Dietz diagnosed Dahmer with substance use disorder, paraphilia, and schizotypal personality disorder. This meant namely a distinction between "paraphilia" and "paraphilic disorder". Sexual sadism was the term employed in the DSM-III, classifying the condition as a paraphilia. Rolling was diagnosed with antisocial personality disorder, borderline personality disorder and paraphilia. Piquerism is a paraphilia as well as a form of sadism. The implication of perversion or paraphilia was derived from there. It may be related to self-harm or a paraphilia involving sexual arousal. An "optional" paraphilia is an alternative route to sexual arousal. Sexologist John Money popularized the term "paraphilia" as a non-pejorative designation for unusual sexual interests. Among some fetishists, the cuckquean's humiliation or victimization is a major element of the paraphilia. Telephone scatologia is usually classed as a paraphilia from a psychiatric viewpoint. Sexologically, the pathological end of the attraction tends to be classified as a paraphilia. In the 1960s, German physicians used antiandrogens as a treatment for sexual paraphilia. Enjoyment of enemas is known as klismaphilia, which medically is classified as a paraphilia. Card has also said paraphilia and homosexuality are linked.