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DSM Articles

The APA Paraphilias Subworkgroup Agrees: Kinky is NOT a Diagnosis In the new proposals for the DSM-V, alternative sexual behavior has been depathologized. The American Psychiatric Association's Paraphilias Subworkgroup's DSM revisions acknowledge that you can be a fetishist, transvestite, sexual sadist or sexual masochist without having a mental disorder. NCSF has worked very hard with its DSM Revision Project to make sure these changes take place, and will continue to strongly advocate for clear language of what exactly constitutes a mental disorder. Susan Wright liaisoned with the work group and supplied data that NCSF has gathered about the real-world discrimination and persecution that takes place against BDSM-fetish practitioners because of the DSM-IV-TR. The DSM Revision Petition was also extremely useful in generating comment from community members and mental health professionals urging that the current diagnoses be changed.  View the proposed changes Read the "Rationale" section under each diagnosis to see their thinking on the paraphilias. The work group makes it clear that "non-normative" sexual behavior is practiced by healthy people: "The first broad change follows from our consensus that paraphilias are not ipso facto psychiatric disorders. We are proposing that the DSM-V make a distinction between paraphilias and paraphilic disorders. A paraphilia by itself would not automatically justify or require psychiatric intervention. A paraphilic disorder is a paraphilia that causes distress or impairment to the individual or harm to others. One would ascertain a paraphilia (according to the nature of the urges, fantasies, or behaviors) but diagnose a paraphilic disorder (on the basis of distress and impairment). In this conception, having a paraphilia would be a necessary but not a sufficient condition for having a paraphilic disorder." "These revisions will affect everything-child custody, job discrimination battles, and even help change the way society views us," says Leigha Fleming, Chairperson and Director of Incident Response. "I think of all the people over the years who have had the DSM used as a tool of discrimination and punishment, and I'm proud of NCSF for continuing the fight to change it. This is the first step towards decriminalization of BDSM, which NCSF is pursuing with our Consent Counts project." The Paraphilias Subworkgroup is now reconsidering what constitutes "clinically significant distress or impairment in social, occupational, or other important areas of functioning" when determining a mental disorder. The DSM must make it clear that people do suffer distress and impairment because of the societal…
NCSF and the NCSF Foundation's position on the discriminatory paraphilias section in the DSM. Because the scientific evidence contradicts the statements currently within the DSM, we must conclude that the interpretation of the Paraphilias criteria has been politically NOT scientifically based. This politically motivated interpretation subjects BDSM practitioners, fetishists and cross-dressers to bias, discrimination and social sanctions without any scientific basis. We call on the American Psychiatric Association to remove or drastically restructure the Paraphilias section in the DSM. The American Psychiatric Association's Diagnostic and Statistic Manual (DSM) is the definitive resource on the Diagnostic Criteria for all mental disorders. It influences the International Statistical Classification of Diseases (ICD) and other entities throughout the world. The DSM-IV-TR definition of a mental disorder is that it is "…a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom… Neither deviant behavior (e.g. political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders…" (p. xxxi) Yet the Paraphilias section categorizes distress and dysfunction according to certain sexual behaviors, not psychological syndromes or patterns. Behavior itself is not evidence of psychopathology; compulsive hand washing may be a symptom of obsessive-compulsive disorder, but it is not a hand-washing disorder. A distinction must be made between the cause and the effect. There is no data to support the Paraphilias as the cause of the distress and dysfunction in individuals. In addition, discrimination and societal pressure cause significant distress for a great number of people, in which the societal stigma is the cause rather than the sexual behavior itself. There are no clear guidelines in the DSM that distinguish a Paraphilia from "healthy" sexuality. Can paraphiliacs be distinguished from those with "healthy" sexuality, except by differences in their sexual behavior? If yes, how? Can someone prefer those exact same behaviors without meeting the diagnostic criteria? Yes, according to the DSM itself (p. 568). So why not just define the abnormal preference instead of the behavior? Diagnostic criteria that pathologize everyone and do not distinguish pathology from normal variants are useless as diagnostic tools. The Differential Diagnosis of the Paraphilias states: "A Paraphilia must be distinguished from…
The DSM-5 Says Kink is OK!   The American Psychiatric Association has depathologized kinky sex – including cross-dressing, fetishes, and BDSM – in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Now the paraphilias are considered to be “unusual sexual interests,” while those who have sex with children or people who haven’t consented, or who deliberately cause harm to themselves or others, may be diagnosed with a Paraphilic Disorder.   “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.   The following are some statements about the various paraphilias in the DSM-5. Although highly clinical in language, they show the APA’s intent to not demand treatment for healthy consenting adult sexual expression:    “A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not necessarily justify or require clinical intervention.” p. 686   “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 a sexual masochism disorder.” p. 694   “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 fetish but not fetishistic disorder.” p. 701   “Clinical assessment of distress or impairment,…
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