Wednesday, May 26, 2010

Changes to the proposed criteria for the paraphilias

From March 10 until April 20, it was possible for people to make comments on the DSM-5 website regarding their proposed diagnostic criteria. In the article APA: Comments Lead to Changes in DSM-5 Draft we learn that over 8000 comments were made.

Based on this feedback, no changes have been made for the sexual dysfunctions (in fact, things regarding the sexual dysfunctions and DSM-5 have been pretty quiet) but a few have been made regarding the paraphilias. These are listed on the page Recent Updates to Proposed Revisions for DSM-5 on the website.
(5/17/2010) Sexual and Gender Identity Disorders Work has made the following updates:

For all Paraphilia Disorders, two specifiers were added: in remission and in controlled environment; for Pedohebophilic Disorder, wording of Criterion B(3) was revised to read “use of pornography depicting prepubescent or pubescent children…” and criterion C now includes reference to Criterion B; Transvestic Disorder now includes the specifier With Autoandrophilia (Sexually Aroused by Thought or Image of Self as Male); In the criteria for Transvestic Disorder, the qualification that the patient must be male was removed from Criterion A. This change made the criteria consistent with other paraphilias, for example, the criteria for Pedohebephilic Disorder, Pedophilic Subtype, which do not formally exclude females from potential diagnosis even though this condition is extremely rare in females.; Hypersexual Disorder now includes wording changes to Criteria A(1) and C, and now includes Criterion D (at least 18 years old).

Regarding "Transvestic Disorder", I get a distinct sense of mockery. Critics of this diagnosis in the trans community have pointed out how its clearly (hetero)sexist nature can be seen in that (in previous DSMs) it explicitely restricted the diagnosis to heterosexual males.

In Ray Blanchard's literature review of this diagnosis, he suggested retaining this. However, in the version posted on in Feb., the requirement of being heterosexual was removed. Now they are suggesting the requirement of being male be removed. Of course, this just makes the diagnosis even broader--something that critics of the diagnosis are not likely to be pleased with. Yet it does mean that they may have to give up certain lines of criticism.

Also, I have a suspicion that "paraphilia in remission" means that someone need not actually meet criteria A and B to receive one of these diagnoses--that is, I suspect that this specifier will encourage people to ignore the actual diagnostic criteria.


SlightlyMetaphysical said...

My favourite is the bit they snook in at the end: You can only have hypersexual disorder if you're over 18. Otherwise, what, your destructive and addictive sexual urges are normal? Because that's how all teenagers are?

ACH said...

I take it as claiming not that all teenagers are, but that "hypersexuality" is supposedly so common among them that it's "normal." So, evidently, it's normal for them, but not people over 18?

SlightlyMetaphysical said...

I know, weird. I thought the point of hyperactive sexuality is when it's a major problem in your life. So when it's a major problem in your life, and you're a teenager, it's not a problem? How many teenagers have they met, because I'm sure most of them don't have destructive sexualities, and the ones that do should sort of be treated the same as adults.

This is completely distracting, but I just thought it was too odd to ignore.