Kinky Is Not A Diagnosis

This month, the American Psychiatric Association released proposed changes to the forthcoming updated edition of the Diagnostic Statistical Manual of Mental Disorders. The standard by which mental disorders are diagnosed, the DSM has a controversial history concerning sexuality; for example, previous editions defined homosexuality as a mental disorder until gay activists successfully fought to have the designation removed.

The revised edition contains new language redefining “paraphilias,” a catch-all term for sexual arousal to objects or situations considered outside normative behavior. As detailed below, the revised language no longer considers an interest in BDSM as necessarily symptomatic of a mental disorder. If this revision is adopted in the new edition, it will have an enormous impact on the lives of people involved in alternative sexualities.

Take, for example, yours truly. When my ex wife discovered my blog and sued for custody of our children, her claims rested on the assertion that our children were in immediate danger due to my sexuality. My sexuality, as described in this blog, was the sole basis of her suit. Given the current language of the DSM, the court conceded to my ex wife’s request that I submit to a psychiatric evaluation. (For the record, it turns out I’m not crazy.) With the revised changes, my ex wife would no longer be able to harass me with claims such as these.

This is salutary news. It’s a good day to be kinky.

The National Coalition for Sexual Freedom—which was incredibly helpful in my own custody case—has issued the following statement about its role in the revisions and their potential impact:

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.

Go here to see 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 stigma against alternative sex, but that doesn't mean they are suffering distress that is generated internally.

As part of the development process, the preliminary draft revisions to the current diagnostic criteria for psychiatric diagnoses are now available for public review and comment until April. Personal comments about discrimination and persecution are welcome additions to this commentary to continue to urge the work group to differentiate between sexual minorities and sex offenders.

Just as Norway recently joined Sweden and Denmark in removing consensual paraphilias entirely, NCSF continues to urge the complete removal of these paraphilias from the DSM. However like the incremental removal of homosexuality (to egodystonic homosexuality and then finally taken out in nineteen eighty-seven) this is an important step for the BDSM-leather-fetish community.

NCSF needs your support to continue important projects like the DSM Revision Project that directly impact peoples' lives. Please join NCSF to show solidarity! We do so much for very little money, and we need your help.

Please donate to NCSF now!