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Sex Disorders According to the APA

COMMENTARY: The American Psychological Association may no longer consider homosexuality a disorder, but according to its updated guidebook, playing with toys or liking sex a lot is cause for concern.  


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Today the American Psychiatric Association released on its website the proposed changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which is the guidebook to help mental health professionals determine particular disorders in patients. Everything from delirium to eating disorders is under review, and it has taken over 10 years and more than 600 experts to get it to this point. This is the famous document that once claimed homosexuality as a disorder, and the new version still keeps a lot of sexual diversity stigmatized under the label of paraphilias.

On the one hand, there are some sexual disorders that can benefit from being in the DSM-5, like sexual interest/arousal disorder and genito-pelvic pain/penetration disorder (though I’m not quite sure if a woman's experience of pain during intercourse constitutes a psychological disorder). Having these disorders included may help patients get insurance coverage for treatment.

On the other hand, the APA feels the need to label as a “disorder” just about every kind of sexual activity besides missionary position. They want to even add “hypersexual disorder,” which seems to apply to everyone even though they state that “significant gaps in basic knowledge remain” about the topic. To determine if a person has hypersexual disorder, the evaluation questionnaire asks a patient if they are having problems with masturbation or problems having sex with consenting adults.

This is what determines if a person is hypersexual?

In fact, it seems anything society deems as sexually “abnormal” gets labeled a disorder. After all, that’s how LGBT people were labeled in the 1950s and ’60s.

The DSM-5 covers its sexual bases by labeling all fetishism a disorder. To be fair, the manual tries to make a distinction between a paraphilia (like using a dildo) and a paraphilic disorder (if the use of a dildo is the basis for distress and impairment). But isn’t that just like saying being gay is OK unless being gay causes you distress or impairs you? There seems to be no acknowledgment that social stigma of people who are different could be the source of distress and impairment.

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Reader Comments
  • Name: Stonewaller
    Date posted: 2/15/2010 6:05:35 PM
    Hometown: Washington DC

    Comment:

    I participated in protests, rallies & demos after Stonewall which have since come to be known as "3 Days of Rage." I was first trained as a scientist & then scientist. I have great deal of experience in fields of psychiatry & psychology. Aforementioned is by way of background & does not mean I am correct about anything. Gay rights activist Frank Kameny took the microphone and persuaded American Psychiatric Association to cease defining "homosexuality" as a medical disease or defect and therefore remove it from the DSM. At the time, the research was 10 to 1 supporting the idea that homosexuality was a psychiatric disorder. The truth is the APA removed homosexuality from the DSM for political not medical reasons (right result, wrong reason). It was another 20 years before the majority of psychiatrists were actually convinced that homosexuality was not a disorder. Clinical psychiatrists responded to distress of their patients not some political agenda as had been suggested.

  • Name: Mike
    Date posted: 2/15/2010 11:52:54 AM
    Hometown: Buffalo

    Comment:

    Dave, the brunt of my criticisms are not about his background, or the institute's lack of accreditation (by-the-by the ACGME has accredited Harvard's psychiatry program). That said, it was rather unnecessary for me to point out the author's background in addition to pointing out the author's factual errors and the irresponsibility of him publishing medical commentary without actually being informed about the issue under discussion.

  • Name: David
    Date posted: 2/15/2010 6:21:03 AM
    Hometown: Vancouver

    Comment:

    The comments I just submitted were intended for Mike.

  • Name: David
    Date posted: 2/15/2010 6:15:02 AM
    Hometown: Vanccouver

    Comment:

    Accreditation has some merits to a point. The Institute is indeed unaccredited but when did that ever prevent a graduate of any unaccredited institution from submitting an intelligent comment. For instance, I don`t believe that Harvard is accredited. The Institute For Advanced Study of Human Sexuaity takes students who have already built professional careers for themselves. Nearly all students come to the Institute with at least a Master's degree in their respective areas. Medical doctors, Urologists, OBGYNs, clergy, psychologists and social workers, amongst other professionals study at this Institute. I happen to have been one such professional with my Master's degree from the University of Toronto. The Wikipedia description (your URL) of the Institute was nothing like the real place. which was filled with serious academics. Feel free to blast the author`s argument but you are doing exactly what you are accusing him of doing...arguing ad hominem.

  • Name: Dave
    Date posted: 2/12/2010 11:04:12 PM
    Hometown: Boston, MA

    Comment:

    Unfortunately, this "sexpert" is lacking basic knowledge about this matter. I'll forgive the error of calling the APA the American Psychological Association rather then Psychiatric; however, questioning the authors understanding of the different fields remains. The author clearly demonstrates limited knowledge about the field of psychiatry as demonstrated by his comment about pelvic-pain associated with intercourse. There is clear evidence that this pain is a psychological disorder since there is not anatomical basis for the disease and it's most effective treatment consisting of psychoactive drugs and counseling. Lastly, I do appreciate the author's opinion on paraphilias. But again, he stops short of anything but offering a sensationalized and limited description. The discussion of hypersexual disorder illustrates this. Clearly someone who is having difficulty controlling the urge to masturbate at inappropriate times should be considered as having a disorder.

  • Name: Tom
    Date posted: 2/12/2010 9:20:12 PM
    Hometown: Skokie, IL

    Comment:

    You begin with a reference to the American Psychological Association and "its updated guidebook." This is, of course, incorrect (as indicated further into the text). The DSM is produced by a different APA: the American Psychiatric Association.

  • Name: David
    Date posted: 2/11/2010 11:58:20 PM
    Hometown: Seattle

    Comment:

    I would have to agree that the article is at least coming across as dishonest. Basically every action people perform anywhere could be taken to the extreme of a disorder, and even though the article mockingly acknowledges this, it doesn't actually address what a disorder would be. Having, say, leather be a turn on isn't automatically a disorder, it may become a disorder if the sex act relies on the presence of leather to the point that it is impacting your quality of sex/life and that of your partner. In the same way that being sad or tired isn't a disorder, but depression is, these psycho-sexual disorders are only such when they are having a continual, strong, negative impact on the person suffering. So no, including a particular "kink" is not inherently discriminatory, and it allows the issue to be studied for people who do need help.

  • Name: Greg M.
    Date posted: 2/11/2010 9:25:02 PM
    Hometown: San Diego

    Comment:

    Well I am extremely freaky weird in a good way then. That just makes everyone else SEEM normal and me the new latest pick of the bunch to otherwise relieve Jack of his regular day... he he... Everyone is screwed up in one way or the other. THAT IS THE NORM so SCREW IT. Who needs to go to school for a 1000 years of blah blah blah to come up with pretending to know what you are talking about & call yourself a scientist just to wast our tax paid government funds for anyone to come up with a report full hot air. I could waist my time by getting a white lab coat from from dropping out of Barbazon Cosmetic School the first day or hour & come up with a better statistic by just counting the one tallest finger in the middle of my hand. See.

  • Name: Mike
    Date posted: 2/11/2010 5:16:19 PM
    Hometown: Buffalo

    Comment:

    Lisa, one thousand characters isn't enough to furnish citations, but my comments all contain easily veritable facts. Here you go: What a mental disorder according to the DSM-TR-VI is: Butcher, J. et al. Abnormal Psychology 13th edition. pg. 9-10 What vaginismus is: http://bit.ly/cRYaH9 The possible inclusion of pathological bias: http://bit.ly/aAAhOi The author's credentials: http://bit.ly/bavlF8 The author's unaccredited university: http://bit.ly/cJIGMX And one for you, what an "ad hominem" is: http://bit.ly/3PSAgo Cheers!

  • Name: Caleb
    Date posted: 2/11/2010 4:50:47 PM
    Hometown: Atlanta

    Comment:

    If you're alive and breathing, you probably have a disorder. Have you ever looked at the DSM?



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