New clinical guidelines: what has changed, and is there cause for panic?

In September 2026, Russia began applying new clinical guidelines entitled “Disorders of Sexual Preference”. Reports followed claiming that fetishism and sadomasochism had supposedly been recognised as mental disorders for the first time, and that people who practise BDSM could now be sent to psychiatric hospitals.

The reality is more complicated. The guidelines have indeed been adopted, but some coverage considerably exaggerates how new they are and what their consequences may be.

What has actually changed?

The document was developed by the Russian Society of Psychiatrists and approved by the Ministry of Health’s Scientific and Practical Council. It is an operative document, not a draft: it has been applied since 16 September 2026. Its next review is due no later than 2028. Guidelines in the Ministry of Health’s registry (in Russian).

Fetishism and sadomasochism were not first classified as disorders in 2026. These categories existed in ICD-10 long before the new guidelines and appeared in Russian medical guidance as early as 1999.

What is new is primarily the clinical document itself, which describes the diagnosis, treatment and follow-up of patients with these disorders in detail.

Does any BDSM practice now count as a disorder?

No. The guidelines explicitly state that mild sadomasochistic elements may be present in normal sexual activity.

At the same time, the diagnostic criteria for sadomasochism are broader: this activity must be the main source of sexual arousal or a necessary condition for satisfaction.

The general criterion also refers to persistent, intense, unusual urges or fantasies that are acted upon or cause significant distress. Distress is therefore not a required condition in every case. Diagnostic criteria (in Russian).

This is one of the document’s main problems. Partners’ consent is not, in itself, stated to be an unconditional reason to rule out a diagnosis, and some of the wording is broad. This leaves room for some consensual sexual practices to be treated as pathological.

However, it does not follow that everyone who practises BDSM will automatically be diagnosed.

Can treatment be imposed without consent?

A sexual preference alone does not create that right. Ordinary outpatient treatment requires informed voluntary consent. Neither a diagnosis nor ongoing psychiatric monitoring automatically authorises medication against a person’s will.

Treatment without consent requires separate grounds relating to involuntary hospitalisation or compulsory medical measures under criminal law.

The new guidelines themselves explicitly state that an isolated disorder of sexual preference is not grounds for admission to a round-the-clock psychiatric inpatient facility. Indications for hospitalisation (in Russian).

The claim that “BDSM enthusiasts will now be sent to psychiatric hospitals” therefore does not reflect the document’s contents.

When is involuntary intervention possible?

It is important to distinguish sexual preference from grounds for psychiatric intervention. The law allows involuntary assessment and hospitalisation, but additional circumstances are required: for example, a severe mental disorder that creates an immediate danger, leaves a person unable to meet basic needs, or would cause substantial harm to their health without care. Law on psychiatric care, Articles 23–25 and 29 (in Russian).

An unusual sexual preference, or even a psychiatric diagnosis, is not enough on its own.

A statement by a relative, former partner or neighbour is also not, by itself, grounds for an involuntary assessment.

What risks does the document actually pose?

The central concern is not only the possibility of treatment without consent, but also the risk of overly broad diagnosis and stigma.

The new guidelines give doctors a common framework for examining a person, making a diagnosis, choosing treatment and assessing its results. Some diagnostic wording is broad enough to raise questions about where the boundary between sexual preference and pathology lies.

The document provides for psychotherapy and, where indicated, medication. It mentions drugs that suppress the action or production of testosterone. Antiandrogens and gonadotropin-releasing hormone (GnRH) analogues require the patient’s informed voluntary consent.

Many medication recommendations carry a recommendation grade of C and an evidence level of 4–5. Official approval of the document therefore does not mean that every individual treatment recommendation has strong scientific evidence behind it. Section on medication (in Russian).

Has the rest of the world already moved to ICD-11?

No. ICD-10 continues to be used in various countries, including Germany. Moreover, ICD-11 coming into effect at WHO level did not mean that all countries switched at once. According to WHO data for May 2024, only 14 countries and territories had begun collecting or reporting data using ICD-11 coding. Others were at different stages of preparation. WHO data on the transition to ICD-11.

It is therefore inaccurate to say that “Russia has stayed with ICD-10 while the entire rest of the world has moved to ICD-11”.

What can you do if you are offered treatment?

An unusual sexual interest does not in itself oblige you to see a psychiatrist or to “correct” yourself. The law prohibits a diagnosis based solely on a departure from society’s moral values, and prohibits using treatment as punishment or in other people’s interests. Article 10 of the law on psychiatric care (in Russian).

If a doctor proposes treatment, you can ask them to explain:

• which specific symptoms they consider to constitute a disorder;
• what outcome the treatment is intended to achieve;
• what risks it carries;
• what alternatives are available.

In an ordinary voluntary treatment setting, you have the right to refuse treatment.

If there is a real threat of coercion, it is important to find out the legal and medical grounds for the intervention, ask for them in writing, contact a lawyer and someone you trust, and avoid signing a voluntary consent form that does not reflect your actual agreement.

Can psychiatry be used as a means of pressure?

Another concern is the possible use of psychiatry to exert pressure, for example during detention. Abuses of psychiatric hospitalisation involving detainees and activists have been documented. However, there are no reliable data on how often people are hospitalised specifically for consensual BDSM practices or fetishes.

Known cases of politically motivated hospitalisation therefore cannot automatically be generalised to everyone with these preferences.

Information about a person’s sex life may nevertheless provide an additional pretext for pressure if officials already intend to exert it. This is a possible mechanism of abuse, not an established consequence of the new clinical guidelines.

What should we take away from this?

The new guidelines are already in use, but sensational coverage exaggerates their novelty and immediate consequences.

They do not mean that:

• fetishism and BDSM have become psychiatric diagnoses for the first time;
• anyone who practises BDSM is automatically a psychiatric patient;
• consensual sexual practices automatically justify treatment without consent;
• a person can automatically be hospitalised solely on the basis of such a diagnosis.

At the same time, it would be wrong to state categorically that “nothing has changed”.

The main problem is the broad diagnostic wording, which may leave room for some consensual sexual practices to be treated as pathological and for further stigma.

It is too early to assess how much the new document will change the everyday practice of Russian psychiatrists: it only began to be applied on 16 September 2026.