As reported by The National Coalition for Sexual Freedom, the makers of the Diagnostic and Statistical Manual of Mental Disorders, commonly known as the DSM, has released its new edition (DSM-5). In previous editions, paraphilias – a catch-all term for “unusual” sexual desires falling under the umbrella of fetishes, BDSM, or kink – were basically considered mental illnesses.
In the new edition, the Manual is making a distinction “between atypical human behavior and behavior that causes mental distress to a person or makes the person a serious threat to the psychological and physical well-being of other individuals.”
This strikes me as quite a step forward, and I’m pleased with the psychological community for finally starting to look at the wide panoply of sexual and gender expression among human beings and seeing that sometimes – perhaps even most of the time – it’s simply not a problem.
Now, in order for these types of desires to be classified as mental disorders, they have to meet several criteria. Besides having desires that are considered out of the ordinary, these desires must cause the person to:
feel personal distress about their interest, not merely distress resulting from society’s disapproval; [emphasis mine] or
have a sexual desire or behavior that involves another person’s psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent.
What this means for my own clients as well as for kinky people everywhere – especially kinky parents who, historically, have been involved in custody disputes resulting in their children being taken from them – is spectacular.
The DSM-5 also distinguishes between sexual interests and sexual disorders. The disorders currently defined under the DSM-5 are: exhibitionistic disorder, fetishistic disorder, frotteuristic disorder, pedophilic disorder, sexual masochism disorder, sexual sadism disorder, transvestic disorder, and voyeuristic disorder. However, any of these may be an interest in a healthy person, rather than a mental illness.
For example, a person may be an exhibitionist, but not have exhibitionistic disorder: a condition that causes her significant shame, guilt, anxiety, personal distress and adverse effects on her life, or causes harm to others. A person may have masochistic sexual interests: i.e., he might get sexual arousal out of being hurt. But that doesn’t mean he has sexual masochism disorder, which might mean he desires pain that causes him significant permanent injury, or that he seeks it out in ways that violate the desires and consent of others.
The one exception is pedophiliac disorder, whose clinical definition remains essentially the same as that in the DSM-4. Having such desires, even if they are not acted upon, is still considered a mental illness, as it falls under the category of “desire for sexual behaviors involving unwilling persons or persons unable to give legal consent.” They have simply changed the name from “pedophilia” to “pedophiliac disorder” in order to maintain consistency.
I have complicated opinions about this last point, but I will save it for another post. For today, I just want to express my happiness that what are simply unusual sexual desires and practices (and honestly, I think our culture is showing more and more that they’re not as unusual as we think…) have been officially de-pathologized.