What the two manuals are for
The International Classification of Diseases (ICD) is the World Health Organization's classification for recording health conditions. The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), whose current text revision is DSM-5-TR, published in 2022. The APA describes its criteria as a tool for trained professionals, not a self-test. These systems are related but do not contain identical categories or wording. A community term such as kink or fetish has a different job: it may describe an interest or help people find language for an agreement, without declaring a clinical condition.
When you encounter a diagnosis claim, ask which manual, edition and category it comes from. The WHO ICD-11 browser displays current mortality and morbidity categories; the APA explains the DSM's diagnostic criteria and descriptive text. A research survey may ask a broader question than either manual. An individual's use of a label is broader still. None of those contexts can be silently substituted for another, and a list of codes cannot decide what is true of a person without a proper clinical assessment.
What changed from ICD-10
WHO's ICD-10 browser grouped ‘disorders of sexual preference’ under F65, including fetishism (F65.0), fetishistic transvestism (F65.1) and sadomasochism (F65.5). Those three names do not appear as stand-alone paraphilic-disorder categories in the current ICD-11 block. Removing a category is a classification change; it does not mean every concern involving an object, clothing or consensual sensation is ignored in care, nor does it transform the old label into a legal rule. The current browser should be used when quoting ICD-11 rather than reciting an ICD-10 list as if it were current.
ICD-11's block focuses its named categories on patterns involving people who have not consented or cannot consent, and has another category for a sustained pattern involving solitary behaviour or consenting individuals when additional clinical conditions are met. The 6D36 browser entry is not a new general code for consensual kink. WHO's clinical description requires marked distress about the arousal pattern that is not solely a consequence of rejection or fear of rejection by others, or a significant risk of injury or death. A clinician must assess the full requirements; a website cannot apply this category to a reader.
Which ICD-11 categories remain
The WHO browser's 2026 release lists exhibitionistic disorder (6D30), voyeuristic disorder (6D31), pedophilic disorder (6D32), coercive sexual sadism disorder (6D33), frotteuristic disorder (6D34) and other paraphilic disorder involving non-consenting individuals (6D35). It also lists paraphilic disorder involving solitary behaviour or consenting individuals (6D36), plus an unspecified category (6D3Z). These are clinical category titles, not identities or invitations to infer an offence from a term. Naming a category here does not reproduce its full diagnostic requirements.
The distinction matters because non-consent, inability to consent, marked distress and significant risk are different clinical concerns. The first group names patterns directed towards non-consenting others; 6D36 addresses the narrower conditions described above for solitary or consensual contexts. Distress arising solely from social disapproval does not, by itself, satisfy that 6D36 requirement. The clinical distinctions guide discusses why an unusual interest alone is not a diagnosis. Where someone's conduct harms another person, attend to the person's safety and the facts rather than debating what community label fits.
When ICD-11 took effect in the UK context
WHO's implementation information says ICD-11 came into effect globally on 1 January 2022, after adoption in 2019. ‘Came into effect’ does not mean every national health system switched its clinical coding on that day. WHO explicitly says countries may continue using ICD-10 while transitioning. This distinction is important when comparing a current WHO category with a code in an NHS record. Ask which classification was actually used for the record or publication instead of assuming the global date changed it automatically.
NHS England's terminology service, last edited in August 2026, still describes ICD-10 as the classification used by hospital coding specialists in England, and ICD-11 as the planned replacement. That confirms continued ICD-10 use for this England coding context as of the cited page; it is not a statement about every UK service or every clinical conversation. A clinician may discuss ICD-11 concepts while an administrative dataset still uses ICD-10. If the exact code in your own record matters, ask its author or the service responsible to explain the system, version and purpose.
The DSM distinction is related, not identical
The APA's DSM-5 explanation distinguishes a paraphilia, an atypical sexual interest, from a paraphilic disorder. It says a paraphilia by itself is not sufficient for a disorder: the additional concern involves personal distress that is not merely social disapproval, or desire or behaviour involving another person's distress, injury, death or lack of consent. This distinction was made explicitly in DSM-5. The APA's DSM-5-TR overview describes the 2022 text revision and stresses professional assessment of complete criteria.
The APA's DSM-5 sheet lists fetishistic, transvestic, sexual masochism and sexual sadism disorders among its named categories, whereas those are not the same stand-alone names in ICD-11. That difference does not mean that a consensual interest automatically meets DSM criteria. Nor should a clinician's use of a DSM term be silently converted into an ICD-11 code. The two manuals may be compared for a specific professional purpose, but readers should not use a label from one as a shortcut for the other. Check the actual edition and full assessment before making a claim about a diagnosis.
Keep community words in their context
Kink, fetish, roleplay and BDSM are everyday or community terms whose meanings vary between people. Someone can describe a fantasy, a preferred role, a relationship agreement or a social identity with one of these words. Ask what they mean rather than translating the word into a diagnostic label. The terminology guide offers examples; an agreement still needs the particular acts, limits, privacy expectations and a way to stop. A person need not use a community label to discuss an experience with a clinician either.
In a care conversation, describe what is happening, whether anyone is distressed or harmed, and what help is wanted. If a professional uses a classification term, ask which criteria and edition they mean. If a person is distressed because of stigma, that fact deserves support without assuming the interest itself is a disorder. If non-consent or substantial physical risk is involved, discuss that directly rather than appealing to a label. A community's acceptance of a term does not settle safety, and a manual's category does not settle someone's identity.
Common questions about ICD and DSM
Was sadomasochism deleted from ICD-11? It is no longer a stand-alone category under that name; the narrower ICD-11 categories have their own requirements. Does ICD-11's 2022 date mean the NHS stopped using ICD-10? No. NHS England's coding page still describes ICD-10 use in hospitals. Does DSM-5 call every paraphilia a disorder? No; the APA explicitly distinguishes the interest from the disorder.
Does a fetish label tell me a diagnosis? No. It may be an everyday self-description. Are ICD-11 and DSM-5-TR the same list? No; check each system's own current material. What if a record contains an older code? Ask the relevant service which coding system and version it used and what the entry was intended to record. A browser page cannot reconstruct an individual assessment from a code alone.
Where to seek UK help
For distress or a question about a diagnosis, start with a GP or qualified mental-health professional. COSRT describes psychosexual therapy concerns, while NHS England describes routes to mental-health services in England. Ask about qualifications, privacy and current fees before choosing support. Bring the exact record, article or category you want explained rather than relying on a paraphrase. The professional can consider your circumstances; this guide cannot diagnose you.
For an ignored boundary, threat or immediate danger, focus on safety and appropriate support through the UK help directory or emergency services. Clinical and legal questions are separate. If this site's wording misstates a manual, send the exact sentence and edition to its correction route. The classification sources linked above are specific enough for a reader to check what was removed, which categories remain and when a system took effect, without treating the code list as a verdict about consensual adults.