Kinky Sex or Paraphilia? This was the title of a one-day conference  sponsored by the New State Psychological Association which I attended about a week ago. The main presenters were Richard Krueger, a psychiatrist who was on the DSM 5 sexual and gender identity disorders workgroup, and Peggy Kleinplatz, a sex-positive activist psychologist from Canada.  Dr. Krueger basically went over the main changes in the DSM 5– gender identity disorder is now gender dysphoria, premature ejaculation now is quantified as a male orgasm occurring 59 seconds or less once sex has begun– and so on. Dr. Kleinplatz gave her objections.

The main topic though was the changes in the DSM 5 regarding paraphlias. Paraphilia is a term created by psychoanalyst Wilhelm Stekel in the 1920s and consists of the latin roots “para”– above or beyond– and “philia”– love. So literally, paraphilia stands for love that is above or beyond the norm. We’re talking about stuff like sadomasochism, transvestism, fetishes. Stuff like that. Kinky stuff. This term was largely unknown for decades until it was popularized by sexologist John Money, who made a career of categorizing various paraphilias. Paraphilias made their official establishment debut in the DSM III in 1980. Even though paraphilias are not the same as fetishes, for all intents and purposes these terms are often used interchangeably.

For years, the psychiatric establishment viewed all of this kinky behavior as pathological. The DSM III basically stated that anyone who was into all this kink was mentally ill. The DSM IV in 1994 softened this stance a bit and stated that kinky sex was a mental illness if it was distressful for the perv. So basically if someone was distressed because their partner acted horrified when they introduced the idea of some light bondage, well that person had a mental disorder. Countless spouses were brought into treatment to get rid of these mental disorders. And yes, they were distressed, so that qualified as a pathology under the conditions of the DSM IV.

This brings us to the DSM 5, which brings us a new category, Paraphilic Disorder. The main difference between a Paraphilia and a Paraphilic Disorder is that someone with a Paraphilic Disorder experiences distress from their sexual interests that is not culturally or socially induced. What that means is that if someone is ashamed of their sexuality because of the judgment of others, then that is not a real disorder. Of course, this is still a slippery slope, but the main point is that a paraphilia or kinky sexual behavior is no longer regarded in and of itself as a mental disorder. So the psychiatric establishment has decided that all of those folks on Fetlife are no longer sick.

So what is actually pathological? I recently spoke about this very subject at a few conferences. In my view, there are three types of sexual behavior which really are disordered. The  first is sex which is coercive and non-consensual. Now we are basically in the realm of sex offenders, both hands-on violent types and hands-off folks who peep into windows and bathroom stalls. The second is compulsive sex. This is another murky area, but a simple way of looking at it is anyone who is endangering his or her job and relationships with their sexual behavior and can’t stop is compulsive. And third is what I call “paraphilic exclusivity”, which refers to folks who are so dependent on their kink that they cannot have sex or achieve orgasm in any other way. The main distress in this situation comes from the anxiety and disappointment of not being able to satisfy a partner in a spontaneous and varied way. This problem usually only surfaces in the context of a relationship and is treated with some standard sex therapy techniques.

And that’s it. Most folks who are into kink enjoy it in the context of a relationship and as just an added (perhaps more intense) way of connecting and bonding. For most, kink is just another form of intimacy. It is the conscious exploration of power dynamics and identity exploration through role-play. I will go into this idea of identity exploration in another blog post, but for now, the most important idea to take away is that the psychiatric establishment has voted and decided that after years of stigmatization, kinky sex is no longer abnormal. The pervs of the world can rejoice.