the appearance and feeling of being a member of the opposite sex.
C. The cross-dressing is closely associated with sexual arousal. Once orgasm occurs and sexual arousal declines, there is a strong desire to remove the clothing.
Exhibitionism
A. The general criteria for disorders of sexual preference must be met.
B. There is either a recurrent or a persistent tendency to expose the genitalia to unsuspecting strangers (usually of the opposite sex), which is almost invariably associated with sexual arousal and masturbation.
C. There is no intention or invitation to have sexual intercourse with the "witness(es)."
Voyeurism
A. The general criteria for disorders of sexual preference must be met.
B. There is either a recurrent or a persistent tendency to look at people engaging in sexual or intimate behavior such as undressing, which is associated with sexual excitement and masturbation.
C. There is no intention to reveal one's presence.
D. There is no intention of sexual involvement with the person(s) observed.
Pedophilia
A. The general criteria for disorders of sexual preference must be met.
B. There is a persistent or predominant preference for sexual activity with a prepubescent child or children.
C. The individual is at least 16 years old and at least 5 years older than the child or children in criterion B.
Sadomasochism
A. The general criteria for disorders of sexual preference must be met.
B. There is preference for sexual activity, as recipient (masochism) or provider (sadism), or both, which involves at least one of the following:
(1) pain;
(2) humiliation;
(3) bondage.
C. The sadomasochistic activity is the most important source of stimulation or is necessary for sexual gratification.
Multiple disorders of sexual preference
The likelihood of more than one abnormal sexual preference occurring in one individual is greater than would be expected by chance. For research purposes the different types of preference and their relative importance to the individual, should be listed. The most common combination is fetishism, transvestism, and sadomasochism.
Other disorders of sexual preference
A variety of other patterns of sexual preference and activity may occur, each being relatively uncommon. These include such activities as making obscene telephone calls, rubbing up against people for sexual stimulation in crowded public places (frotteurism), sexual activity with animals, use of strangulation or anoxia for intensifying sexual excitement, and a preference for partners with some particular anatomical abnormality such as an amputated limb.
Erotic practices are too diverse and many too rare or idiosyncratic to justify a separate term for each. Swallowing urine, smearing feces, or piercing foreskin or nipples may be part of the behavioral repertoire in sadomasochism. Masturbatory rituals of various kinds are common, but the more extreme practices, such as the insertion of objects into the rectum or penile urethra, or partial self-strangulation, when they take the place of ordinary sexual contracts, amount to abnormalities. Necrophilla should also be coded here.
Disorder of sexual preference, unspecified
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