694 Paraphilic Disorders
disorders, bipolar disorders, anxiety disorders, and substanc e use disorders also co-occur.
Potential differential diagnoses for frotteuristic disorder so metimes occur also as comor-
bid disorders. Therefore, it is generally necessary to evaluate  the evidence for frotteuristic
disorder and possible comorbid co nditions as separate questions. 
Sexual Masochism Disorder
Diagnostic Criteria 302.83 (F65.51)
A. Over a period of at least 6 months, recurrent and intense sexual arousal from the act
of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fan-
tasies, urges, or behaviors.
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impair-
ment in social, occupational, or other important areas of functioning.
Specify if:
With asphyxiophilia:  If the individual engages in the practice of achieving sexual
arousal related to restriction of breathing.
Specify if:
In a controlled environment:  This specifier is primarily applicable to individuals living
in institutional or other settings where opportunities to engage in masochistic sexual
behaviors are restricted.
In full remission:  There has been no distress or impairment in social, occupational,
or other areas of functioning for at last 5 years while in an uncontrolled environment.
Diagnostic Features
The diagnostic criteria for sexual masochism disorder are intended to apply to individuals
who freely admit to having such paraphilic interests. Such individuals openly acknowl-
edge intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise
made to suffer, as manifested by  fantasies, urges, or behaviors. If these individuals also re-
port psychosocial difficulties because of thei r sexual attractions or preferences for being