Still working to recover. Please don't edit quite yet.
Paraphilia (in Greek para Ï€Î±ÏÎ¬ = besides and -philia Ï†Î¹Î»Î¯Î± = love) - in psychology and sexology, is a term that describes a family of persistent, intense fantasies, urges, or behaviors involving sexual arousal to (1) nonhuman objects, (2) pain or humiliation experienced by oneself or one's partner, or (3) children or other nonconsenting individuals. Paraphilias may interfere with the capacity for reciprocal affectionate sexual activity.  Paraphilia is also used to imply non-mainstream sexual practices without necessarily implying dysfunction or deviance. [unverified] Also, it may describe sexual feelings toward otherwise non-sexual objects. Template:Sexual orientation
- 1 Overview
- 2 Clinical views of paraphilias
- 3 Non-clinical views on paraphilias
- 4 Drug treatment of paraphilias
- 5 List of paraphilias
- 6 See also
- 7 External links
- 8 Notes
A paraphilic interest is not normally considered clinically important by clinicians unless it is also causing suffering of some kind, or strongly inhibiting a "normal" sex life, according to the subjective standards of the culture and times.
Many sexual activities now considered harmless or even beneficial (such as masturbation) have in the past been considered perversions or psychosexual disorders in various societies and how to regard these behaviors has been, and continues at times to be a controversial matter.
Usage of the term in English
The term "paraphilia" is rarely used in general English, as references to the actual interest are more common. Some may see the term as helping to aid objectivity when discussing taboo behaviors, or those meeting public disapproval, while others may interpret the term pejoratively -- seeing paraphilias as "rare conditions or serious disorders" that require serious treatment.
It is worth noting typical clinical warnings given against improper assumptions about paraphilias:
- "Paraphilias are: sexual fantasies urges and behaviors that are considered deviant with respect to cultural norms..."
- "Although several of these disorders can be associated with aggression or harm, others are neither inherently violent nor aggressive"
- "The boundary for social as well as sexual deviance is largely determined by cultural and historical context. As such, sexual orientations once considered paraphilias (e.g., homosexuality) are now regarded as variants of normal sexuality; so too, sexual behaviors currently considered normal (e.g., masturbation) were once culturally proscribed"
(Source: Psychiatric Times)
What is considered to be "perversion" or "deviation" varies from society to society. Some paraphilias fall into the kinds of activities often called 'sexual perversions' or 'sexual deviancy' with negative connotations, or 'kinky sex' with more positive connotations. Some specific paraphilias have been or are currently crimes in some jurisdictions. In some religions certain sexual interests are forbidden, leading some members of those religions to believe that all paraphilias must be sins. The field of psychology has attempted to characterize paraphilias in terms of their etiology and in terms of the ways they change the functioning of individuals in social situations. Some of these psycho-medical etiologies and descriptions have allowed some societies and religious/ethical traditions to view the paraphilias more positively. Some behaviors that might be classified as paraphilias by some subsets of society may be viewed as harmless eccentricities by other subsets of society, or entirely normal behavior within other societies.
Due to the somewhat subjective nature of their definition, the specific acts included under the umbrella of paraphilia vary from time to time and from place to place, and indeed from edition to edition of such works as the Diagnostic and Statistical Manual of Mental Disorders (DSM).
History of the term
Although its coinage is often attributed to sexologist John Money, the term was coined by Croatian sexologist Friedrich Salomon Krauss during the 19th century, first popularized by Viennese psychotherapist Wilhelm Stekel (in his book Sexual Aberrations) in 1925, from the Greek para- (beside) + philos (loving), and first used in English in Stekel's translated works. It was not in widespread use until the 1950s, and was first used in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) in 1980. It was used by Sigmund Freud as well.[unverified]
Clinical views of paraphilias
There is much debate about what (if anything) should constitute a paraphilia, and how these should be clinically classified (see Controversy, below).
Clinically recognized paraphilias
Clinical literature discusses eight major paraphilias individually. According to the Diagnostic and Statistical Manual of Mental Disorders, the activity must be the sole means of sexual gratification for a period of six (6) months, and either cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning" or involve a violation of consent to be diagnosed as a paraphilia.
- Exhibitionism: the recurrent urge or behavior to expose one's genitals to an unsuspecting person.
- Fetishism: the use of non-sexual or nonliving objects or part of a person's body to gain sexual excitement. Partialism refers to fetishes specifically involving nonsexual parts of the body.
- Frotteurism: the recurrent urges or behavior of touching or rubbing against a nonconsenting person.
- Pedophilia: the sexual attraction to prepubescent or peripubescent children.
- Sexual Masochism: the recurrent urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made to suffer.
- Sexual Sadism: the recurrent urge or behavior involving acts in which the pain or humiliation of the victim is sexually exciting.
- Transvestic fetishism: a sexual attraction towards the clothing of the opposite gender.
- Voyeurism: the recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing or engaging in sexual activities, or may not be sexual in nature at all.
- Other rarer paraphilias are grouped together under Other paraphilias not otherwise specified (ICD-9-CM equivalent of "Sexual Disorder NOS") and include telephone scatalogia (obscene phone calls), necrophilia (corpses), partialism (exclusive focus on one part of the body), zoophilia (animals), coprophilia (feces), klismaphilia (enemas), urophilia (urine).
Homosexuality was previously listed as a paraphilia in the DSM-I and DSM-II. Consistent with the change in consensus among psychiatrists it was not included in later editions. A disorder of clinical distress caused by the repression of homosexuality is still listed. Literature also documents many other paraphilias, both common and rare.
Intensity and specificity
Clinicians distinguish between optional, preferred and exclusive paraphilias, though the terminology is not completely standardized. An "optional" paraphilia is an alternative route to sexual arousal. For example, a man with otherwise unremarkable sexual interests might sometimes seek or enhance sexual arousal by wearing women's underwear. In preferred paraphilias, a person prefers the paraphilia to conventional sexual activities, but also engages in conventional sexual activities. For example, a man might prefer to wear women's underwear during sexual activity, whenever possible. In exclusive paraphilias, a person is unable to become sexually aroused in the absence of the paraphilia.
Optional paraphilias are far more common than preferred paraphilias, which are, in turn, far more common than exclusive paraphilias.
Optional paraphilias sometimes disrupt stable relationships when discovered by an unsuspecting partner. Preferred paraphilias often disrupt otherwise stable relationships. Open communication and mutual support can minimize or prevent such disruption in both of these cases. Exclusive paraphilias often preclude normal courtship and committed romantic relationships, even when the person in question desires such a relationship. Loneliness or social isolation are common consequences. In extreme cases, preoccupation with a preferred or exclusive paraphilia completely displaces the more typical desire for loving human relationships.
Psychology of paraphilias
Observation of paraphiliac behavior has provided valuable scientific information on the mechanisms of sexual attraction and desire, such as behavioral imprinting. Careful investigation has also led to the tentative conclusions that normal biological processes may sometimes be manifested in idiosyncratic ways in at least some of the paraphilias, and that these unusual manifestations are frequently associated with unusual (and especially traumatic) events associated with early sexual experience. They tend to be caused by classical conditioning in that a sexual stimulus has been paired with stimuli and situations that do not typically result in sexual response and has then been perpetuated through operant conditioning because the sexual response is its own reward or positive reinforcement.
Non-clinical views on paraphilias
Some religious adherents view various paraphilias as deviations from their conception of God's original plan for human sexuality, or from their religious laws. Depending in part on the nature of the paraphilia in question, judgements can differ as to whether religiously it should be considered a case of sexual sin, mental illness, or simply harmless sexual variation. Another variable is whether it is the acting out, or (less commonly) just the desirous thought alone, which is critically viewed in such cases. In any event, several paraphilias, as with many "non-mainstream" behaviors, are viewed negatively (or with distaste) by various religions.
Some religious traditions include forms of extreme asceticism, such as whipping , which, when practiced as sexual activities, would usually be considered masochism and popularly viewed as paraphilias. When practiced for non-sexual reasons, they are usually valued by the religious groups concerned as a part of their religious observance and submission to God.
As a general rule, the law in many countries often intervenes in paraphilias involving young or adolescent children below the legal age of consent, nonconsensual deliberate displays or illicit watching of sexual activity, harm to animals, acts involving dead people, harassment, nuisance, fear, injury, or assault of a sexual nature. Separately, it also usually regulates or controls censorship of pornographic material.
Exhibitionism, in cases where people who have not previously agreed to watch are exposed to sexual display, is also an offense in most jurisdictions, as is voyeurism when unarranged. (See indecent exposure and peeping tom)
Non-consensual sadomasochistic acts may legally constitute assault and therefore belong in the list below. Some jurisdictions criminalize some or all sadomasochistic acts, regardless of legal consent, and impose liability for any injuries caused. For these purposes, non-physical injuries are included in the definition of grievous bodily harm in English law. (See Consent (BDSM)), Operation Spanner)
The paraphilias listed below may carry a condition of illegality in some areas if acted out (though they may usually be legally role-played between consenting partners).
- Biastophilia: sexual pleasure from committing rape
- Exhibitionism and voyeurism, if lacking mutual agreement.
- Frotteurism: sexual arousal through rubbing one's self against an unknowing stranger in public
- Lust murder: sexual arousal through committing murder
- Necrophilia: sexual attraction to corpses
- Necrozoophilia: sexual attraction to the corpses or killings of animals (also known as necrobestiality)
- Pedophilia: sexual attraction to peripubescent or pre-pubescent minors
- Renfield's syndrome: clinical vampirism, or a compulsion to drink blood as a sexually-arousing act
- Telephone scatologia: being sexually aroused by making obscene telephone calls
- Zoophilia: emotional or sexual attraction to animals
- Zoosadism: the sexual enjoyment of causing pain and suffering to animals.
Paraphilia in popular culture
In the late twentieth and early twenty-first century, previously censored or stigmatized images of many paraphilias became more prevalent in the popular culture of Western countries.
- Sadomasochism: In the independent 1974 Italian film The Night Porter, Charlotte Rampling wore a hat from a Nazi uniform in a sadomasochistic sex scene. At the time, the image was startling and new, but over the following years the use of Nazi-tinged iconography in a sexual context became mainstream, appearing first in mass-marketed pornography like Playboy and Penthouse, and finally becoming so tame that teen queen Britney Spears wore a similar outfit to a primetime awards show in 2003.
- By 2006, sadomasochistic imagery had become mainstream enough for singer Justin Timberlake to have a hit song, SexyBack, with the lyric "You see these shackles baby, I'm your slave! / I'll let you whip me if I misbehave!"
- Zoophilia: Sex with animals has been a theme in a number of popular comedies, including Bachelor Party, Clerks II, and The 40-Year-Old Virgin. All these movies present the paraphilia as funny rather than erotic, as something ordinary young men are curious about but in the end find disgusting; in a minority of films and documentaries, the subject is given serious or thoughtful treatment. In all three movies the animal involved is an equine. In an episode of The Simpsons, Troy McClure acknowledges being sexually attracted to fish; his career had been damaged following an unspecified incident at an aquarium.
Controversy over the term
The definition of various sexual practices as paraphilias has been met with opposition. Advocates for changing these definitions stress that, aside from "paraphilias" with a criminal element, there is nothing inherently pathological about these practices; they are undeserving of the stigmatism associated with being "singled out" as such. Those who profess such a view hope that, much as with the removal of homosexuality from the DSM (see homosexuality and psychology), future psychiatric definitions will not include most of these practices.
Drug treatment of paraphilias
The treatment of men with paraphilias and related disorders has been challenging for patients and clinicians. In the past, surgical castration was advocated as a therapy for men with paraphilias, but it was abandoned because it is considered a cruel punishment and is now illegal in most countries. Psychotherapy, self-help groups, and pharmacotherapy (including the controversial hormone therapy sometimes referred to as "chemical castration") have all been used but are often unsuccessful. Here are some current drug treatments for these disorders.
Hormone drug treatments
In humans, testosterone has a crucial role not only in the development and maintenance of male sexual characteristics but also in the control of sexuality, aggression, cognition, emotion, and personality. Testosterone is a major determinant of sexual desire, fantasies, and behavior, and it increases the frequency, duration, and magnitude of spontaneous and nocturnal erections. The deviant sexual fantasies, urges, and behavior of men with paraphilias also appear to be triggered by testosterone. Therefore, reducing testosterone secretion or inhibiting its action is believed to control these symptoms.
Antiandrogenic drugs such as medroxyprogesterone (also known as the long-acting contraceptive Depo Provera) have been widely used as therapy in these men to reduce sex drive. However, their efficacy is limited and they have many unpleasant side effects, including breast growth, headaches, weight gain, and reduction in bone density. Even if compliance is good, only 60 to 80 percent of men benefit from this type of drug. Long-acting gonadotropin-releasing hormones, such as Triptorelin (Trelstar) which reduces the release of gonadotropin hormones, are also used. This drug is a synthetic hormone which may also lead to reduced sex drive.
Psychoactive drug treatments
Selective serotonin reuptake inhibitor (SSRI) class of antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), and paroxitine (Paxil), have all been used to treat paraphilias and related disorders by reducing impulse control problems and/or sexual obsessions with some success. SSRIs work by selectively inhibiting presynaptic serotonin reuptake with minimal effect on levels of norepinephrine or dopamine.
Tricyclic antidepressants (TCA), such as imipramine (Tofranil) and desipramine (Norpramin), inhibit the reuptake of serotonin and noradrenaline, and can also modify the activity of glutamatergic neurons. This effect is caused by blocking the reuptake pumps in monoamine nerve synapses, extending the length of time neurotransmitters remain in the synapse and increasing their concentration. OCD responds preferentially to the TCA clomipramine (Anafranil), which is relatively selective for serotonin reuptake. Concern about these medications, however, persist as a result of their extensive side-effects, drug interactions, and toxicity when taken in excess.
Lithium, the mood-stabilizing drug also known as Eskalith is typically used for the treatment of mania in bipolar disorder. There are some reports of reduced sexual compulsive behavior and a reduction in obsessive sexual thoughts in patients, which they attribute to the drug's enhancement of serotonergic functioning.
Anxiolytics are not considered a typical treatment for these type of disorders, however the efficacy of buspirone (BuSpar) has been clinically demonstrated.
Psychostimulants have been used recently to augment the effects of serotonergic drugs in paraphiliacs. In theory, the prescription of a psychostimulant without pretreatment with an SSRI might further disinhibit sexual behavior, but when taken together, the psychostimulant may actually reduce impulsive tendencies. Methylphenidate (Ritalin) is a type of amphetamine used primarily to manage the symptoms of attention deficit hyperactivity disorder (ADHD). Recent studies imply that methylphenidate may also act on serotonergic systems; this may be important in explaining the paradoxical calming effect of stimulants on ADHD patients. Amphetamine is also used medically as an adjunct to antidepressants in refractory cases of depression.
(Source: BrainPhysics About Sexual Compulsions)
List of paraphilias
- Also see article -philia for "-philias" in other fields
Used in a sexual context, terms with the -philia suffix refer to conditions in which the person's primary sexual interest involves the stimulus or situation mentioned (the suffix is also used for non-sexual interest in or admiration of a subject). Terms with the -lagnia suffix refer to an action involving the stimulus or situation. For example, someone who is consistently sexually excited by feces would have coprophilia; any sexual act involving feces, even by someone for whom that is not a primary interest, would be coprolagnia.
The following terms mostly represent combinations of Greek or Latin words or roots, but few qualify as clinical paraphilias. Some of the following sexual interests are fairly common, while others are very rare.
- Abasiophilia: love of (or sexual attraction to) people who are lame or crippled and/or who use leg braces or other orthopaedic appliances
- Acarophilia: sexual pleasure from being tickled
- Acomophilia: sexual attraction to baldness (also hairless genitalia)
- Acousticophilia: sexual arousal from certain sounds
- Acrotomophilia: love of (or sexual attraction to) amputation or amputees
- Adolescentilism: sexual pleasure from acting or dressing like an adolescent
- Aelurophilia: a form of zoophiliaâ€”sexual attraction to cats
- Agalmatophilia: sexual attraction to statues or mannequins or immobility
- Algolagnia: sexual pleasure from pain
- Amaurophilia: sexual arousal by a partner whom one is unable to see due to artificial means, such as being blindfolded or having sex in total darkness. (See: sensory deprivation)
- Andromimetophilia: love of women dressed as men or have had a sex change; see also gynemimetophilia
- Apodysophilia: desire to undress, see also nudism
- Apotemnophilia: desire to have (or sexual arousal from having) a healthy appendage (limb, digit, or male genitals) amputated
- Aquaphilia: arousal from water and/or in watery environments, including bathtubs or swimming pools
- Aretifism: sexual attraction to people who are without footwear, in contrast to retifism
- Asphyxiophilia: sexual attraction to asphyxia; also called breath control play (or being strangled); including autoerotic asphyxiation; see medical warnings
- Autoabasiophilia: sexual attraction to oneself being lame or crippled
- Autagonistophilia: sexual arousal from being observed or creating conditions for faciliating observation; see also exhibitionism
- Autogynephilia: love of oneself as a woman (also see Blanchard, Bailey, and Lawrence theory for discussion on controversy)
- Autonephioplia: (a.k.a diaper fetishism) sexual arousal from diapers
- Autossassinophilia: sexual arousal from fantasizing about or staging one's own murder
- Biastophilia: sexual pleasure from committing rape or being raped; see also raptophilia
- Celebriphilia: pathological desire to have sex with a celebrity
- Chrematistophilia: sexual arousal from paying for sex or being robbed by oneâ€™s sexual partner; see also harpaxophilia
- Coprophilia: sexual attraction to (or pleasure from) feces
- Crush fetish: sexual arousal from seeing small creatures being crushed by members of the opposite sex, or being crushed oneself
- Dacryphilia: sexual pleasure in eliciting tears from others or oneself
- Dendrophilia: sexual attraction to trees and other large plants, popularized by the movie Superstar with Molly Shannon
- Dwarf or 'midget' fetishism: sexual attraction to little people
- Emetophilia (a.k.a. vomerophilia): sexual attraction to vomit
- Ephebophilia (a.k.a. hebephilia): sexual attraction towards adolescents
- Eproctophilia: sexual attraction to flatulence
- Erotophonophilia: sexual arousal from trying to commit murder
- Exhibitionism: (a.k.a peodeiktophilia) sexual arousal through sexual behavior in view of third parties (also includes the recurrent urge or behavior to expose one's genitals to an unsuspecting person)
- Faunoiphilia: sexual arousal from watching animals mate
- Sexual fetishism: is the use of non-sexual or nonliving objects or part of a person's body to gain sexual excitement. Examples include:
- Balloon fetishism -- breast fetishism -- bike fetish -- foot fetishism (podophilia) -- fur fetishism -- leather fetishism -- lipstick fetishism -- medical fetishism -- panty fetishism -- robot fetishism -- rubber fetishism -- shoe fetishism -- smoking fetishism -- spandex fetishism -- dental braces fetishism -- transvestic fetishism (see below)
- Formicophilia: sexual attraction to smaller animals, insects, etc. crawling on parts of the body
- Forniphilia: sexual objectification in which a person's body is incorporated into a piece of furniture
- Frotteurism: sexual arousal from the recurrent urge or behavior of touching or rubbing against a nonconsenting person
- Galactophilia: (a.k.a lactophilia) sexual attraction to human milk or lactating women
- Gerontophilia: sexual attraction towards the elderly
- Gynemimetophilia: love of men dressed as women or have had a sex change; see also andromimetophilia
- Gynophagia: sexual attraction toward eating woman
- Haematophilia: sexual attraction involving blood (either on another person or the liquid itself; not to be confused with haemophilia, a genetic disorder of the blood)
- Harpaxophilia: sexual arousal from being the victim of a robbery or burglary; see also chrematistophilia
- Homeovestism: sexual attraction towards the clothing of one's own gender
- Hybristophilia: sexual arousal to people who have committed crimes, in particular cruel or outrageous crimes
- Hypephilia: sexual attraction to fabrics
- Incestophilia: sexual attraction to one's own family
- Infantilism: sexual pleasure from dressing, acting, or being treated as a baby
- Katoptronophilia: sexual arousal from having sex in front of mirrors
- Kleptophilia: sexual arousal from stealing things
- Klismaphilia: sexual pleasure from enemas
- Lust murder: sexual arousal through committing murder
- Macrophilia: sexual attraction to larger people and large things (including larger body organs such as breasts and genitalia)
- Maiesiophilia: sexual attraction to childbirth or pregnant women
- Masochism: the recurrent urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made to suffer
- Mechaphilia: sexual attraction to machines, especially robots or androids
- Microphilia: sexual attraction to smaller people and things of smaller size
- Mysophilia: sexual attraction to soiled, dirty, foul or decaying material
- Narratophilia: sexual arousal in the use of dirty or obscene words to a partner
- Nasophilia: sexual attraction to the sight, touch of human noses
- Necrophilia: sexual attraction to corpses
- Necrozoophilia: (a.k.a necrobestiality) sexual attraction to the corpses or killings of animals
- Nepiophilia: (a.k.a. infantophilia) sexual attraction to children three years old or younger
- Olafactophilia: sexual stimulus with smells or odors
- Parthenophilia: sexual attraction to virgins
- Pecattiphilia: sexual arousal from sinning or guilt
- Pediophilia: sexual attraction to dolls
- Pedophilia: sexual attraction to prepubescent children (British spelling: paedophilia)
- Phalloorchoalgolagnia: sexual arousal by the experiencing of painful stimuli being administered to the male genitals
- Pictophilia: sexual attraction to pictorial pornography or erotic art
- Plushophilia: sexual attraction to stuffed toys or people in animal costume, such as theme park characters
- Pyrophilia: sexual arousal through watching, setting, hearing, talking or fantasizing about fire
- Raptophilia: sexually attracted to the idea of being raped; see also Biastophilia
- Retifism: sexual arousal from shoes
- Sadism: sexual arousal from giving pain
- Saliromania: sexual arousal or satisfaction of soiling or damaging a partnerâ€™s clothing
- Schediaphilia (a.k.a. toonophilia): love of (or sexual arousal from) cartoon characters or situations
- Scoptophilia: sexual pleasure from watching other people have sex; not to be confused with voyeurism
- Sitophilia: sexual arousal from food
- Somnophilia: sexual arousal from sleeping or unconscious people
- Spectrophilia: sexual attraction to ghosts
- Stigmatophilia: sexual focus on a partner who is tatooed or scarred
- Stygiophilia: sexual pleasure from the thought of going to hell
- Symphorophilia: sexual attraction with stage-managing a disaster, such as a traffic accident
- Telephone scatologia: being sexually aroused by making obscene telephone calls to strangers
- Telephonicophilia: sexual arousal in explicit phone conversations
- Teratophilia: sexual attraction to deformed or monstrous people
- Toonophilia: (a.k.a. schediaphilia) sexual attraction to cartoon or anime character
- Transformation fetish: sexual arousal from depictions of transformations of people into objects or other beings
- Transvestic fetishism: (a.k.a transvestitism) sexual attraction towards the clothing of the opposite gender
- Trichophilia: sexual arousal from hair
- Troilism: sharing a sexual partner with another person while looking on
- Urolagnia: sexual attraction to urine
- Vincilagnia: sexual arousal by bondage
- Vomerophilia: (a.k.a. emetophilia) sexual attraction to the act of vomiting
- Vorarephilia: sexual attraction to being eaten by, and/or eating, another person or creature
- Voyeurism: sexual arousal through secretly watching others having sex (also includes the recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing or engaging in sexual activities, see peeping tom)
- Xenophilia: sexual attraction to foreigners (in science fiction, can also mean sexual attraction to aliens)
- Xylophilia: sexual attraction to wood
- Zelophilia: sexual arousal from jealousy
- Zoophilia: emotional or sexual attraction to animals
- Zoosadism: the sexual enjoyment of causing pain and suffering to animals
- Sadism and masochism are often grouped together, under "sado-masochism", as a clinical term; see also algolagnia. As a lifestyle interest, see BDSM (bondage & discipline, domination & submission, and sadism & masochism.)
- -philia (list of philias)
- Sexual fetishism
- Kink (sexual)
- Psychosexual development
- Human sexuality
- Developmental psychology
- Human development
- Sex crime
- Dorian Gray syndrome
- John Money
- Richard Freiherr von Krafft-Ebing for history of classifying sexual object choice as a disease
|This article is based on a GNU FDL LGBT Wikia article: Paraphilia||LGBT|
- American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed., text revision). Pp. 566-567.