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INTRODUCTION: The World Health Organization (WHO) has made substantial changes to the classification of paraphilic disorders for the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), recently approved by the World Health Assembly. The most important is to limit paraphilic disorders primarily to persistent and intense patterns of atypical sexual arousal involving non-consenting individuals, manifested through persistent sexual thoughts, fantasies, urges, or behaviors, that have resulted in action or significant distress. AIM: To analyze the legal, regulatory, and policy implications of the changes in the ICD-11 classification of paraphilic disorders for forensic practice, health systems, adjudication of sex offenders, and the provision of treatment in Mexico. METHODS: An expert Mexican advisory group was appointed to conduct this evaluation following an assessment guide provided by the WHO. MAIN OUTCOME MEASURES: The WHO assessment guide covered (i) laws related to sexual behaviors; (ii) the relationship between legal and clinical issues for non-forensic health professionals; (iii) implications of mental disorder classification for forensic practice; (iv) other implications of ICD-11 paraphilic disorders proposals; and (v) contextual issues. RESULTS: A variety of factors in Mexico make it highly unlikely that appropriate, evidence-based treatments for paraphilic disorders will be provided to those who need them, even if they seek treatment voluntarily and have not committed a crime. Mexican law focuses on the punishment of specific sexual behaviors rather than on underlying disorders. A paraphilic disorder would not be considered sufficient grounds for exemption from criminal responsibility. The application and scope of mental health evaluations in Mexican legal proceedings are quite limited, and individuals who commit sexual crimes almost never undergo forensic evaluations to establish the presence of paraphilic disorders. Psychiatric services may be mandated for sex offenders in highly specific circumstances but cannot exceed the duration of the criminal sentence. CLINICAL IMPLICATIONS: Evaluation and treatment guidelines should be developed based on international evidence and standards and promulgated for use with individuals with paraphilic disorders in forensic and non-forensic poopulations. The much greater specificity and operationalization of the ICD-11 guidelines as compared with the ICD-10 guidelines provide a better basis for identification and case formulation. STRENGTHS & LIMITATIONS: Major strengths of this analyses were that it was conducted to facilitate international comparability across several participating countries and the fact that it was conducted by a diverse multidisciplinary group representing various relevant legal, forensic and and clinical sectors. A limitation was that it was only possible to examine relevant federal laws and those of Mexico City rather than those of all 32 Mexican states. CONCLUSION: The descriptions of paraphilic disorders in the ICD-11 could support substantial improvements in the treatment of individuals with paraphilic disorders and the adjudication of sex offenders in Mexico, but specific changes in Mexican law would be required. Martínez-López JNI, Robles R, Fresán A, et al. Legal and Policy Implications in Mexico of Changes in ICD-11 Paraphilic Disorders. J Sex Med 2019;16:1623-1637.

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There are a few instruments available to measure pornograhy consumption-related constructs, and this lack of instruments can compromise the validity of research findings. The Pornography Consumption Inventory (PCI) assesses four motivations for pornography consumption, and it has been validated in hypersexual men and medical students. However, whether the psychometric properties of this instrument are comparable across genders remains unclear. Multigroup confirmatory factor analysis (MGCFA) was used to verify the invariance of the structure of the PCI across male (100) and female (105) university students. The confirmatory factor analysis (CFA) for each group showed a reasonably good fit of the data to the four-factor model. The MGCFA model included only factor loadings constrained to be equal between both genders (ΔCFI < 0.01 and p > 0.05). However, the ΔCFI did not support a strong and strict factorial invariance, ΔCFI > 0.01. Although both genders seemed to agree with the conceptualization of pornography and motivations for consuming it, the PCI was not gender-invariant, as men showed a stronger degree of motivation to consume pornographic material than women did. The implications of these findings regarding the measurement of motivations for pornography use are outlined.

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Epidemiological, behavioral, and clinical data on sexual compulsivity in Brazil are very limited. This study sought to adapt and validate the Sexual Compulsivity Scale (SCS), the 22-item version of the Compulsive Sexual Behavior Inventory (CSBI-22), and the Hypersexual Disorder Screening Inventory (HDSI) for use in Brazil. A total of 153 participants underwent psychiatric assessment and completed self-reported measures. The adaptation process of the instruments from English to Portuguese followed the guidelines of the International Society for Pharmacoeconomics and Outcomes Research. The reliability and validity of the HDSI criteria were evaluated and the construct validity of all measures was examined. For the SCS and HDSI, factor analysis revealed one factor for each measure. For the CSBI-22, four factors were retained although we only calculated the scores of two factors (control and violence). All scores had good internal consistency (alpha >.75), presented high temporal stability (>.76), discriminated between patients and controls, and presented strong (ρ > .81) correlations with the Sexual Addiction Screening Test (except for the violence domain = .40) and moderate correlations with the Impulsive Sensation Seeking domain of the Zuckerman Kuhlman Personality Questionnaire (ρ between .43 and .55). The sensitivity of the HDSI was 71.93 % and the specificity was 100 %. All measures showed very good psychometric properties. The SCS, the HDSI, and the control domain of the CSBI-22 seemed to measure theoretically similar constructs, as they were highly correlated (ρ > .85). The findings support the conceptualization of hypersexuality as a cluster of problematic symptoms that are highly consistent across a variety of measures.

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PURPOSE OF REVIEW: Highlighting the relationship between sexual disorders and crime, reviewing and summarizing the articles published throughout 2011 which add to the current knowledge on this subject. RECENT FINDINGS: Studies on specific populations confirm the association between sexual disorders and crime, particularly between paraphilias and sexual crimes regarding male offenders. Female offenders are less likely to be diagnosed with a sexual disorder. Some case reports focus on unusual paraphilias and lead us to question the vast possibilities of paraphilic contents and sexual arousal patterns. The variations of paraphilic-associated sexual arousal patterns, unconventional sex behaviors or paraphilic disorders are constantly changing. In this sense, the American Psychiatric Association's DSM-5 current proposals for a sexual dysfunction diagnostic category are under intense discussion because of their important clinical and forensic consequences. SUMMARY: Sexual violence is a theme not well understood yet. Because of its nature, researching it can raise many ethical problems. There is no possibility of clinical trials and of case-control studies. Even cohort studies may be problematic in themselves. So, most of the research involves biased samples or case reports, or is merely theoretical. Further research is needed to improve our understanding of the subject, so that preventive and rehabilitative measures can be taken.

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This review attempts to assemble the characteristics of a distinct variant of sleepwalking called sexsomnia/sleepsex from the seemingly scarce literature into a coherent theoretical framework. Common features of sexsomnia include sexual arousal with autonomic activation (e.g. nocturnal erection, vaginal lubrication, nocturnal emission, dream orgasms). Somnambulistic sexual behavior and its clinical implications, the role of precipitating factors, diagnostic, treatment, and medico-legal issues are also reviewed. The characteristics of several individuals described in literature including their family/personal history of parasomnia as well as the abnormal behaviors occurring during sleep are reported.

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Com o intuito de elucidar a relação entre transtornos do controle de impulsos (TCI) e transtorno obsessivo-compulsivo (TOC), faz-se mister estudar subgrupos mais clinicamente homogêneos de transtornos impulsivos. Por meio do relato de quatro casos de pacientes com TOC e diferentes tipos de transtornos parafílicos (fetichismo transvético, sadismo, ginandromorfofilia e exibicionismo), são discutidos os conceitos de compulsividade, impulsividade e a relação temporal entre ambos. O estudo dos casos aqui descritos mostra que (1) pacientes com TOC e transtornos parafílicos tendem a desenvolver o TOC primeiro, (2) diante de desejos, fantasias ou atos sexuais parafílicos, pacientes com TOC podem lançar mão de comportamentos tipicamente compulsivos, (3) pacientes com TOC e obsessões sexuais egodistônicas podem desenvolver desejos, fantasias ou atos sexuais parafílicos de conteúdo semelhante ao das obsessões, (4) em um mesmo paciente, TOC e parafilias podem apresentar cursos independentes, e (5) pacientes com TOC e parafilias podem não apresentar obsessões sexuais. O sofrimento de pacientes com TOC e parafilias justifica a investigação continuada de tais condições no intuito de elucidar os mecanismos que subjazem esta associação e de criar estratégias que aumentem a adesão ao tratamento.

In order to elucidate the relationship between impulse control disorders and obsessive-compulsive disorder (OCD), it is essential to study more clinically homogenous subgroups of patients with impulsive disorders. Using four cases of patients with OCD and comorbid paraphilias (transvestic fetishism, sadism, gynandromorphophilia, and exhibitionism) as reference-points, we discuss the concepts of compulsivity, impulsivity, and the temporal relationship between them. The case studies here described suggest that (1) patients with OCD and comorbid paraphilias tend to develop OCD first, (2) once developing paraphilic fantasies, desires, or behaviors, patients with OCD can exhibit typical compulsive behaviors in an attempt to keep these phenomena under control, (3) patients with OCD and ego-dystonic sexual obsessions can develop paraphilic fantasies, desires, or behaviors with similar content to the first phenomenon, (4) OCD and paraphilias can follow independent courses in the same patient, and (5) patients with OCD and paraphilias may not present obsessions with sexual content. The distress presented by patients with OCD and paraphilias give good reason for the continuous investigation of this association, aiming at clarifying the neurobiological mechanisms underlying this association.

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