The DSM Needs to be Based on Research
I’ve been following the developments surrounding the upcoming changes to The Diagnostic and Statistical Manual of Mental Disorders (DSM). If you’re not familiar with it, the DSM is a document produced by the American Psychiatric Association and it effectively serves as the dictionary of mental health. If a doctor, therapist, psychiatrist or other mental health professional wants to submit paperwork for insurance reimbursement, they need to include a diagnosis code from the DSM. In fact, that was the original intent when the DSM was first created. However, it has evolved to the point where inclusion in the DSM is pretty defines what mental health means.
That would be fine if everything included in the DSM was based on actual research. And for many of the diagnoses, there is plenty of clinical evidence to support the definitions. But when it comes to the sexuality diagnoses, the criteria are often based on prejudices and misconceptions rather than facts. There’s generally some grain of truth to some of them, but they’re still rooted in sex-negative definitions of pleasure that don’t take sexual diversity into account.
In all fairness, the DSM includes some version of “[t]he problem causes clinically significant distress or impairment” in the diagnostic criteria because there’s a general recognition that if everyone is happy with their sexual desires and practices, there’s no problem. But it’s all too easy for a therapist to decide that the problem in a relationship rests with the person who wants to try BDSM, cross-dress, or what have you. Since most therapists get less than 10 hours of sexuality training, plenty of them fail to distinguish between problematic sexuality, sexuality that a partner has a problem with, and sexual practices that the therapist has problems with.
One of the best ways to ensure consistent, fair, and compassionate care would be for the diagnostic criteria to be based on research instead of sex-negativity and erotophobia. So I think it’s really great that the Society for the Scientific Study of Sexuality sent the letter below to Ken Zucker and the rest of the folks working on the changes to the sexuality section of the DSM. We need more of this in the world:
March 18, 2010
DSM-V Sex and Gender Disorders Workgroup
Dear Dr. Zucker:
We, the Board of Directors of The Society for the Scientific Study of Sexuality, support the American Psychiatric Association’s (APA) own goal of making its Diagnostic and Statistical Manual (DSM) a scientific document, based on empirical research and devoid of cultural bias. A diagnosis of a mental disorder, especially in the Sexual and Gender Identity Disorders section, can have a severe adverse impact on employment opportunities, child custody determinations, an individual’s well-being, and other areas of functioning.
Therefore we urge the APA to remove all diagnoses of sexual pathology that are not based upon peer-reviewed, empirical research, demonstrating distress or dysfunction, from the DSM. The APA specifically should not promote current social norms or values as a basis for clinical judgments, such as the pathologization of some erotic minorities who are not doing harm to themselves or others, but who may feel ego-dystonic due to societal stigma placed onto them by a naive or unkind culture.
On behalf of the Board of Directors, thank you for your time and consideration,
Herbert P. Samuels, Ph.D.