The American Psychiatric Association depathologized kinky sex – including cross-dressing, fetishes, and BDSM – in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013. The DSM was updated in 2022 – DSM-5-TR. The following are some statements about the various paraphilias in the DSM-5-TR. Although highly clinical in language, they show the APA’s intent to not demand treatment for healthy consenting adult sexual expression:
The DSM-5-TR defines paraphilia as: “any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners.” (DSM-5-TR, p. 779)
A paraphilic disorder is a “paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others.” (DSM-5-TR, p. 780)
“A paraphilia is a necessary but not sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not necessarily justify or require clinical intervention.” (DSM-5-TR, p. 780)
Sexual Masochism –
“Such individuals openly acknowledge intense sexual arousal from the act of being
humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies,
urges, or behaviors…. In contrast, if they declare no distress, exemplified by anxiety,
obsessions, guilt, or shame, about these paraphilic impulses, and are not hampered
by them in pursuing other personal goals, they could be ascertained as having
masochistic sexual interest but should not be diagnosed with sexual masochism
disorder.” (DSM-5, p. 694)Sexual Sadism –
The term bondage-domination-sadism-masochism (BDSM) is broadly used to refer
to a wide range of behaviors that individuals with sexual masochism and/or
sexual sadism (as well as other individuals with similar sexual interests) engage in,
such as restraints or restriction, discipline, spanking, slapping, sensory deprivation
(e.g. using blindfolds), and dominance-submission roleplay involving
themes such as master/enslaved person, owner/pet, or kidnapper/victim.”
(DSM-5-TR, p. 791)Fetishism –
“Many individuals who self-identify as fetishist practitioners do not necessarily report
clinical impairment in association with their fetish-associated behaviors. Such
individuals could be considered as having a fetishistic sexual interest (i.e., a recurrent
and intense sexual arousal from either the use of nonliving objects or a highly specific
focus on a nongenital body part, as manifested by fantasies, urges or behaviors), but
not a fetishistic disorder.” (DSM-5-TR, p. 797)Transvestism –
“The diagnosis of transvestic disorder does not apply to all individuals who dress as
the opposite sex, even those who do so habitually.” (DSM-5-TR, p. 799)
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“The APA has made it clear that being kinky is not a mental disorder,” says Susan Wright, Spokesperson for NCSF. “That means people no longer have to fear being diagnosed as mentally ill just because they belong to a BDSM group. We’ve already seen the impact – NCSF immediately saw a sharp rise in the success rate of child custody cases for kinky parents after the proposed DSM-5 criteria was released three years ago.”
NCSF would like to thank everyone who participated in signing our DSM Revision Petition and for telling the APA about their own stories of discrimination and persecution. NCSF also thanks every member of the APA Paraphilias Subworkgroup for responding to our concerns, and drawing a hard line between consensual adult kinky sex and those who willfully engage in nonconsensual or harmful activities. NCSF is proud to build on the work of kink-aware professionals who have come before us, including Race Bannon and Guy Baldwin, who helped make seminal changes in the DSM-IV in 1994.
BDSM Versus the DSM – The Atlantic recounts how NCSF, Race Bannon, Guy Baldwin, Charles Moser and Peggy Kleinplatz helped convince the APA to acknowledge that BDSM is a healthy form of sexual expression!
Normal or Not? A Sexual Attraction to Objects – The DSM-5 marks a transition by attaching the term “disorder” when an unusual sexual interest crosses the boundaries. So, hypothetically, someone who simply uses shoes to masturbate or whose partner accepts his unusual interest in shoes could be diagnosed with fetishism, but not a fetishistic disorder — unless the fetish crosses the threshold in one of the ways described above.
Whips, chains and full of life: BDSM practitioners ‘healthier and less neurotic’ than ‘vanilla’ peers – Along the same lines, Wismeijer also suggested that accepting one’s unusual sexual preferences and choosing to live in a societal niche like the BDSM community might involve huge amounts of psychological work, which could translate into positive mental health.