Requesting participants

To fulfill one of the requirements for my MA in linguistics (and to be able to proceed to the Ph.D. part of the program), I am currently doing a research project (which has absolutely nothing to do with asexuality) but I would greatly appreciate it if any of you would be kind enough to participate in it (or to get your friends to participate if you feel so motivated.)

To be eligible to participate you need to be a native speaker of English and be at least 18 years of age.

Click here to take the survey

Thanks!

I've got some big projects due at the end of the semester (including a paper about this research project.) After that, I hope to be able to spend more time blogging than I have been of late.

Randomness

Have you ever wondered why I blog under the name that I do? Have you ever asked yourself, “Who is this pretzelboy, this rolled and salted dough named blogger, this international man of asexuality?”

If you have—or even more likely, if you haven’t—I thought I would diverge from the more serious topics I’ve tackled of late and answer this question, sharing some lesser-known facts about myself and attempting to make it tangentially related to asexuality.

The highschool I attended, a private school with grades 7-12, had every year an event called “Spirit Week” wherein we would show our school spirit and participate in lots of random games, activities, etc., involving numerous competitions between classes, many of which were held at an assembly comprising the last 50 minutes or so of each school day for that week. My freshman year, we had a “Stupid Talent Contest” in which each class, having about 100 members, had to select one member to represent it and display their stupid talent.

I, being extraordinarily stupid-talented, volunteered to represent my class, a volunteering rapidly accepted as, evidently, they had already been considering asking me. Whether to view this as a compliment or an insult, I do not know, but either way, to make my stupid talent more superlatively so, I opted to combine two of my peculiar abilities into one act: my greater-than-normal flexibility and my ability to memorize stuff. So, on the day of the contest, I got up before the school and, on the gym floor, put both of my feet behind my head and recited, from memory, 95 decimal places of pi. Sadly, I had said I would recite 135, but my mind blanked and I had given a printout to the judges. Alas! I only got second place—beaten by the senior who put floss up is nose and out of his mouth!

As pi-memorization goes, it was nothing especially amazing—I had learned maybe 150 decimal places at my best. If you ask me now, I could do much less. The first 60 decimal places were memorized first and, for the cognitive psych folks out there, seem to have shifted from declarative to procedural memory. (Now, it just sort of comes out and I have little idea what I’m saying; it comes to me with such rapidity that even having to articulate it slows me down. Of all the useless things to be able to do…)

As for the name pretzelboy, I’m sure you can imagine why this nickname was given to me by my peers. A couple years later, during my junior year of highschool, I discovered that I could kick my left leg over my head and get it to latch around my neck and stay; I could then hop around for a little while like this, which proved to be a source of amusement among my peers and came to be known as “the leg thing.” As in, “Do the leg thing!” A frequent request while I was in college.

Now, many asexuals complain of the very limited range of responses people give to asexuality. They find it frustrating to get the same questions over and over and over again. With the leg thing, it was very much the same: basically, people asked one of two questions. “Does it hurt?” (No) “How did you learn that you can do that?” (Make up some crap because the actual answer was long, complicated, and not especially exciting.)

Since my senior year of college, I haven’t been able to do the leg thing except once while alone a few years back, and then only after stretching first. It seems that what happened was that I had started to get slightly less flexible, causing my leg to not quite go far enough on many of my attempts. And while being able to repeatedly kick myself in the back of the head while trying to do the leg thing may be an impressive feat in itself, it wasn’t one I wanted to show off too often. And now, if I try to put both feet behind my head, it hurts my back.

So there you have it: the origin of my blogger name Pretzelboy. It’s quite a lot more interesting than the origin of my blog name, which comes from a college algebra text book

Is asexuality a sexual orientation? Legal definitions

In my several posts, I've largely dealt with issues pertaining to the upcoming DSM-V, which sometimes dealt with asexuality and sometimes didn't. I now return you to your regular asexual programming, continuing a series on whether asexuality is a sexual orientation.

In the start of that series, I made the claim that sexual orientation has at least three separate meanings: sexual orientation as a scientific concept, as a legal concept, and as a social concept. In answering whether asexuality is/should be a sexual orientation, the answer may or may not be the same in each.

I gave a bare outline of the scientific issues here, and I now turn to sexual orientation as a legal concept. For some reason, I had decided to start with this because the issues seemed the most straightforward of the three meanings of sexual orientation I wanted to consider (which I knew to be a foodhardy assumption where the law is concerned.) After I started to write about it, I become less certain and asked a friend in law school for clarification on one point, and then other things came up and the post got delayed about a month.

Is asexuality (legally) a sexual orientation? It depends where you live. In the state of New York, yes. (See the definition of "sexual orientation" in SONDA) Elsewhere, the answer is either no or maybe. (I haven't been able to find anyone else that includes asexuality in the definition of "sexual orientation" in non-discrimination bills, but that's just with Google, which is not be the most thorough analysis of the matter.) The legislation where (the definition of) sexual orientation is most significant is hate-crimes legislation and non-discrimination legislation for employment and/or housing.

(Aside: I'm excluding same-sex marriage/marriage equality because the definition of sexual orientation is sort-of irrelevant for the laws themselves--what matters there is the sex/gender of the people wanting to get married, not their sexual orientation. I use "sex/gender" because the legal gender of transgender and intersex people depends on a number of factors, including the jurisdiction they live in. I say "sort-of irrelevant" because sexual orientation does play an important role in judicial questions--in the US at least--of whether prohibitions against same sex/gender marriage violate either federal or state constitutions, especially with respect to equal protection rights. End aside.)

In places that include sexual orientation in hate crime or non-discrimination legislation, is asexuality a sexual orientation? Because many bills define sexual orientation by giving a list, if asexuality is included in the list, it's a sexual orientation according to that law. If it's not included in the list, the matter is less certain. Because sexual orientation is typically defined by a list, if asexuality is not specifically enumerated, this may mean that, according to that law, asexuality is not a sexual orientation. Or it might mean that that law takes no stance on the issue one way or the other. And unless this question arises in an actual case before some court, there's not going to be an answer. Even then, there would only be an answer for that particular law. (As possible evidence that lack of inclusion does not necessarily mean exclusion, the Illinois Human Rights Act, for example, explicitly excludes one group not enumerated in the definition of sexual orientation.)

My friend in law school has pointed out that in addressing the issue of asexuality, an important source of evidence would be legislative deliberations concerning the law in question. If the issue of asexuality came up and they decided not to include it, then it's probably not a sexual orientation according to that law. If the matter never came up in discussion, the matter is less clear. In that case, perhaps expert testimony arguing that asexuality is a sexual orientation might be relevant.

There does seem to be some evidence that the issue of asexuality has come up. Asexuality was listed as a sexual orientation in a book arguing for sexual orientation as a human right published in the 90's (Sexual Orientation: A human right, and it was included in a New York Statute passed in 2002. It is likely that one of both of these were considered in passing non-discrimination or hatecrimes laws. Also, there is evidence suggesting that asexuality was intentionally excluded from a recently passed Ohio statue banning discrimination in employment or housing on the basis of sexual orientation. There, Sexual orientation is defined as, " actual or perceived, heterosexuality, homosexuality, or bisexuality." In a version of the bill proposed last year (that, I believe, never got voted on) sexual orientation was defined as, "heterosexuality, homosexuality, bisexuality, asexuality, or transgenderism, whether actual or perceived,"

Another question that seems like it might be relevant is that if sexual orientation is defined as "heterosexual, homosexual or bisexual" and asexuals aren't any of these, does that make asexuality a lack of sexual orientation? And if it is a lack of a sexual orientation, then this may imply recognition of it as a sexual orientation category, which may be relevant.

This raises what is perhaps the biggest question regarding whether asexuality is a sexual orientation: Is asexuality a sexual orientation or is it a lack of a sexual orientation? It's a question I've seen raised by a number of different people in a number of different contexts.

In some sense, the question of whether asexuality is legally a sexual orientation may be pointless intellectual exercise. There have been lots of people discriminated against for being LGB and there have been lots of people discriminated against for being T (who may or may not be protected by the same laws.) Even after participating in the asexual community for two years, I've never heard of a single case of an asexual being discriminated against in employment or housing for being asexual. I've never heard of any asexuals who were the victims of hate crimes for being asexual. My suspicion is that if some asexual was the victim of either a hate crime or sexual orientation based discrimination, it's a lot more likely that it would be the result of homophobia than "aphobia." (Many asexuals are suspected of being gay on the basis of their not being straight, and there are a number of asexuals who also identify within one of the LGBT categories.)

Asexuals real issues to deal with: struggling against feelings of alienation, wondering if they're "the only one," facing misunderstanding and disbelief. But outright discrimination doesn't seem to be much of an issue for us, so whether asexuality is legally regarded as a sexual orientation is probably not all that important of an issue. On the other hand, I'm inclined to think that regarding asexuality as a sexual orientation for the purposes of on-the-job ethics training wouldn't be such a bad thing in terms of increasing sensitivity towards asexual employees.

A political ploy to include "Coercive Paraphilic Disorder" in DSM-V?

In my last post, I discussed a report on the proposed diagnosis Coercive Paraphilic Disorder. Since writing that post, a fact came to mind that seems to be relevant.

Ray Blanchard, chair of the DSM-V paraphilias subworkgroup, gave two presentations earlier this year in which he discussed, among other things, a proposal for a definition for paraphilia for DSM-V. (first talk, second talk.)

The term paraphilia denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, consenting, adult human partners.

This definition has some rather substantial problems it. I could very easily provide several thousand words about problems with it, but I will spare readers. The short version is that a) the motive behind it is radically antithetical to the logic of the 1973 decision to declassify homosexuality per se from the DSM and the DSM's definition of mental disorder largely stemming from that event, and b) the definition fails on so many counts that, to use it, you have to pretend that it means what it's intended to mean and ignore what it actually says.

Of particular concern for the present purposes is the word "consenting." Evidently, sexual interest in sex with non-consenting adults is supposed to be understood as paraphilic. Now, it's not really clear what that means. One of the biggest problems with the definition is that it can’t deal with sexual fantasies. If someone sexually fantasies about someone without their consent to be fantasized about, is that a sexual interest in sexual acts with a non-consenting person? I imagine the author of the definition saying, “That’s not what I mean, and you know it!” True enough, but it may be what he said.

Probably it's not fantasies about people who haven't consented to be fantasized about, but maybe it's fantasies about people who are fantasized as being non-consenting? However, studies on what people have sexual fantasies about have consistently found that fantasies of sexual coercion are among the most common (c.f. This paper.) Is this supposed to be paraphilic despite the fact that it's far from even being atypical? (DSM-III explicitly said that this is not paraphilic.) What about someone who finds it sexually exciting to role-play non-consensual acts with a consenting partner and a safe-word? Based on Blanchard's definition, it's not clear, but the fact is that lots of people have fantasies about things that they would never actually want to do (because, for instance, they care about other people’s feelings), and most people are perfectly capable of distinguishing between fantasy and reality. What matters is that consent is taken very seriously in practice. But that’s true regardless of whether someone has the kinkiest or the most vanilla sexual interests imaginable.

So, it’s not clear what the definition actually does mean by including the word “consenting,” but I’m pretty sure that what it is intended to mean is that “Coercive Paraphilic Disorder” is supposed to be contained under that definition. Now that is interesting. This suggests that Blanchard has intended to have this diagnosis included in DSM-V for some time.

Now, a diagnosis with an almost identical name was proposed for DSM-III-R (1987): the name of the diagnosis that Quinsey (author of the report) rejects is “Coercive Paraphilic Disorder” (which, in quotes, gives about 10 results on google). DSM-III-R rejected “Paraphilic Coercive Disorder,” which yields 3,850 results.) Interestingly, the first of these is a 1991 paper by Martin Kafka titled, “Successful treatment of paraphilic coercive disorder (a rapist) with fluoxetine hydrochloride.” Kafka is currently one of the members of the paraphilia subworkgroup.

A history of this diagnosis can can be found in Inventing Diagnosis for Civil Commitment of Rapists by Thomas Zander. According to him, proposals for including Paraphilic Coercive Disorder in DSM-III-R were considered from 1983 to 1986. However, there was enormous public opposition to this, along with two other proposed diagnoses.

The American Psychological Association, the American Orthopsychiatric Association, the National Association of Social Workers, and the National Organization for Women mounted strong opposition to the proposed diagnoses. (citation) Even the U.S. Department of Justice, which rarely takes public policy positions on matters related to mental health, argued that the proposed diagnosis of PCD would be used by criminal defendants to avoid legal responsibility in criminal prosecutions for rape.

(Also, see New Psychiatric Syndromes Spur Protest, an article from the NYTimes at the time.)

In my last post, I suggested to hypotheses about the point of Quinsey's report--6 pages in inflamatory irrelavence with just about the the vilest argument publishable against including this disorder in the DSM.

(1) A number of the proposals for diagnoses in DSM-V are deeply politically controvercial, and they may be trying to divert attention away from those, by drawing it towards this argument, especially given that room for published commentary is limited.

(2) They may be wanting to add this diagnosis to DSM-V but felt they could not get enought political support for it as is. Thus, they get someone not in their workgroup to create an utterly abhorent arguement against it's inclusion, in hope that reactions against his arguments, may create reactions against his conclusion, thereby (they hope) creating support for adding this diagnosis in DSM-V.

While these remain speculation, the evidence I have considered in this post provide non-trivial support for (2). I feel that the hypothesis is plausible enough to merit serious investigation.

Edit: On further consideration, it seems that both (1) and (2) are seem very plausible. Possibly both are the true, but I definitely don't want to rule out (1).

Report for DSM-V that Really, Really Scares Me

Yesterday, the report on the proposed diagnosis of Coercive Paraphilic Disorder was published online. It was not authored by a member of the Paraphilias Subworkgroup, but by one of their advisors. Something about this is very, very troubling, which is why I’m writing about it even though this isn’t about asexuality at all. I will begin by describing the report, and I will then move into speculation about why the report even exists.

The Report

The question of whether a propensity towards rape should be classified as a mental disorder has been a controversial issue since at least the 80's. So far, the dominant opinion has been “No. This should be viewed as ‘ordinary criminality’ not as a mental disorder.” There are a number of ethical, political and legal issues involved that I’m not going to get into. Personally, I think that it shouldn’t be a mental disorder. This is the position that the author of this report argues for, but he takes that view for all the wrong reasons.

The report takes a strong sociobiological (evolutionary psychological) stance, with two main components. First, it relies on an ideology that attempts to use the (imagined) evolutionary adaptivity/maladaptivity of some behavior/trait as a large part of the justification for regarding something as a mental disorder or not, adopting J.C. Wakefiled’s definition of mental disorder, which he describes as follows:

A condition is a mental disorder if (1) it causes some harm or deprivation to the person as judged by the standard of the person’s culture (the value criterion), and (2) it results from the inability of some mental mechanism to perform its natural function. A natural function is an effect that is part of the evolutionary explanation of the existence and structure of the mental mechanism (the explanatory criterion). From a biological point of view, pathological conditions are associated with lowered Darwinian fitness.

The next component is sexual selection theory, viewing the relationship of males and females, with respect to reproduction, as one of conflict.

Male and female sexual psychologies have been designed by relative reproductive success over evolutionary time. As in all sexually reproducing species, however, the interests of males and females are sometimes antagonistic because the principal factors that limit reproductive success are different in the two sexes. The most important (but not the only) factor limiting a man’s success is the number of his sexual partners. In contrast, the principal factor limiting a woman’s reproductive success is the quality and amount of resources invested in her offspring.

Within this theoretical framework, the author applies Wakefield’s criteria to decide whether a propensity towards committing rape is a mental disorder. He first concludes it meets criterion (1), and then considers criterion (2):

It is doubtful…that rape represents a malfunction of the male sexual preference system because the victims are generally women of fertile age and the behavior increases a man’s number of sexual partners and, thus, his fitness. This is neither to deny that rape-prone men have dominance and aggressive aspects of the male courtship system (citation) turned very high nor that they may qualify for a diagnosis of antisocial personality disorder.

I suppose it shouldn’t be a surprise the report’s bibliography includes nothing from the book Evolution, Gender, and Rape, which represents some of the strongest scientific criticisms of the view that propensity towards rape evolved as an adaptive trait because it increases the number of offspring, criticisms from a number of scientists from a number of fields.

This report—and much of the sociobiological sexual selection theory underlying it—relies on the worst kind of gender research: the kind where getting a p-value less than 0.05 makes people feel entitled to generalize statistically significant differences to entire populations.

(Translation into normal English: On average, adult human males are taller than adult human females, but it would be obviously wrong to describe this by saying, “Men are tall; women are short” or by saying “Men are taller than women.” There’s a large range in heights for each group, there’s a lot of overlap, and there are a lot of exceptions to the rule. The generalization is only true on average. A lot of gender research misses this point, especially were “sexual selection” is concerned. They pretend like it is okay to say “Men are tall. Women are short.”)

This report ignores all of the substantive issues involved in deciding whether the DSM-V should include the diagnosis “Coercive Paraphilic Disorder.” Here’s his justification for ignoring these:

Because I think that coercive paraphilia disorder does not fulfill the criteria for a pathology, I have not addressed the issues of diagnostic criteria nor the practical or policy difficulties that the diagnosis may or may not entail. (Citations.)

Thoughts

When I was first reading this report, my response was “Holy fucking shit! This is the one of the most horrifying things I’ve read in years.” Horrifying not just because of the opinions expressed, but because this guy is acting in an official advisory role for the paraphilias subworkgroup. Advisors were nominated by members of each subworkgroup.

When I first started to write this post, I did so with an intention to sound the proverbial alarm—this seemed to me to be so horrible that it demanded a strong political reaction against it. It demanded a strong condemnatory response, arguing against the assumption that evolutionary fitness should be the basis for calling something a mental disorder; arguing against the (empirically unsupported) idea that a propensity towards rape is evolutionary adaptive; arguing against the modernist, individualistic nonsense underlying much of sexual selection theory, ignoring the simple fact that we are not autonomous individuals living largely in isolation: we are social beings, and as such, cooperation and altruism are advantageous traits.

But then, after I had almost finished this post (or so I thought), I was re-reading the end of the report and my train of thought took a very different direction. Something he wrote in the last paragraph stood out to me, “Should Wakefield’s conceptualization of pathology not be adopted in this context, a workable set of criteria for diagnosis could likely be developed.” He then spends about half a paragraph on how this might be done.

There is something very strange going on: Of course Wakefield’s analysis will be ignored. That isn’t the model of mental disorder that the DSM relies on. The DSM is intended to appeal to clinicians of a wide variety of theoretical persuasions, and relying on a definition of mental disorder with a sociobiological basis (or with a behaviroistic basis, or a psychoanalytic basis, etc.) would be completely antithetical to that goal.

What this means is that this article is 6 pages of incendiary irrelevance, with some data and arguments thrown in (which I’ve omitted) that seem very similar to arguments that have been put forward by the chair of the Paraphilias subworkgroup to support classifying hebephilia (attraction to pubescent children) as a subtype of an expanded version of pedophilia (pedohebephilia.)

And it’s 6 pages of incendiary irrelevance by someone who is an advisor, not a member of one of the DSM-V workgroups. Moreover, none of the members of the Paraphilias subworkgroup are even mentioned in the acknowledgements. In Zucker's introduction to these reports, there wasn’t even any mention of reports written by advisors. However, there is mention of the matter in his April 2009 progress report for the Sexual and Gender Identity Disorders Workgroup:

Each sub-work group is providing internal feedback for the literature reviews and the next step will be to obtain feedback from advisors who have been nominated to comment on specific literature/diagnostic reviews. The Paraphilias Sub-work group has also nominated advisors to provide a literature review and recommendations about potential paraphilias that do not have formal status as specific diagnostic entities in the DSM-IV-TR. Once these reviews are completed, the sub-work group will provide a recommendation about potential inclusion.

I'm not really sure how much this clarifies the issue of why they are having advisors rather than subworkgroup members writing reports, nor do I know if this is typical. (I suspect it's not.)

Because the author is not a subworkgroup member and the arguments advanced as so controversial, at first, I had wondered if he was writing this report because the views represented those of some subworkgroup members, but they didn’t want to bear the brunt of the criticism that will likely spring up in response to this. There has already been a lot of criticism over the membership of this Workgroup (especially regarding Zucker and Blanchard), and perhaps, to avoid more, they wanted to express viewpoints by proxy. They may well have intended to do argument by proxy, but I don’t think this is the reason.

I can think of two possible reasons (besides the one where it’s just some guy expressing his opinion.) In the introduction to the special issue that will contain these reports it says the following: “Commentaries that are no more than 1500 words in length will be considered for subsequent publication.” Some of these reports contain very controversial proposals. (For example, the current diagnosis of Transvestic Fetishism is recommended to have its name changed to Transvestism, basically be kept intact with one change: “With autogynophilia” is recommended to be added as a specificier. The trans-community generally wants this diagnosis deleted entirely, and there was a strong negative reaction against adding the term autogynophilia in the supporting text of DSM-IV-TR. Adding it to the diagnosis will probably cause even more negative reaction.) Likewise there is likely going to be a lot of controversy surrounding “Gender Identity Disorder” (though the reports on this have not yet come out.) I can’t help but wonder of the report on “Coercive Paraphilic Disorder” is intended to create controversy to draw attention away from other matters.

Another possibility: some members of the Paraphilias subworkgroup want to add Coercive Paraphilic Disorder to the DSM, but they don’t think that any arguments that they could make would be persuasive to enough people (as the reasons it was rejected in the 80's are just as valid today as they were then.) So instead, they get someone not on in the subworkgroup (but who is connected to it in an official capacity) to make such an utterly vile argument against adding it (while sneaking in evidence that they think could be used to support it), in hope that the strong reaction against this argument may cause a number of people to reject not only the arguments, but also the conclusion, thus (it may be hoped) gaining additional support for including Coercive Paraphilic Disorder in DSM-V.

I could be totally wrong in these speculations, but I think they’re just plausible enough to be believable. The DSM is, after all, a very political document, and the Sexual and Gender Identity Disorders chapter is possibly the biggest source of political controversy in the whole book.

Edit: In the the next post, A political ploy to include "Coercive Paraphilic Disorder" in DSM-V?, I provide evidence that I feel supports the second of my two hypotheses for the purpose of this report, though the first one is still very plausible.

Proposed changes to HSDD

In my last post, I informed readers that the report of the Sexual and Gender Identity Disorders Workgroup for DSM-V for female HSDD has been published, and I said that I would summarize it and give a little commentary.

First, there are documents that I will be discussing: the report of female HSDD and the report of Female Sexual Arousal Disorder (FSAD). Mostly, I'll talk about the first one, but the current proposal involves merging them, so I'll refer to the other one a few times as well.

Brotto, L.A. (in press) The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Women. Archives of Sexual Behavior DOI 10.1007/s10508-009-9543-1

Graham, C. A. (in press) The DSM Diagnostic Criteria for Female Sexual Arousal Disorder Archives of Sexual Behavior DOI 10.1007/s10508-009-9535-1


I would strongly encourage readers with sufficient library access to simply read at least these, especially the first (as it deals more with issues of direct concern to the asexual community.) I'll summarize the main issues that I think will be of interest to members of the asexual community.

The part of Brotto's paper where asexuality is directly addressed is the section on whether the distress criterion should be kept. There have been serious proposals to remove it, and she briefly mentions some of these--premature ejaculation and Female Orgasmic Disorder--noting that it seems illogical to say that a woman who cannot orgasm does not have this simply because she is not distressed by it. She notes, however, that according to the New View, labeling this as a disorder in the absence of distress "assumes that orgasm is a normal/natural state and that its absence denotes pathology."

Regarding low desire, she claims, the matter is less clear; to support this, she notes that "there is a small but growing body of literature on the
phenomenon of human asexuality [citations] defined as lifelong lack of
sexual attraction." People have described asexuality as a sexual identity rather than as a sexual dysfunction because of the "finding that the only distress
experienced by asexual persons is in reaction to sociocultural pressures to be sexual, and pathologizing those who do not wish to be sexual."

She continues,

The removal of distress from the criteria for HSDD may lead to the unfortunate labeling of asexuals as having a sexual dysfunction and there is strong opposition to this view among the asexual community [citation]. Although research on asexuality is still in its infancy, there is also insufficient evidence to suggest that asexuality is a sexual dysfunction of low desire. I would forward that the DSM-V consider making this point in the text or adding it to the list of exclusion diagnoses.

She also notes that in studies on the prevalence of low sexual desire and associated distress, there are more who aren't distressed about their low sexual desire than there are who are distressed about it.

Also, of interest is a suggestion that was made by, I think, by L. Tiefer, who is a DSM-V advisor*. The proposal is to replace HSDD, FSAD, and Female Orgamic Disorder with a disorder based on distress about these. (After all, it is distress that causes people see clinicians). A proposed name is "Sexual Response Distress." The idea is only discussed briefly, but Brotto states, "This intriguing idea deserves consideration." I would agree with that judgment.

Proposed changes
The report recommends that the requirement of the absence of fantasies be deleted. It recommends that the "hypoactive" part be deleted from the name, and that the diagnoses HSDD and FSAD be combined into a single diagnosis. Two names are proposed: "Sexual Interest/Arousal Disorder" and "Sexual Arousability Disorder."

I'll quote the language for the proposed diagnostic criteria:

A. Lack of sexual interest/arousal of at least 6 months duration as manifested by at least four of the following indicators:
(1) Absent/reduced interest in sexual activity
(2) Absent/reduced sexual/erotic thoughts or fantasies
(3) No initiation of sexual activity and is not receptive to a partner’s attempts to initiate
(4) Absent/reduced sexual excitement/pleasure during sexual activity (on at least 75% or more of sexual encounters)
(5) Desire is not triggered by any sexual/erotic stimulus (e.g., written, verbal, visual, etc.)
(6) Absent/reduced genital and/or nongenital physical changes during sexual activity (on at least 75% or more of sexual encounters)
B. The disturbance causes clinically significant distress or impairment

Specifiers
(1) Lifelong or acquired
(2) Generalized or situational
(3) Partner factors (partner’s sexual problems, partner’s health status)
(4) Relationship factors (e.g., poor communication, relationship discord, discrepancies in desire for sexual activity)
(5) Individual vulnerability factors (e.g., depression or anxiety, poor body image, history of abuse experience)
(6) Cultural/religious factors (e.g., inhibitions related to prohibitions against sexual activity)
(7) Medical factors (e.g., illness/medications)

Not surprisingly, this proposed diagnosis is almost identical with the diagnosis proposed in Graham's report on FSAD. The differences between them are of interest: there are only two. Graham has one proposed only one name (Sexual Interest/Arousal Disorder), and, in her proposal, criterion A requires 3 out of 5 indicators, rather than 4 out of 6, as in Brotto's proposal. (Graham's does not include Brotto's #5.) There are a number of possible reasons for these differences (e.g. disagreement among the authors, one report being finished some time after the other, wanting to propose multiple versions to stakeholders, etc.) So I will not speculate on the matter.

Thoughts and comments
My guess is that most people in the field will regard these proposed criteria as a considerable improvement over the current diagnosis. It's not clear what comments about asexuality might be made in the text of the DSM-V or how relevant clinicians and researchers would react to such a change. (I assume that no decisions on the matter have been made.)

There are some points in the proposed definition for Sexual Interest/Arousal Disorder (which I'll call SIAD) that seem to lack as much clarity as might be desirable--though these are mostly things that could be dealt with in the supporting text for DSM-V.

There is one issue whose omission seemed to stand out in the Female HSDD report. There is no justification given for including the specifiers "Lifelong or acquired" and "Generalized or situational." The specifiers themselves are nothing new. They were included (under various names) in the original proposals for HSDD/ISD in 1977; they were included in the introduction to the sexual dysfunctions in DSM-III, and they were added as subtypes in the diagnostic criteria for HSDD in DSM-IV.

Brief mention of them is made in Graham's report.

The first two of these subtypes, ‘‘lifelong’’ vs. ‘‘acquired’’ and ‘‘generalized’’ vs. ‘‘situational,’’ seem potentially useful for clinical purposes, although it is worth noting that, in epidemiological research, these distinctions have very rarely been made. The recommendation made here would be to retain these distinctions, although rather than include these as ‘‘subtypes’’ they could instead be incorporated as specifiers.

This strikes me as odd. One of the two subtyping** systems is seen as useful, so both recommended to be included. But they're degraded to the status of specifiers because of lack of empirical evidence. If there is a meaningful difference between generalized and situational low sexual desire in women, it seriously draws into question certain parts of the proposed diagnostic criteria. Namely, indicators (2) and (5):

(2) Absent/reduced sexual/erotic thoughts or fantasies
(5) Desire is not triggered by any sexual/erotic stimulus (e.g., written, verbal, visual, etc.)

Indicator (2) would only be an indicator for "generalized" SIAD, but not for "situational." In (5), it is not clear if "desire" includes solitary desire or is limited to to dyadic desire. If the "generalized" vs. "situational" distinction is meaningful for (at least some?) women, this distinction is crucial. And if it's not, why is the "generalized vs. situational" distinction being retained?

Conclusion
It remains to be seen what commentary will be published in response to this proposed diagnosis, and it remains to be seen what the proposed diagnosis for male HSDD will look like (or whatever might be proposed to replace it.) Personally, I'm a fan of deleting HSDD, FSAD, and Female Orgasmic Disorder and replacing them with Sexual Response Distress.

*In addition to members of each workgroup, the DSM-V Taskforce nominates people to serve in advisory roles. According to the April 2009 report from the Sexual and Gender Identity Disorders Workgroup, "Each sub-work group is providing internal feedback for the literature reviews and the next step will be to obtain feedback from advisors who have been nominated to comment on specific literature/diagnostic reviews." Google didn't provide me with any information on who any of these people are, but names are given in the Acknowledgments of each paper I've cited. Each lists five people, four of whom are on both lists.

**On p. 1 of DSM-IV-TR there is an explanation of the distinction between specifiers and subtypes. Essentially, subtypes should create a partition on the set but specifiers don't have to. The goal is to create more homogeneous sub-populations.

More news

The report of the Sexual and Gender Identity Workgroup for DSM-V for HSDD in women has now been published online. (Current thinking seems to be to divide sexual dysfunctions in women and sexual dysfunction in men into different categories.)

The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Women.

So far, I've only gotten to skim it so far. I'll make another post on it after I've gotten a chance to read through it in full, but I figured that readers would be interested to know about this.

Also, the articles for Female Sexual Arousal Disorder and Paraphilia NOS have been published as well.

Edit: The current proposal is to merge (female) Hypoactive Sexual Desire Disorder and Female Sexual Arousal Disorder, and to give them a new name. The main reasons are, more or less, that a) there is enormous overlap between these two diagnoses and b) many women have difficulty distinguishing sexual desire and sexual arousal, to the point that it's not even clear that they're different (if subjective sense of arousal is what is being considered.)

Before I make comments, I will need to read both articles.