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Sex Disorders According to the APA


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.

All this disorder determination has its purpose and may be well intended, but just as the APA overstepped its authority when labeling homosexuality a disorder before it had sufficient research, all of these other sexual "disorders" need a hell of a lot more research before we go stigmatizing people's natural and diverse sexual expressions.

I am not the only one who takes this position. Many sexologists and other psychological professionals have called for the removal of all paraphilias from the DSM because there simply is no concrete evidence that, for example, someone who likes sex a lot should be diagnosed as having a "disorder."

In the Journal of Psychology & Human Sexuality, Charles Moser, Ph.D., MD, and Peggy Kleinplatz, Ph.D., argued "that the present diagnostic category [paraphilias] has not fulfilled the criteria for inclusion set out in its own text; its foundations are faulty, the criteria for diagnosis are not supported, and its applications [are] subject to misuse and abuse."

The good thing is that the APA appears to be open to constructive criticism and feedback. Until April 20, just about anyone can go to the site and and offer their two cents.

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Dr. Jallen Rix