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The DSM got changed - 2/10/2010 5:39:36 PM   
Madame4a


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Status: offline 		Check it out...

http://www.dsm5.org/ProposedRevisions/Pages/SexualandGenderIdentityDisorders.aspx

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RE: The DSM got changed - 2/10/2010 5:43:25 PM   
RedMagic1


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Status: offline 		Thanks.

Do I understand correctly that the only significant change currently planned is to remove the "not wanting to fuck" disorder?


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RE: The DSM got changed - 2/10/2010 5:50:02 PM   
Madame4a


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From: Washington, DC area
Status: offline 		I would suggest that NCSF's website is the best source for information on this as they have worked tirelessly to get the changes made...

http://www.ncsfreedom.org/

They'll get a press release out about it soon, but you can read about it on their website... smarty pants...

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RE: The DSM got changed - 2/10/2010 7:11:44 PM   
kushiels


Posts: 55
Joined: 11/1/2009
Status: offline 		If I understand it correctly, they are changing it so that having the desire for masochism (as an example) and partaking of it, is not a disorder--it is now only considered a disorder if it impairs one's ability to function.

Very cool!


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RE: The DSM got changed - 2/10/2010 8:52:04 PM   
antipode


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quote:

Check it out...


Why? What is it? I am supposed to click on a link just because you posted it? Isn't that what we tell everybody not to do, to be safe?

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RE: The DSM got changed - 2/10/2010 9:33:02 PM   
afkarr


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Status: offline 		My understanding is that it is currently a proposed changed, not a done deal. What the NCFS was calling for is:

The American Psychiatric Association has formed working committees to revise by 2011 its Diagnostic and Statistic Manual (DSM), the definitive resource on the Diagnostic Criteria for all mental disorders. Statements currently within the DSM Paraphilias criteria are contradicted by scientific evidence, therefore NCSF 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.


However, I already thought that the DSM-IV did not consider paraphilia to be a disorder unles it "cuased clinically significant distress or impairment in social, occupational, or other significant areas of life."

So are they prosing that the entire catagory be removed in all circumstances?

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RE: The DSM got changed - 2/10/2010 9:59:10 PM   
spokanesub85


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Status: offline 		kushiels, I'm looking at the DSM-IV-TR right now and it's diagnostic criteria for both sadism and masochism is that the behavior causes significant distress or impairment.

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RE: The DSM got changed - 2/10/2010 9:59:55 PM   
lovingpet


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quote:

ORIGINAL: afkarr

My understanding is that it is currently a proposed changed, not a done deal. What the NCFS was calling for is:

The American Psychiatric Association has formed working committees to revise by 2011 its Diagnostic and Statistic Manual (DSM), the definitive resource on the Diagnostic Criteria for all mental disorders. Statements currently within the DSM Paraphilias criteria are contradicted by scientific evidence, therefore NCSF 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.


However, I already thought that the DSM-IV did not consider paraphilia to be a disorder unles it "cuased clinically significant distress or impairment in social, occupational, or other significant areas of life."

So are they prosing that the entire catagory be removed in all circumstances?


The bolded portion is the issue.  As it stands, placement of paraphilias in the dsm at all automatically subject practictioners to negative sanctions from society.  It is not the practice of the paraphilias that is at issue, but it appears that way to people who do not take the time to think and evaluate for themselves.  You have to ask why this "significant impairment" is occurring.  Basically, if I understand what was written, the dsm will not really be changing a darn thing that actually needed changing.  Their token response is supposed to be an appeasement.  What a waste of a good opportunity to show that psychiatry isn't actually about enforcing social and cultural norms, but about doing what's best for the individuals seeking therapy!  Sadly, however, I am not surprised.  Some practitioners have managed to grow beyond such foolishness, but the profession as a whole is still quite backwards.

lovingpet


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RE: The DSM got changed - 2/10/2010 10:01:31 PM   
lovingpet


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quote:

ORIGINAL: spokanesub85

kushiels, I'm looking at the DSM-IV-TR right now and it's diagnostic criteria for both sadism and masochism is that the behavior causes significant distress or impairment.


Again, but why is it causing this distress or impairment?  Is it the activity itself or the social and cultural stigma that has been attached to it?  It really does matter.

lovingpet

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RE: The DSM got changed - 2/10/2010 10:10:51 PM   
spokanesub85


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Status: offline 		I'm no psychiatrist or psychologist, lovingpet, the highest psych class I've taken is abnormal psych, but I personally take the DSM's text regarding an activity causing impairment as meaning the behavior itself, i.e. if I can't make it to work because my girlfriend has me tied to the bed.  I mean, homosexuality has been out of the DSM for decades, and I think if I were homosexual it would cause more impairment due to social stigma in my life vs. me being a heterosexual masochist.

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RE: The DSM got changed - 2/10/2010 10:21:27 PM   
lovingpet


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Status: offline 		If  the "impairment" was about the activity itself, then I would agree with the dsm phrasing, but it is intentionally unclear.  I don't think clarification would be a bad thing in this case.  It is possible that they need not be removed so long as what the actual clinical issue is that leads to diagnosis is more aptly defined.  Right now, it could mean absolutely anything.  It is so vague as to be useless and even subject to abusive use.  It is a problem throughout the dsm.  Sexual disorders are not the only victims.  I would like to see the profession be a lot more demanding of themselves.  DEFINE these disorders clearly instead of leaving wiggle room through intentional deceptive, opaque, confusing, and suggestive terminology.  Psychology is constantly whining it isn't treated like a true hard science.  This is why.

lovingpet

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RE: The DSM got changed - 2/10/2010 10:25:35 PM   
spokanesub85


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Status: offline 		You're right.  Psychology has a lot of subjectivity.  I don't think it'll ever be treated like a hard science by most people.  They should be clear in the DSM if what they mean is that masochism is causing impairment because I neglect important areas of my life in order to fulfill a masochistic urge, which is what I believe is intended.  If everything that caused social stigma were in the DSM, the thing would be much bigger than it already is.

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RE: The DSM got changed - 2/11/2010 3:40:24 AM   
DesFIP


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Status: offline 		I'm not sure if the unclearness is intentional. However I'm curious as to the sexual sadism proposal stating it isn't a problem unless you've tried to do this on two separate people without consent. Does that mean you get a free ride on the first person you hurt without consent?

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RE: The DSM got changed - 2/11/2010 8:18:13 AM   
onlyfreelycaged


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quote:

ORIGINAL: DesFIP

I'm not sure if the unclearness is intentional. However I'm curious as to the sexual sadism proposal stating it isn't a problem unless you've tried to do this on two separate people without consent. Does that mean you get a free ride on the first person you hurt without consent?
quote:





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I think that it means that the first person doesn't make it a mental illness.. the first one could just have been a fist fight, or something..

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RE: The DSM got changed - 2/11/2010 11:18:06 AM   
lovingpet


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quote:

ORIGINAL: DesFIP

I'm not sure if the unclearness is intentional. However I'm curious as to the sexual sadism proposal stating it isn't a problem unless you've tried to do this on two separate people without consent. Does that mean you get a free ride on the first person you hurt without consent?


Every professor I had in my education stated unequivocably that the lack of clarity was intentional so as to be inclusive supposed for "insurance and liability" purposes.  The professional can't get paid without slapping a label on something.  The problem is that this admitted practice along with the social and moral stigma of mental illness makes even the listing of fetishes and paraphilias an easy target for those who want to demonize them.

I don't know what's up with the second offense proposition on sexual sadism.  Further, are we now going to have to have legal hearings to determine if someone is mentally ill under this definition?  Consent is always hard to pin down because all anyone is going to have are the stories of those involved.  Basically this would mean no practitioner could treat sexual sadism as a diagnosed mental illness until they have been found criminally liable, thus removing the question of whether consent was given or not.  If they plan to do otherwise, then the wording is useless because the patient would have to admit the other party was nonconsenting AND risk being reported to law enforcement (no one ever said all therapists play by the rules after all).  What that wording actually does is elevate the possibility that a sexual sadist will face criminal charges and increase conviction rates in order to secure their "treatment".  This is clearly only conjecture, but as I think about it, the insurance companies as well as government programs could refuse to pay for the treatment of a sexual sadist without a criminal conviction because it is logical that only a court of law can determine consent issues.  This little nugget  of psychiatric genius is worthless.

lovingpet

<<edited for significant typo

< Message edited by lovingpet -- 2/11/2010 11:19:11 AM >

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RE: The DSM got changed - 2/11/2010 8:56:51 PM   
kushiels


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Status: offline 		lovingpet--thanks for clarifying where the actual change was! a bit disappointing, really.

At least for masochism, it does seem to specify that the activity must cause stress not just in the bedroom to be considered a disorder:

quote:

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

lovingpet, I think you make a good point that the STIGMA could be causing the problem in this case, not the person's masochistic desires/behaviors. 



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RE: The DSM got changed - 2/11/2010 10:25:00 PM   
lovingpet


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quote:

ORIGINAL: kushiels

lovingpet--thanks for clarifying where the actual change was! a bit disappointing, really.

At least for masochism, it does seem to specify that the activity must cause stress not just in the bedroom to be considered a disorder:

quote:

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

lovingpet, I think you make a good point that the STIGMA could be causing the problem in this case, not the person's masochistic desires/behaviors. 




And I would propose that it is a double edged sword too.  Not only does it set up biases from society leading to job and status loss, but also creates undue stress within the person because they know how they will be judged and what the consequences could be.  That is an awful burden to bear and has absolutely NOTHING to do with having sadistic/masochistic drives.

lovingpet

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RE: The DSM got changed - 2/11/2010 10:31:29 PM   
kitastrophe33


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Status: offline 		Even though I can see some of the reasons it's in there (it's a cluster of loosely related behaviors that can cause distress/impairment. The dsm is organized around tons of clusters of human behavior. Sexual behavior can cause a ton of difficulty for people)...they may as well remove this category from the DSM anyway, because no one uses that diagnosis. I can't remember them even mentioning the diagnoses during my nurse practitioner training, other than to say that it will probably get taken out.

(The below refers to pretty much all of the paraphilias except pedophilia. That diagnosis captures the behavior better than any other one and therefore should stay.)

The rest are basically useless diagnoses. The people (like most of us) who are into this and not experiencing distress or impairment because of our interests, don't go seek treatment. The folks that do have difficulty...and there are some people who do, usually are given other diagnoses. Adjustment disorder is a good one. The person is experiencing psychological stress due to an event or situation in their life. The fetish isn't the problem, per se. Their reaction to it might be. The folks who develop shoe or for or whatever fetishes that they're more into the object than their partner and it's causing trouble can go in that diagnosis too. In the case of those clients, we're sensitive to the fact that psych diagnoses may follow them. The don't need a sex related dsm disorder on their medical record when I can use language that better protects their privacy AND better describes the problem, like adjustment disorder secondary to relationship stress or intrapersonal conflict or whatever.

The other clients we would possibly see might be referred to us through the legal system for behaviors that would technically be consistent with the sadism diagnosis, but we wouldn't give that diagnosis, because it would be incomplete. I'd bet my left kidney that someone that would not once, but twice, try to force this sort of thing on a nonconsenting person will also meet criteria for antisocial personality disorder and that does a better job describing the clinical picture.

I'm not sure how many non-clinicians read the DSM, and in my education the whole "must cause distress or impairment to be a disorder" principle was really driven home. On our end, I think that we know that masochism etc is not, on it's own, a mental illness. Most don't know too much more about them than that though. I wish they would do more to educate healthcare and mental health providers about paraphilias because we may have somewhat different psychological and physical health nuances. Maybe if I someday go insane and decide to go back for my Ph.D I'll do the research and put something together.



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RE: The DSM got changed - 2/12/2010 4:04:22 AM   
elleX


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Status: offline 		 Hi everyone ,
i just want to stress out that the masochist and sadism are paraphilies when they impair our ability to function in our life and when they cause distress to the people involved !
please keep that in mind ,,,!
wishes you a good week end
elleX

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RE: The DSM got changed - 2/12/2010 4:53:30 AM   
DesFIP


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quote:

ORIGINAL: onlyfreelycaged


quote:

ORIGINAL: DesFIP

I'm not sure if the unclearness is intentional. However I'm curious as to the sexual sadism proposal stating it isn't a problem unless you've tried to do this on two separate people without consent. Does that mean you get a free ride on the first person you hurt without consent?
quote:





Jump to:



I think that it means that the first person doesn't make it a mental illness.. the first one could just have been a fist fight, or something..


A fist fight I view as two guys in a bar losing their cool, not as something that gives him a hard on. Nonconsensual sexual sadism means you do it to someone deliberately without them agreeing in order to get aroused. And that's a lot different then a Colts fan and a Saints fan having a fight.

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