Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11).

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.

"Doidas e putas": usos das categorias travesti e transexual / "Locas y putas": usos de las categorías travesti y transexual / "Freaks and whores": uses of travesti and transsexual categories

Neste artigo discuto os usos das categorias travesti e transexual com base em trabalho de campo realizado entre 2008 e 2009 com participantes das reuniões denominadas Terças Trans. A questão central que norteou a análise foi como as diferentes pessoas observadas utilizavam categorias relacionadas a identidades sexuais e de gênero e como acionavam e articulavam diversas associações convencionais nesse processo para produzir sentidos e diferenças acerca destas categorias. Embora as convenções do discurso médico sejam referências centrais para a definição de corpos, subjetividades e identidades das pessoas pesquisadas, foi possível observar também uma variedade de reelaborações e deslocamentos de sentidos. Procuro desenvolver o argumento de que travesti e transexual são categorias performativas, e que tal performatividade não se esgota apenas em enunciados de gênero e sexualidade, mas também pode ser expressa por meio de articulações contingentes que remetem a diferenças de classe, cor/raça e geração.

Se discuten en este artículo los usos de las categorías travesti y transexual, a partir de un trabajo de campo realizado entre 2008 y 2009 con participantes de reuniones denominadas Martes Trans. La cuestión central que orientó el análisis fue cómo las diferentes personas observadas utilizaban categorías relacionadas a identidades sexuales y de género, y cómo accionaban y articulaban diversas asociaciones convencionales en este proceso, para producir sentidos y diferencias acerca de dichas categorías. Aun cuando las convenciones del discurso médico son referencias centrales para la definición de cuerpos, subjetividades e identidades de las personas involucradas en la investigación, se pudo observar también una variedad de reelaboraciones y desplazamientos de sentido. Se procura desarrollar el argumento de que travesti y transexual son categorías performativas, y que tal performatividad no se agota sólo en enunciados de género y sexualidad, sino que pueden también expresarse por medio de articulaciones contingentes que remiten a diferencias de clase, color/raza y generación.

In this article I discuss the uses of travesti and transexual categories based on fieldwork carried out from 2008 to 2009 with people who joined at Terças Trans. The main issue that frames my analysis was how people researched used categories regarding sexual and gender identities, especially travesti and transsexual and how they agency and articulate several conventional associations in this process to produce meanings and differences about these categories. Although the conventions of medical discourse are key references for the definition of bodies, subjectivities and identity of people surveyed, it was possible to note also a variety of re-elaborations and displacements of meanings. I try to develop the argument that travesti and transexual categories are performatives, and that this performativity is not limited only in statements of gender and sexuality, but can also be expressed by means of contingent articulation which refer to differences of class, color/race and generation.

Two types of fetishism.

This study attempted to differentiate two clinical types of fetishism-fetishism proper and tranvestism-and to determine if tranvestites are truly fetishistic. The transvestites were further divided into gender-conforming and gender-noncomforming groups according to their score on a gender identity scale. These groups were compared using a self-report scale measuring fetishistic interests, and a set of questionnaire items regarding their childhood history, parental characteristics, and their emotional closeness with their parents. In addition, the penile responses of a subset of fetishists and tranvestites were recorded while they were presented with visual depictions of female and male public regions and potentially fetishistic objects (nylon stockings, female and male shoes, panties, male underwear, female and male feet). The fetishists proper and the transvestite subgroups did not differ from each other in terms of self-reported fetishistic interest or childhood and family histories. Moreover, there were no differences between these groups in their penile response to the potentially fetishistic stimulus they were most aroused by, relative to the depictions of the pubic region of their preferred gender. These results suggest that transvestites are in fact fetishistic, and that they are difficult to distinguish from fetishists proper.

Gender-disturbed males.

Adolescent and adult cross-dressing or "transvestism" is the most common antecedent behavioral pattern among those who request sex reassignment surgery. Transvestites are actually a diverse group of men who differ in their gender identities, orientation, and intention. They do, however, have in common a soothing image of themselves as women. Because of this, whether cross-dressing occurs among masculine or feminine males or heterosexuals, homosexuals, bisexuals, or asexuals, or among those with paraphilia, the behavior should be considered the expression of their consciously felt femininity. The confusing differences among cross-dressing males may be explained by their diversity along three dimensions: 1) the ambition for heterosexual intercourse; 2) the natural history of their sexual arousal to female clothing; 3) their current capacity to integrate their masculine and feminine strivings into separate compartments. When cross-dressers give up all vestiges of male gender role behaviors and successfully live and work full time as women, the appropriate descriptive term for them becomes "transsexual."

A sex caused inconsistency in DSM-III-R: the definition of mental disorder and the definition of paraphilias.

The DSM-III-R definition of mental disorder is inconsistent with the DSM-III-R definition of paraphilias. The former requires the suffering or increased risk of suffering some harm while the latter allows that deviance, by itself, is sufficient to classify a behavioral syndrome as a paraphilia. This inconsistency is particularly clear when examining the DSM-III-R account of a specific paraphilia, Transvestic Fetishism. The author defends the DSM-III-R definition of mental disorder and argues that the DSM-III-R definition of paraphilias should be changed. He recommends that the diagnostic criteria for specific paraphilias, particularly that for Transvestic Fetishism, be changed to make them consistent with the DSM-III-R definition of mental disorder.

The clinical syndromes of femmiphilic transvestism.

Thirty-four members of a club established for heterosexual transvestites were interviewed. They were categorized into two groups. Subjects in group I were satisfied with cross-dressing and did not desire additional feminization. Subjects in group II desired to alter their bodily appearance toward female by taking female hormones or by having surgical intervention. Group II transvestites cross-dressed more frequently and had a more intense feminine gender identity and stronger homosexual interests than did group I transvestites. A feminine gender identity appeared to be present from childhood in both groups but to be stronger in group II. Cross-dressing in subjects of both groups often occurred first during childhood and almost always prior to age 15. All subjects showed a period of fetishistic arousal to women's clothes during adolescence. With increasing age, fetishistic arousal diminished or disappeared and the frequency of cross-dressing increased. Terms in the literature used to describe the type of transvestism reported in this study are discussed. It was suggested that the term "femmiphilic transvestism" be used to describe the condition of the subjects of both groups. The term has fewer disadvantages than terms previously suggested.