1. Either of the following must be present:

   1. persistent and distressing complaints of feelings of exhaustion after a minor mental effort (such as performing or attempting to perform everyday tasks that do not require unusual mental effort);
   2. persistent and distressing complaints of feelings of fatigue and bodily weakness after minor physical effort;
   At least one of the following symptoms must be present:
   1. feelings of muscular aches and pains;
   2. dizziness;
   3. tension headaches;
   4. sleep disturbances;
   5. inability to relax;
   6. irritability

The patient is unable to recover from the symptoms in Criterion A (1) or (2) by means of rest, relaxation, or entertainment.
The duration of the disorder is at least 3 months.
Most commonly used exclusion clause. The disorder does not occur in the presence of organic emotionally labile disorder, postencephalitic syndrome, postconcussional syndrome, mood disorders, panic disorder, or generalized anxiety disorder.

1. Intentional production or feigning of physical or psychological signs or symptoms.
2. The motivation for the behavior is to assume the sick role.
3. External incentives for the behavior (such as economic gain, avoiding legal responsibility, or improving physical well-being, as in malingering) are absent.

Code based on type:
With predominantly psychological signs and symptoms: if psychological signs and symptoms predominate in the clinical presentation
With predominantly physical signs and symptoms: if physical signs and symptoms predominate in the clinical presentation
With combined psychological and physical signs and symptoms: if both psychological and physical signs and symptoms are present but neither predominates in the clinical presentation

This category includes disorders with factitious symptoms that do not meet the criteria for factitious disorder. An example is factitious disorder by proxy: the intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual's care for the purpose of indirectly assuming the sick role (see Table 19-4 for suggested research criteria).

1. Physical symptoms originally due to a confirmed physical disorder, disease, or disability become exaggerated or prolonged in excess of what can be explained by the physical disorder itself.
2. There is evidence for a psychological causation for the excess symptoms (such as evident fear of disability or death, possible financial compensation, disappointment at the standard of care experienced).

Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder]

1. The individual exhibits a persistent pattern of intentional production or feigning of symptoms and/or self-infliction of wounds in order to produce symptoms.
2. No evidence can be found for an external motivation such as financial compensation, escape from danger, or more medical care. (If such evidence can be found, the category, malingering, should be used.)
3. Most commonly used exclusion clause. There is no confirmed physical or mental disorder that could explain the symptoms.

Other specified disorders of adult personality and behavior
This category should be used for coding any specified disorder of adult personality and behavior that cannot be classified under any one of the preceding headings.

This category is included for disorders in which the predominant feature is a dissociative symptom (i.e., a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment) that does not meet the criteria for any specific dissociative disorder. Examples include the following:

1. Clinical presentations similar to dissociative identity disorder that fail to meet full criteria for this disorder. Examples include presentations in which (a) there are not two or more distinct personality states or (b) amnesia for important personal information does not occur.
2. Derealization unaccompanied by depersonalization in adults.
3. States of dissociation that occur in individuals who have been subjected to periods of prolonged and intense coercive persuasion (e.g., brainwashing, thought reform, or indoctrination while captive).
4. Dissociative trance disorder: single or episodic disturbances in the state of consciousness, identity, or memory that are indigenous to particular locations and cultures. Dissociative trance involves narrowing of awareness of immediate surroundings or stereotyped behaviors or movements that are experienced as being beyond one's control. Possession trance involves replacement of the customary sense of personal identity by a new identity, attributed to the influence of a spirit, power, deity, or other person and associated with stereotyped involuntary movements or amnesia, and is perhaps the most common dissociative disorder in Asia. Examples include amok (Indonesia), bebainan (Indonesia), latah (Malaysia), pibloktoq (Arctic), ataque de nervios (Latin America), and possession (India). The dissociative or trance disorder is not a normal part of a broadly accepted collective cultural or religious practice.
5. Loss of consciousness, stupor, or coma not attributable to a general medical condition.
6. Ganser syndrome: the giving of approximate answers to questions (e.g., 2 + 2 = 5) when not associated with dissociative amnesia or dissociative fugue.

1. Either (1) or (2):

   1. Trance, that is, temporary marked alteration in the state of consciousness or loss of customary sense of personal identity without replacement by an alternate identity, associated with at least one of the following:
      1. Narrowing of awareness of immediate surroundings or unusually narrow and selective focusing on environmental stimuli
      2. Stereotyped behaviors or movements that are experienced as being beyond one's control
   2. Possession trance, a single or episodic alteration in the state of consciousness characterized by the replacement of customary sense of personal identity by a new identity. This is attributed to the influence of a spirit, power, deity, or other person, as evidenced by one or more of the following:
      1. Stereotyped and culturally determined behaviors or movements that are experienced as being controlled by the possessing agent
      2. Full or partial amnesia for the event
2. The trance or possession trance state is not accepted as a normal part of a collective cultural or religious practice.
3. The trance or possession trance state causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
4. The trance or possession trance state does not occur exclusively during the course of a psychotic disorder (including mood disorder with psychotic features and brief psychotic disorder) or dissociative identity disorder and is not due to the direct physiological effects of a substance or a general medical condition.

1. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
2. At least two of these identities or personality states recurrently take control of the person's behavior.
3. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
4. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.

1. The predominant disturbance is sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past.
2. Confusion about personal identity or assumption of a new identity (partial or complete).
3. The disturbance does not occur exclusively during the course of dissociative identity disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).
4. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

1. Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream).
2. During the depersonalization experience, reality testing remains intact.
3. The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
4. The depersonalization experience does not occur exclusively during the course of another mental disorder, such as schizophrenia, panic disorder, acute stress disorder, or another dissociative disorder, and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).

1. The predominant disturbance is one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.
2. The disturbance does not occur exclusively during the course of dissociative identity disorder, dissociative fugue, posttraumatic stress disorder, acute stress disorder, or somatization disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a neurological or other general medical condition (e.g., amnestic disorder due to head trauma).
3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

1. Intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual's care.
2. The motivation for the perpetrator's behavior is to assume the sick role by proxy.
3. External incentives for the behavior (such as economic gain) are absent.
4. The behavior is not better accounted for by another mental disorder.

G1. There must be no evidence of a physical disorder that can explain the characteristic symptoms of this disorder (although physical disorders may be present that give rise to other symptoms).
G2. There are convincing associations in time between the onset of symptoms of the disorder and stressful events, problems, or needs.
Dissociative amnesia

1. The general criteria for dissociative disorder must be met.
2. There must be amnesia, partial or complete, for recent events or problems that were or still are traumatic or stressful.
3. The amnesia is too extensive and persistent to be explained by ordinary forgetfulness (although its depth and extent may vary from one assessment to the next) or by intentional simulation.

Dissociative fugue

1. The general criteria for dissociative disorder must be met.
2. The individual undertakes an unexpected yet organized journey away from home or from the ordinary places of work and social activities, during which self-care is largely maintained.
3. There is amnesia, partial or complete, for the journey, which also meets Criterion C for dissociative amnesia.

Dissociative stupor

1. The general criteria for dissociative disorder must be met.
2. There is profound diminution or absence of voluntary movements and speech and of normal responsiveness to light, noise, and touch.
3. Normal muscle tone, static posture, and breathing (and often limited coordinated eye movements) are maintained.

Trance and possession disorders

1. The general criteria for dissociative disorder must be met.
2. Either of the following must be present:
   1. Trance. There is temporary alteration of the state of consciousness, shown by any two of the following:
      1. Loss of the usual sense of personal identity
      2. Narrowing of awareness of immediate surroundings or unusually narrow and selective focusing on environmental stimuli
      3. Limitation of movements, postures, and speech to repetition of a small repertoire
   2. Possession disorder. The individual is convinced that he or she has been taken over by a spirit, power, deity, or other person.
3. (1) and (2) of Criterion B must be unwanted and troublesome, occurring outside, or being a prolongation of, similar states in religious or other culturally accepted situations.
4. Most commonly used exclusion clause. The disorder does not occur at the same time as schizophrenia or related disorders, or mood (affective) disorders with hallucinations or delusions.

Dissociative motor disorders

1. The general criteria for dissociative disorder must be met.
2. Either of the following must be present:
   1. Complete or partial loss of the ability to perform movements that are normally under voluntary control (including speech)
   2. Various or variable degrees of incoordination or ataxia, or inability to stand unaided

Dissociative convulsions

1. The general criteria for dissociative disorder must be met.
2. The individual exhibits sudden and unexpected spasmodic movements, closely resembling any of the varieties of epileptic seizure but not followed by loss of consciousness.
3. The symptoms in Criterion B are not accompanied by tongue biting, serious bruising or laceration due to falling, or urinary incontinence.

Dissociative anesthesia and sensory loss

1. The general criteria for dissociative disorder must be met.
2. Either of the following must be present:
   1. Partial or complete loss of any or all of the normal cutaneous sensations over part or all of the body (specify: touch, pin prick, vibration, heat, cold)
   2. Partial or complete loss of vision, hearing, or smell (specify)

Mixed dissociative (conversion) disorders
Other dissociative (conversion) disorders
This residual code may be used to indicate other dissociative and conversion states that meet Criteria G1 and G2 for dissociative (conversion) disorders but do not meet the criteria for the dissociative disorders listed previously.
Ganser syndrome (approximate answers)
Multiple personality disorder

1. Two or more distinct personalities exist within the individual, only one being evident at a time.
2. Each personality has its own memories, preferences, and behavior patterns and, at some time (and recurrently), takes full control of the individual's behavior.
3. There is inability to recall important personal information, which is too extensive to be explained by ordinary forgetfulness.
4. The symptoms are not due to organic mental disorders (e.g., in epileptic disorders) or psychoactive substance-related disorders (e.g., intoxication or withdrawal).
   Transient dissociative (conversion) disorders occurring in childhood and adolescence
   Other specified dissociative (conversion) disorders
   Specific research criteria are not given for all disorders mentioned previously, because these other dissociative states are rare and not well described. Research workers studying these conditions in detail should specify their own criteria according to the purpose of their studies.
   Dissociative (conversion) disorder, unspecified

1. Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person's life.
2. The disturbance causes marked distress or interpersonal difficulty.
3. The sexual dysfunction is not better accounted for by another Axis I disorder (except another sexual dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors

1. Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner.
2. The disturbance causes marked distress or interpersonal difficulty.
3. The sexual dysfunction is not better accounted for by another Axis I disorder (except another sexual dysfunction).

1. Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement.
2. The disturbance causes marked distress or interpersonal difficulty.
3. The sexual dysfunction is not better accounted for by another Axis I disorder (except another sexual dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors

1. Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection.
2. The disturbance causes marked distress or interpersonal difficulty.
3. The erectile dysfunction is not better accounted for by another Axis I disorder (other than a sexual dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors

1. Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Women exhibit wide variability in the type or intensity of stimulation that triggers orgasm. The diagnosis of female orgasmic disorder should be based on the clinician's judgment that the woman's orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives.
2. The disturbance causes marked distress or interpersonal difficulty.
3. The orgasmic dysfunction is not better accounted for by another Axis I disorder (except another sexual dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors

1. Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration.
2. The disturbance causes marked distress or interpersonal difficulty.
3. The orgasmic dysfunction is not better accounted for by another Axis I disorder (except another sexual dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors

1. Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.
2. The disturbance causes marked distress or interpersonal difficulty.
3. The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opioids).

Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors

1. Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse.
2. The disturbance causes marked distress or interpersonal difficulty.
3. The disturbance is not better accounted for by another Axis I disorder (e.g., somatization disorder) and is not due exclusively to the direct physiological effects of a general medical condition.

Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors

1. Clinically significant sexual dysfunction that results in marked distress or interpersonal difficulty predominates in the clinical picture.
2. There is evidence from the history, physical examination, or laboratory findings that the sexual dysfunction is fully explained by the direct physiological effects of a general medical condition.
3. The disturbance is not better accounted for by another mental disorder (e.g., major depressive disorder).

Select, code and term based on the predominant sexual dysfunction:
Female hypoactive sexual desire disorder due to …[indicate the general medical condition]: if deficient or absent sexual desire is the predominant feature
Male hypoactive sexual desire disorder due to …[indicate the general medical condition]: if deficient or absent sexual desire is the predominant feature
Male erectile disorder due to …[indicate the general medical condition]: if male erectile dysfunction is the predominant feature
Female dyspareunia due to …[indicate the general medical condition]: if pain associated with intercourse is the predominant feature
Male dyspareunia due to …[indicate the general medical condition]: if pain associated with intercourse is the predominant feature
Other female sexual dysfunction due to …[indicate the general medical condition]: if some other feature is predominant (e.g., orgasmic disorder) or no feature predominates
Other male sexual dysfunction due to …[indicate the general medical condition]: if some other feature is predominant (e.g., orgasmic disorder) or no feature predominates
Coding note: Include the name of the general medical condition on Axis I, e.g., male erectile disorder due to diabetes mellitus; also code the general medical condition on Axis III.

1. Clinically significant sexual dysfunction that results in marked distress or interpersonal difficulty predominates in the clinical picture.
2. There is evidence from the history, physical examination, or laboratory findings that the sexual dysfunction is fully explained by substance use as manifested by either (1) or (2):
   1. the symptoms in Criterion A developed during, or within a month of, substance intoxication
   2. medication use is etiologically related to the disturbance
3. The disturbance is not better accounted for by a sexual dysfunction that is not substance induced. Evidence that the symptoms are better accounted for by a sexual dysfunction that is not substance induced might include the following: the symptoms precede the onset of the substance use or dependence (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of intoxication, or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non–substance-induced sexual dysfunction (e.g., a history of recurrent non–substance-related episodes).

Note: This diagnosis should be made instead of a diagnosis of substance intoxication only when the sexual dysfunction is in excess of that usually associated with the intoxication syndrome and when the dysfunction is sufficiently severe to warrant independent clinical attention.
Code [Specific substance]-induced sexual dysfunction: Alcohol; amphetamine [or amphetamine-like substance]; cocaine; opioid; sedative, hypnotic, or anxiolytic; other [or unknown] substance
Specify if:
With impaired desire
With impaired arousal
With impaired orgasm
With sexual pain
Specify if:
With onset during intoxication: if the criteria are met for intoxication with the substance and the symptoms develop during the intoxication syndrome

This category includes sexual dysfunctions that do not meet criteria for any specific sexual dysfunction. Examples include:

1. No (or substantially diminished) subjective erotic feelings despite otherwise normal arousal and orgasm
2. Situations in which the clinician has concluded that a sexual dysfunction is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced

G1. The subject is unable to participate in a sexual relationship as he or she would wish.
G2. The dysfunction occurs frequently, but may be absent on some occasions.
G3. The dysfunction has been present for at least 6 months.
G4. The dysfunction is not entirely attributable to any of the other mental and behavioral disorders in ICD-10, physical disorders (such as endocrine disorder), or drug treatment.
Comments
Measurement of each form of dysfunction can be based on rating scales that assess severity as well as frequency of the problem. More than one type of dysfunction can coexist.
Lack or loss of sexual desire

1. The general criteria for sexual dysfunction must be met.
2. There is a lack or loss of sexual desire, manifest by diminution of seeking out sexual cues, or thinking about sex with associated feelings of desire or appetite, or of sexual fantasies.
3. There is a lack of interest in initiating sexual activity either with a partner or as solitary masturbation, resulting in a frequency of activity clearly lower than expected, taking into account age and context, or in a frequency very clearly reduced from previous much higher levels.

Sexual aversion and lack of sexual enjoyment
Sexual aversion

1. The general criteria for sexual dysfunction must be met.
2. The prospect of sexual interaction with a partner produces sufficient aversion, fear, or anxiety that sexual activity is avoided, or, if it occurs, is associated with strong negative feelings and an inability to experience any pleasure.
3. The aversion is not the result of performance anxiety (reaction to previous failure of sexual response).

Lack of sexual enjoyment

1. The general criteria for sexual dysfunction must be met.
2. Genital response (orgasm and/or ejaculation) occurs during sexual stimulation, but is not accompanied by pleasurable sensations or feelings of pleasant excitement.
3. There is no manifest and persistent fear or anxiety during sexual activity (see sexual aversion).

Failure of genital response

1. The general criteria for sexual dysfunction must be met. In addition, for men:
2. Erection sufficient for intercourse fails to occur when intercourse is attempted. The dysfunction takes one of the following forms:
   1. full erection occurs during the early stages of lovemaking but disappears or declines when intercourse is attempted (before ejaculation if it occurs);
   2. erection does occur, but only at times when intercourse is not being considered;
   3. partial erection, insufficient for intercourse, occurs, but not full erection;
   4. no penile tumescence occurs at all.

In addition, for women:

1. There is failure of genital response, experienced as failure of vaginal lubrication, together with inadequate tumescence of the labia. The dysfunction takes one of the following forms.
   1. general lubrication fails in all relevant circumstances;
   2. lubrication may occur initially but fails to persist for long enough to allow comfortable penile entry;
   3. Situational: lubrication occurs only in some situations (e.g., with one partner but not another, or during masturbation, or when vaginal intercourse is not being contemplated).

Orgasmic dysfunction

1. The general criteria for sexual dysfunction must be met.
2. There is orgasmic dysfunction (either absence or marked delay of orgasm), which takes one of the following forms:
   1. orgasm has never been experienced in any situation;
   2. orgasmic dysfunction has developed after a period of relatively normal response:
      1. general: orgasmic dysfunction occurs in all situations and with any partner;
      2. situational:
         For women: orgasm does occur in certain situations (e.g., when masturbating or with certain partners); For men, one of the following can be applied:
         1. orgasm occurs only during sleep, never during the waking state;
         2. orgasm never occurs in the presence of the partner;
         3. orgasm occurs in the presence of the partner but not during intercourse.

Premature ejaculation

1. The general criteria for sexual dysfunction must be met.
2. There is an inability to delay ejaculation sufficiently to enjoy lovemaking, manifest as either of the following:
   1. occurrence of ejaculation before or very soon after the beginning of intercourse (if a time limit is required: before or within 15 seconds of the beginning of intercourse);
   2. ejaculation occurs in the absence of sufficient erection to make intercourse possible.
3. The problem is not the result of prolonged abstinence from sexual activity.

Nonorganic vaginismus

1. The general criteria for sexual dysfunction must be met.
2. There is spasm of the perivaginal muscles, sufficient to prevent penile entry or make it uncomfortable. The dysfunction takes one of the following forms:
   1. normal response has never been experienced;
   2. vaginismus has developed after a period of relatively normal response;
      1. when vaginal entry is not attempted, a normal sexual response may occur;
      2. any attempt at sexual contact leads to generalized fear and efforts to avoid vaginal entry (e.g., spasm of the adductor muscles of the thighs).

Nonorganic dyspareunia

1. The general criteria for sexual dysfunction must be met.

In addition, for women:

1. Pain is experienced at the entry of the vagina, either throughout sexual intercourse or only when deep thrusting of the penis occurs.
2. The disorder is not attributable to vaginismus or failure of lubrication, dyspareunia of organic origin should be classified according to the underlying disorder.

In addition, for men:

1. Pain or discomfort is experienced during sexual response. (The timing of the pain and the exact localization should be carefully recorded.)
2. The discomfort is not the result of local physical factors. If physical factors are found, the dysfunction should be classified elsewhere.

Excessive sexual drive
No research criteria are attempted for this category. Researchers studying this category are recommended to design their own criteria.
Other sexual dysfunction, not caused by organic disorder or disease
Unspecified sexual dysfunction, not caused by organic disorder or disease

1. Recurrent or persistent genital pain associated with sexual intercourse in either a male or a female.
2. The disturbance causes marked distress or interpersonal difficulty.
3. The disturbance is not caused exclusively by vaginismus or lack of lubrication, is not better accounted for by another Axis I disorder (except another sexual dysfunction), and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors

1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one's genitals to an unsuspecting stranger.
2. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects (e.g., female undergarments).
2. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. The fetish objects are not limited to articles of female clothing used in cross-dressing (as in transvestic fetishism) or devices designed for the purpose of tactile genital stimulation (e.g., a vibrator).

1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person.
2. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).
2. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.
3. The person is at least age 16 years and at least 5 years older than the child or children in Criterion A.

Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old.
Specify if:
Sexually attracted to males
Sexually attracted to females
Sexually attracted to both
Specify if:
Limited to incest
Specify type:
Exclusive type (attracted only to children)
Nonexclusive type

1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer.
2. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.
2. The person has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity.
2. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

1. Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.
2. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:
With gender dysphoria: if the person has persistent discomfort with gender role or identity