Tag: paraphilia

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DSM – Diagnostic and Statistical Manual of Mental Disorders

About The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)

By Svein Skeid

The American Psychiatric Association, APA, considerably revised their Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994. SM and Fetishism were considered to be healthy forms of sexual expression, as long as they do not impair the daily functioning of the subject.

According to DSM-IV, SM and Fetishism only become diagnosable dysfunctions when the urges, fantasies or behaviors “cause clinically significant distress or impairment in social, occupational or other important areas of functioning.”

In addition APA said that “a paraphilia must be distinguished from the non-pathological use of sexual fantasies, behaviors or objects as a stimulus for sexual excitement.”

The DSM-IV revision, in 1994, was seen as a step forward, but is far from satisfactory. Stigma knowledge shows that many psychological, physical and social problems are not caused by the individual afflicted, but by taboos, prejudices, and discrimination imposed by the environment.

According to Charles Moser, the diagnostic criteria changed yet again in 2000 for the worse introducing version DSM-IV-TR (2000).

According to The Differential Diagnosis of the Paraphilias “A Paraphilia must be distinguished from the non-pathological use of sexual fantasies, behaviors, or objects as a stimulus for sexual excitement in individuals without a Paraphilia. Fantasies, behaviors, or objects are paraphilic only when they lead to clinically significant distress or impairment (e.g., are obligatory, result in sexual dysfunction, require participation of nonconsenting individuals, lead to legal complications, interfere in social relationships). (DSM, p. 568)

“The way this diagnosis is interpreted, any reason that you are seen by a physician or therapist (including court order, as to assess who should get custody of your children in the event of a divorce), can bring about the diagnosis even if it has nothing to do with the issue being investigated.”  Charles Moser on the ReviseF65 discussion group January 22, 2006.

In a press release November 25, 2008, NCSF, National Coalition for Sexual Freedom says about DSM-IV TR:

“We know from the hundreds of requests for help that NCSF gets every year through our Incident Response program that the Sexual Sadism, Sexual Masochism, Fetishism and Transvestic Fetishism diagnoses in the DSM reinforce the negative stereotypes and stigma against alternative sexual behaviors.”

From the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders

The DSM-IV defines mental disorders. Previous editions of the DSM listed sadism and masochism as diagnosable disorders just for having such fantasies or urges over a period of time. The new edition adds modifying criteria: with both masochism and sadism, both A & B criteria must be met in order to make a diagnosis. That is, you must have the fantasies, urges, etc., and the fact that you have them must make you effectively dysfunctional in an important area of your life.

Diagnosic criteria for 302.83 Sexual Masochism

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound or otherwise made to suffer.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Diagnostic criteria for 302.84 Sexual Sadism

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.


DSM Revision White Paper: http://ncsfreedom.org/index.php?option=com_keyword&id=305

Charles Moser and Peggy J. Kleinplatz:
DSM-IV-TR and the Paraphilias:
An Argument for Removal http://home.netcom.com/~docx2/mk.html

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Support the ICD project SM is healthy Remove SM/fetish diagnoses

Support the ICD project SM is healthy Remove SM/fetish diagnoses

SM and Fetishism are positive and healthful parts of peoples lives. To accept one’s SM orientation, preference, sexuality and love is essential for a healthy life, identity and decisive for the ability to protect oneself against sexually transmitted diseases.


SM is love – not a disease
Europride in Cologne 2002. Photo by Svein Skeid, Smia-Oslo.

Love and respect are basic parts of SM relationships. Stigmatizing minorities by diagnosing their sexual orientation is on the contrary as disrespectful as discriminating people because of their race, ethnicity or religion.

For many years homosexuality has been abolished as a disease by the World Health Organization (WHO). But did you know that leather men and SM dykes are still not reported off the sick list? SM sex is even now considered an illness by the WHO, despite the fact that US psychiatrists removed it from their DSM manual eight years ago.

In connection with Europride 2002 the ICD project asks for testimony, quoted reference and supporting evidence from psychiatrists, psychologists, sexologists and reseachers of human sexuality in order to remove Fetishism, Sadomasochism and Transvestic Fetishism as paraphilic diagnoses from ICD, The International Classification of Diseases published by the World Health Organization (WHO).

The initiative of individuals is always to be welcomed, but even more efficient would be the formation of local and national working groups which are able to approach to the professionals in question.

Women suffer the most harassment
Branding perfectly healthy sexuality is an unacceptable insult to the dignity and integrity of the people who enjoy these safe, sane and consensual practices. Stigmatizing minorities by diagnosing their sexual orientation is as disrespectful as discriminating people because of their race, ethnicity or religion.

Even though the paraphilias in question are very rarely used, the stigma of being diagnosed make harassment of sexual minorities legitimate. The U.S. Leather Leadership Conference documents that between one-third and one-half of the leather/SM population suffer discrimination, violence or persecution because of their sexual orientation and identity. As with other assaults, women suffer the most harassment, losing their job or even their children, because of their SM love, lifestyle and self-expression.

Because lesbians also experience physical attacks – approximately one out of every four SM dykes consider or actually commit suicide because of severe persecution by their fellow-sisters – the U.S. National Organization for Women, NOW in 1999 erased previous censure of sadomasochism from their “Delineation of Lesbian Rights” policy.

The United Nations High Commissioner for Human Rights in 2001 became involved in the question of such abuses, and has registered individual cases of violence against SM practitioners worldwide.

Healthy leather people
In recent years as more research has been published, also the mental health and medical communities have begun to accept that SM is a safe and legitimate pursuit.

Sadomasochism is considered to be a healthy form of sexual expression as long as it does not impair the daily functioning of the subject, according to the latest 1994 edition of American Psychiatric Association Diagnostic & Statistic Manual (DSM-IV).

Denmark, as the first European country, totally removed the diagnoses of Sadomasochism from their national version of ICD in 1995 because this non-violent and healthy activity was considered as a private matter by the Health Authority.

In the rest of Europe and the world, fetishists, SM’ers and transvestites are still considered among the mentally ill by the ICD psychiatric authorities.

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World Psychiatric Association – Symposium S08.5

World Psychiatric Association International Thematic Conference
“Diagnosis in Psychiatry: Integrating the Sciences”
Vienna, Austria June 19-22, 2003

Symposium SO8.5
Classification of Sexual Disorders
WPA Section “Psychiatry and Human Sexuality”
Friday, 20 June, 2003

I World Psychiatric Association diskuteres det ulogiske i kriteriene for tre ICD-10 diagnosene F65.0 Fetisjisme, F65.1 Fetisjistisk transvestittisme og F65.5 Sadomasochisme slik de nå er oppført, og man må forvente en betydelig endring av diagnosene ved neste revisjon av den internasjonale diagnosemanualen ICD-10, som utgis av Verdens Helseorganisasjon.

Spesialist i psykiatri, og faglig medlem av LLHs Diagnoseutvalg, Reidar Kjær, deltok 19.-22. juni 2003 på diagnosekongressen til World Psychiatric Association (WPA) i Wien i forbindelse med den forestående revisjon av diagnosemanualen ICD-10. Det er WPA som er den viktigste fagorganisasjon i revisjonsarbeidet med psykiatridelen av World Health Organization’s diagnoseliste som er offisiell liste i Norge.

Reidar Kjær deltok blant annet med foredraget:
”Do we need all the Paraphilias?” Det var plassert i symposiet Classification of Sexual Disorders (S08.5) og ble avholdt fredag 20.juni i kongressenteret i Hofburg i Wien.

Sammendrag (abstrakt) av Kjærs foredrag:

”Do we need all the Paraphilias?”
The ICD-10 diagnoses F-65.0 (fetishism), 65.1 (fetishistic transvestism) and 65.5 (sadomasochism) are no longer used in everyday Norwegian Psychiatry. But they still figure in the International and National ICD-10 manual. This paper addresses the pros et contras in the ongoing discussion about the revision of the diagnoses. A possible approach could be that national health authorities formally decided not to use these diagnoses, as was done in Denmark with 65.5 in 1995, and propose to delete them from the ICD list at the next revision. Parts of this discussion can be followed on the website www.revisef65.org

Abstraktene til denne konferansen ble trykket i et særnummer av bladet World Psychiatry som er Official Journal of The World Psychiatric Association.
WPA har mer enn 150.000 psykiatere som medlemmer fordelt på 106 medlemsland.

Dokumentasjon:
http://www.wpa2003vienna.at/home_E.htm

http://www.mednet.org.uy/spu/wp/WPA_Symposia.pdf

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English Professional work

Remove SM/fetish diagnoses (spring 2002)

Examples of statements, quotes and evidence of support

Will be forwarded to the WHO’s Department of Mental Health and Substance Abuse

The ICD diagnoses of “Sadism” and “Masochism” are certainly messy because abuse and violence is mixed into the same category as consensual sexual games.” “Any kind of sexuality may be perverted – even heterosexuality. I think it may be useful to reserve the words “perversion” and “paraphilia” for abusive, disrespectful and other harmful sexual activities.
Psychologist and sexologist Odd Reiersøl.

SM practitioners have been victimized by society as a whole and by many groups that should know better. There is no credible evidence that SM practitioners have any more problems or issues than other sexu al orientations. There is no data to suggest that SM leads to violence. All research so far, indicates that SM practitioners are indistinguishable from individuals with other sexual orientations, except by their sexual behaviour.
Charles Moser, Ph.D., M.D.

To stigmatize, diagnose and marginalize consenting SM and leatherpeople, is not going to help the victims of domestic violence. On the contrary, false reports, blackmailing and diagnosing healthy and innocent people weakens the credibility of true sexual abuse victims.
The lesbian and gay SM support group Smia-Oslo.

Sexual [SM] impulses form a strong part of each person’s day to day life, so that their suppression can effect the development or balance of the individual’s emotional life, happiness and personality.
Paras 10.46 and 10.49 in the official appointed Law Commission’s document No 139 1995 issued by the UK Home Office.

Unlike the psychiatrists and psychologists who deal primarily with psychologically troubled individuals who are also interested in D&S [Dominance and Submission], I did not find them to be psychologically troubled or socially inept; rather … their backgrounds, activities and attitudes are quite unlike the social stereotype that depicts sadomasochism as a form of violence, mischief, or mayhem perpetrated by the psychologically unstable who seek to hurt others or to be hurt themselves. … Thus, quite unlike its public image, the community is a warm, close and supportive one.
Sociologist Gini Scott in her 1983 book “Erotic Power” about the dynamics of the heterosexual SM subculture.