DSM-VI Draft

"Kneecap Fetish" (Proposed Condition)

Diagnostic Criteria:

A. Persistent and intense sexual arousal stemming from a specific focus on the kneecap, as characterized by:

  1. Recurrent and intrusive thoughts or fantasies involving the kneecap, specifically its edges, ridges, and movements.

  2. Arousal patterns that are distinctly centered on the physical attributes of the kneecap rather than the broader knee area or other body parts.

  3. The use of the kneecap in sexual activities, either in fantasy or practice, becomes central to sexual experiences.

B. The individual may experience:

  1. Significant distress or impairment in social, occupational, or other areas of functioning due to their kneecap-focused arousal patterns.

  2. Persistent difficulty in achieving sexual satisfaction without direct or indirect involvement of the kneecap.

C. The fetishistic interest in kneecaps must not be better explained by another mental disorder, substance use, or a broader fetishistic disorder.

Specifiers:

  • Exclusive type: Sexual arousal occurs solely with kneecaps.

  • Non-exclusive type: Kneecaps are one of several focuses of sexual arousal but are distinctly preferred.

Differential Diagnosis:

  • Other forms of paraphilia or body part fetishes (e.g., podophilia for feet), do not specifically involve the kneecap.

  • Obsessive-compulsive disorder (OCD), where the focus on the kneecap is part of a broader obsession, not a source of sexual arousal.

Background:

The proposal for the inclusion of "Kneecap Fetish" emerged from ongoing debates in the psychological community regarding the specificity of fetishistic arousal patterns. Proponents argue that the kneecap, with its unique physical structure and subtle movements, presents a distinct source of sexual arousal for some individuals, distinct from broader knee-related interests. Despite advocacy efforts, including public campaigns and intense lobbying by individuals like Chris W the DSM-VI committee has debated whether such a specific fetish warrants its own category, or whether it should be included under a broader "knee fetish" classification. As of the latest discussions, a consensus has not been reached.

Discussion:

The debate highlights challenges in the classification of paraphilias within the DSM framework, particularly when considering the fine line between benign sexual preferences and those that cause significant distress or impairment. The proposal reflects ongoing efforts to refine diagnostic criteria that accurately reflect the experiences of individuals while avoiding unnecessary pathologization.

Note:

This entry is a draft proposal and has not been officially included in the DSM-VI. Further research, clinical evidence, and expert consensus are needed before any final determination is made.