Monday, June 14, 2010

Asexuality, HSDD. amd DSM-5: More news

Recently, I've been blogging a fair amount about the DSM-5 and the work of the Paraphilias Subworkgroup, but I haven't spent much time on the Sexual Dysfunctions Subworkgroup--the group whose work originally got me interested in the DSM process.

The main reason for this is that there has simply been less news on that front. Well, now there is some news to report on. Previously, all but one of the reports of the Sexual Dysfunctions Subworkgroup had been published online--the ones for diagnoses for women in Archives of Sexual Behavior and the ones for men in the Journal of Sexual Medicine. The one that hadn't been published was the report on HSDD in men, which has now been published in the Journal of Sexual Medicine, along with commentary from a number of authors. The report on HSDD in men was written by Lori Brotto, who also wrote the report on HSDD in women.

Of particular interest to the asexual community is a section in Brotto's report titled "Is Loss of Sexual Desire in Men Equivalent to Asexuality?"
There has been increasing media and academic interest in asexuality, defined as the lifelong lack of sexual attraction [68,69]. Such individuals will describe limited, if any, sexual encounters, an inability to relate to others who pursue sexual activity, and little to no sexual desire [69–72]. The latter finding has raised concern that, perhaps, asexuality represents the polar low end of the
sexual desire continuum, and therefore, individuals identifying as asexual might better fit within the category of HSDD. There has been strong opposition to this suggestion from the asexuality community on the Asexuality Visibility and Education Network (AVEN; ttp://www.asexuality.org)—the largest online community of asexuals which is involved in education and advocacy efforts. In fact, an AVEN DSM Task Force prepared a 75-page document which included interviews on seven academics with expertise in human sexuality, which concluded that the DSM-5 should explicitly exclude asexual individuals from receiving a diagnosis of HSDD. Part of the rationale stems from the finding that asexuals are not distressed by their lack of sexual interest [72], unlike individuals with HSDD who are usually motivated to seek treatment to restore their low libido. Moreover, the AVEN community views asexuality as an identity, and feel that it is better placed within the different sexual orientations, and not as a sexual dysfunction [70]. Although data are extremely limited on the characteristics of asexual individuals, the available data do support this view of asexuality as not being a sexual dysfunction, and argue that a thorough assessment of the man presenting with low/no desire should be assessed to rule out asexuality.

I'm not entirely sure what "assessed to rule out asexuality" would mean. In practice, it could mean that people could be referred to the asexual community and asked whether they thing identifying as asexual would make more sense for them than being diagnosed with HSDD. The alternative would be that there is some kind of "real asexuality" and the clinician should try to identify whether the individual meets that. This latter possibility troubles me--and is my biggest reason for being wary of an exception clause for asexuals. (Everyone other than me in the "AVEN DSM Taskforce" other than me supported an exception clause for asexual. I withheld judgment on the matter, and I continue to withhold judgment on the matter.)

After I get a chance to digest these documents better, I'll be writing more about them.

6 comments:

Ily said...

The latter finding has raised concern that, perhaps, asexuality represents the polar low end of the
sexual desire continuum, and therefore, individuals identifying as asexual might better fit within the category of HSDD.


Is that a contradiction, or is it just me? The "polar low end" sounds like normal (albeit uncommon) variation, not a disorder.

Also...why just men?

ACH said...

As for why it's just men, that question is easy. They're planning on making a separate set of diagnoses for men and for women. The report on HSDD in women was published a while ago. (I wrote about it last September.) The report on HSDD in men was published last week.

As for your other question, the best I can come up with is "It depends." For instance, if intelligence is normally distributed, people are still going to label as disordered the extreme low end of that. It depends on whether or not you assume the extremes (or one of the extremes) to be disordered.

Hezaa said...

If HSDD is split into separate diagnoses for cis men and cis women, how would a trans person be diagnosed if suffering from a sudden drop in sex drive? Would a trans woman on female hormones who has a diagnosis of GID get a diagnosis of "Man HSDD" or "Woman HSDD"?

ACH said...

@Hezza,
I have absolutely no idea, and have wondered the same thing myself. From what I know about the people on the committee, I'm sure it is a question that they have considered, but they have given no indication of an answer to it. My guess would be that the clinician would just give them whichever one of the in men/in women diagnoses seems more appropriate or at least less inappropriate.

SlightlyMetaphysical said...

"In practice, it could mean that people could be referred to the asexual community and asked whether they thing identifying as asexual would make more sense for them than being diagnosed with HSDD"

Ohh, yes please. That'd be perfect.

And I agree with Ily, that 'might better fit' reads almost like a justification for diagnosing asexuals with HSDD. However, maybe Brotto's just mentioning some other people's concerns. The logic would seem carelessly off otherwise- there is a disorder called HSDD -> asexuals often fit the criteria of HSDD, except for distress -> they must have HSDD, rather than -> we should consider whether they should be defined as having HSDD, and change the definition of HSDD to fit.

Naru said...

I think the main thing about diagnosing a client with HSDD is whether it causes them marked distress and their lack of libido is effecting their functioning in life. If not, then they are asexual and do not have a disorder.