The document, titled "Disorders of Sexual Preference," appeared on a Health Ministry portal and was prepared by the Russian Society of Psychiatrists, according to Kommersant, which spotted the publication. No approved guidance for diagnosing and treating such conditions had previously existed in Russia.
The list of disorders is based on the ICD-10, which remains in force in Russia. It includes fetishism, fetishistic transvestism, exhibitionism, voyeurism, pedophilia, sadomasochism and "multiple and unspecified forms." Russia has not officially switched to the ICD-11, in which some of these diagnoses were revised, The Insider reported. The newer version removed fetishism as a separate disorder and narrowed sadomasochism to "coercive sexual sadism disorder," under which a diagnosis applies only to coercion without a partner's consent.
Physicians are to assess a patient's condition against several criteria: how far "abnormal" urges dominate sexual life, whether they are acted on, whether the partner consented, whether the person experiences subjective distress and whether there is a risk of harm. The duration and intensity of the urges or fantasies are also taken into account. An atypical sexual interest alone is not enough for a diagnosis, the document states.
The authors note separately that "unusual" sexual behavior may be a symptom of schizophrenia, an organic personality disorder or intoxication, in which case further diagnostics are required. A clinical interview with a physician remains the main method of diagnosis. If its data are insufficient, a psychological examination of the psychosexual sphere is ordered, and psychometric tests may be used when pedophilia is suspected. The guidelines mention the polygraph but note that it is not widely used in Russia because of the absence of transparent protocols.
Treatment is divided into levels by severity. For a mild form, psychotherapy alone may suffice; for a moderate form, antidepressants — selective serotonin reuptake inhibitors (SSRIs) — are added. For a pronounced form, antiandrogens are also prescribed, and for a severe form accompanied by aggressive-sadistic fantasies or impulsive actions, drugs that suppress testosterone production. Patients with contact forms of paraphilic behavior may be prescribed cyproterone or medroxyprogesterone, and in severe cases triptorelin or leuprorelin. Cognitive behavioral therapy is recommended for all patients, and drug treatment must always be accompanied by psychotherapy.
The authors note that disorders of sexual preference are often not formally included in the list of indications for these hormonal drugs. The decision to prescribe them is made by a medical commission, and treatment is possible only with the patient's voluntary informed consent. The document defines the goal of therapy as reducing "abnormal" attraction and forming "normative models" of behavior, which the authors say should lower the risk of sexual crimes.
Roman Suleimanov, an associate professor at the psychiatry department of RUDN University, drew attention to the authors' warning that a patient who seeks help voluntarily may come under "heightened police attention" once placed on a dispensary register. The psychiatrist said this could discourage people from seeking help voluntarily.
In June 2023, the Russian Society of Psychiatrists already put a draft with the same title up for professional discussion, but without a year of approval on the title page. At the time, the text remained a draft for specialists to debate. In May, Olga Bukhanovskaya, chief physician of the Feniks treatment and rehabilitation research center, told the XVIII Congress of Psychiatrists of Russia that homosexuality and transgender identity are mental illnesses. In the ICD-11, which took effect in 2022, transsexualism was removed from the list of mental disorders.