NCSF Petition to get the DSM standards on paraphilia revised

[Homburg]

This showed up on a couple of mailing lists I'm on. Reposting it here with permission, and explicit permission was granted for folks to repost it on other kink-friendly list, boards, etc.

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 include things such as exhibitionism, voyeurism, SM, and others, that are contradicted by scientific evidence (for example, it says that there are 20 male masochists for every female masochist - and no female sadists, exhibitionists, etc.!). Therefore NCSF concluded 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. Thus, NCSF is calling on the American Psychiatric Association to remove or drastically restructure the Paraphilias section in the DSM.

A white paper on the DSM Revision is located at here.

http://www.ncsfreedom.org/index.php?option=com_keyword&id=305

To help fight for this, there is a petition that has just been started. It says "We, the undersigned, support the American Psychiatric Association's (APA) own goal of making its Diagnostic and Statistical Manual (DSM) a scientific document, based on empirical research and devoid of cultural bias. A diagnosis of a mental disorder can have a severe adverse impact on employment opportunities, child custody determinations, an individual's well-being, and other areas of functioning. Therefore we urge the APA to remove all diagnoses that are not based upon peer-reviewed, empirical research, demonstrating distress or dysfunction, from the DSM. The APA specifically should not promote current social norms or values as a basis for clinical judgments."

As you see, it isn't even specifically about being kinky - just about doing what is right. go to the Petition. http://www.thepetitionsite.com/1/DSMrevisionpetition

You can sign it and have your name kept anonymous except for verifying that there are no duplicates, and your contact information will not be released regardless. After all, being kinky isn't crazy!

 

[00Syd]

Signed

 

[Toa_lin]

signed

 

[La_soumise]

I do have a question. I mean it with all due respect, I assure you. Do you understand and have you read the Diagnostic and Statistical Manual on Mental Disorders? Before I continue I want to gladly say that I am submissive and am very comfortable with it, so I am not at all projecting any disdain on the lifestyle or on people who have BDSM proclivities. Further, I think the general consensus in the psychological community is that sexuality is not set to one "vanilla" thing.

Now, to my apology for the DSM. When I first really, really considered my submissivity, I (being a student of psychology) examined the DSM in the Paraphilias section. I just wanted to make sure I was okay, you know? (Stigma and such.) I also consulted my therapist as well as a psychology professor who specializes in clinical psychology (i.e., abnormal psychology). Though I have sexual tendencies similar to most people who would claim submissivity, it is not at all a disorder. Nor are the frequent forms of Dominance.

However, the point of the DSM is to measure and see when it goes beyond mere personal taste and turn-ons and into something harmful to the individual and/or others.

To quote the DSM-IV-TR on what the consider mental disorder:

"Each of the mental disorders is conceptualized as 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" (APA xxxi).

In terms of the Paraphilias of Sadism and Masochism, this means that it would have to be something that the person could not at all escape. For instance, a Sadist could not at all gain sexual pleasure unless he or she inflicted heavy pain on another (even if it is a nonconsenting person). Anything else is irrelevant and that person can end up harming other people to the point of death if his or her desires take him or her that far. A sexual Masochist would need physical pain to receive any sexual sensation. Again, the Masochist can harm him or herself to the point of death through another (or his or her own mechanations). They are fixated on that one thing, the both. And it causes harm and significant distress to themselves and/or others.

What a therapist tries to do with paraphilias is tries to work it so that the person can receive a pleasant sexual experience in a variable way, thereby decreasing the harm to that person's self or to others. I have read a case study in which an exhibitionist had some masturbation training in which he gradually added on other things to his fantasies of merely showing himself to random people. (He was arrested for exposure and attempted rape, prior.)

Anyway, what I'm trying to say in the end is that it isn't a witch hunt at all. Psychologists, I think, are more understanding than most people when it comes to sex and what people desire. At the same time, though, they want to make sure that if there is a problem which is causing harm or disability that it is fixed.

 

[Homburg]

Anyway, what I'm trying to say in the end is that it isn't a witch hunt at all. Psychologists, I think, are more understanding than most people when it comes to sex and what people desire. At the same time, though, they want to make sure that if there is a problem which is causing harm or disability that it is fixed.

Psychologists might be. Judges are not. If you are brought before a judge in a nasty custody battle and your soon to be ex brings up your submissiveness, calling it a dangerous paraphilia, the lawyer will have the DSM to back up those allegations. Unlike the criminal court, civil courts do not presume innocence.

It hasn't been all that long since homosexuality was present as a disorder, right?

 

[Marquis]

Interesting stuff.

 

[00Syd]

Psychologists might be. Judges are not. If you are brought before a judge in a nasty custody battle and your soon to be ex brings up your submissiveness, calling it a dangerous paraphilia, the lawyer will have the DSM to back up those allegations. Unlike the criminal court, civil courts do not presume innocence.

It hasn't been all that long since homosexuality was present as a disorder, right?

Yep. I believe that was changed in the 70s.

 

[La_soumise]

But what I am getting at is that it is not at all the same thing. There must needs be severity and distress to others. And yes, a man who likes to beat his wife (under certain circumstances) could feasibly be considered a sexual Sadist under the DSM. It has nothing to do with BDSM.

But sexual submissiveness is not in the DSM under paraphilias. You should know that.

I imagine that there may well be people who misuse the criteria to judge a person who is into a little kink or who is in the lifestyle unjustly. In a court situation, that is possible. However, I would imagine there should be more of a cause to want to talk about how practitioners use the criterion rather than getting rid of them completely. I am still positively convinced that there are people who do need treatment for these things which are, again, not your typical D/s or BDSM-type situations.

And further, yes, such cases as you have mentioned might really put a black spot on the lifestyle and those who have the sexual interests that we do, but I would say that has more to do with misunderstanding on the part of the public than anything else. Most people aren't going to get a thorough education into the different types of sexuality that people practice, that are really an integral part of these people. They aren't going to be able to realize that these people can do things different in the boudoir but still be decent and wonderful people. That's a tragedy, I admit it, but that is the way things are at the moment (though it is getting much better). I don't blame the DSM for that.

 

[the_mgp]

signed

 

[Homburg]

But what I am getting at is that it is not at all the same thing. There must needs be severity and distress to others. And yes, a man who likes to beat his wife (under certain circumstances) could feasibly be considered a sexual Sadist under the DSM. It has nothing to do with BDSM.

But sexual submissiveness is not in the DSM under paraphilias. You should know that.

Using it as a blanket term to describe their participation in th elifestyle. Sorry about not being more specific. Masochism, etc.

I imagine that there may well be people who misuse the criteria to judge a person who is into a little kink or who is in the lifestyle unjustly. In a court situation, that is possible. However, I would imagine there should be more of a cause to want to talk about how practitioners use the criterion rather than getting rid of them completely. I am still positively convinced that there are people who do need treatment for these things which are, again, not your typical D/s or BDSM-type situations.

Thirty years ago, this argument could be used to defend the inclusion of homosexuality in the DSM. What is the difference? Why is it okay to remove homosexuality, but not various paraphilias? Sure, there are individuals that take of their paraphilia to excess, but could not that be included under some other appropriate diagnosis? Is frotteurism (to pick a random fetish) the problem, or the obssessive ends to which someone truly afflicted with that goes to feed his fetish? Does it need to be a seperate diagnosis, or can it be dealt with under a more generic sexual obssession? (Honest question)

The problem I have is the layman reading the entry and then looking at me. Looks at the entry, looks at me. Does the layman really need the DSM telling him that I'm somehow bad, especially when you are telling me that psychologist would (potentially) be okay with me? I'm not worried about the psychologist. I'm worried about the judge. I'm worried about Child Protective Services.

Still, the core question for me is why is homosexuality okay and not paraphilia?

 

[Toa_lin]

What we're saying LS is we agree that for those who take it too far, it is a problem and a disorder. But how its currently written in the DSM means that anyone who practices these things to any extent can be held liable. Regardless of what the intent for the paraphilia was in the DSM.

I, personally, am not asking for extreme cases to be forgiven. Instead, for the defining factors to be re-written to suggest directly, in that specific section again, that it only applies to extreme cases. Not the average SSC abiding individual.

 

[celticsunspiral]

Signed.

 

[La_soumise]

I have a feeling that I'm sounding like a horrible person without meaning to. I really just want to be rational.

The reason homosexuality was removed (besides just backlash) is, mainly, because it in and of itself does not present distress or harm to that person or to others. It's really a similar reason to why they are removing Gender Identity Disorder.

As for what a layperson would say about the DSM, I couldn't say. I think that it is dangerous reading a manual about mental disorders if you don't know what you are doing. Just in the same way it's dangerous to read a surgeon's manual and then try to cut someone up.

Further, there do have to be certain extents for these criteria. It isn't that someone who likes a spanking is going to be chucked in with someone who wants to mutilate themselves to the point of severe scarification all over their body. Again, having read that aspect (and many others) of the DSM, I can confidently say that the text in and of itself does not misconstrue that.

And frotteurism as a disorder does harm other people. The frotteur doesn't care about rubbing against someone who has consented to it, or likes it. All he or she wants to do is rub against someone randomly. Frankly, I think most people would be horrified to feel someone trying to stroke his penis all over their buttocks if they're merely trying to get to work on the subway. The key is that such a person cannot judge between when he should act out his fantasies and when he should not. It isn't that the person likes rubbing other people as a "kink." It's that that person has delusions that if he rubs random strangers, they will think it's okay and become aroused. And they don't. And they're traumatized, most of the time.

Again, I do not want to come off as an argumentative douchebag. That is not my intention. I guess I just want to show that there is another view and it is a rational one for the Paraphilias section of the DSM.

 

[Homburg]

I have a feeling that I'm sounding like a horrible person without meaning to. I really just want to be rational.

The reason homosexuality was removed (besides just backlash) is, mainly, because it in and of itself does not present distress or harm to that person or to others. It's really a similar reason to why they are removing Gender Identity Disorder.

This is different from many of the paraphilias how? That said, well, most folks I know with Gender Identity Disorder do suffer a fair amount of ditress until they figure it out. And society is pretty good at causing distress in homosexuals. The difference between this and masochism is what?

As for what a layperson would say about the DSM, I couldn't say. I think that it is dangerous reading a manual about mental disorders if you don't know what you are doing. Just in the same way it's dangerous to read a surgeon's manual and then try to cut someone up.

I agree. How would you suggest that we stop it from happening?

Further, there do have to be certain extents for these criteria. It isn't that someone who likes a spanking is going to be chucked in with someone who wants to mutilate themselves to the point of severe scarification all over their body. Again, having read that aspect (and many others) of the DSM, I can confidently say that the text in and of itself does not misconstrue that.

To the average person, including something in the DSM is pretty clear indicator that it is something wrong with the individual that has/suffers from it. The reason you listed for removing homosexuality applies to many paraphilias. Why the different treatment?

And frotteurism as a disorder does harm other people. The frotteur doesn't care about rubbing against someone who has consented to it, or likes it. All he or she wants to do is rub against someone randomly. Frankly, I think most people would be horrified to feel someone trying to stroke his penis all over their buttocks if they're merely trying to get to work on the subway. The key is that such a person cannot judge between when he should act out his fantasies and when he should not. It isn't that the person likes rubbing other people as a "kink." It's that that person has delusions that if he rubs random strangers, they will think it's okay and become aroused. And they don't. And they're traumatized, most of the time.

Picked a random paraphilia. In this case, rubbing is not the issue, nor is the kink of rubbing, it's the additional delusion that other will become aroused. Why not specify the delusion as the issue, not the rubbing?

Again, I do not want to come off as an argumentative douchebag. That is not my intention. I guess I just want to show that there is another view and it is a rational one for the Paraphilias section of the DSM.

I don't think that you're being a douchebag at all. You are presenting a differing viewpoint. My problem with it is that I don't see the reason why many of the paraphilias are included, given the reasoning for removing homosexuality, and I also don't see why they are included as is, when the issues that needs treatment are delusions, obssessions, fixation, etc and can easily be lumped into other categories - to my untrained eye. I accept that there could be a very good reason of which I am unaware. That's the point to my objections though. The reason is unclear. Why continue to include them when other, more politically hot inclusions such as homosexuality and Gender Identity Disorder have been tossed?

 

[cherokee_dove]

First off, signed; Homburg.

Secondly, La Soumise.

The reason homosexuality was removed (besides just backlash) is, mainly, because it in and of itself does not present distress or harm to that person or to others. It's really a similar reason to why they are removing Gender Identity Disorder.

The part that i bolded...put in any of the different fetishes and kinks of most of us here the BDSM forum.

First off, we know what we are doing is different than the vanilla world. But, we are consensual about it.

Replace the word homosexuality with any of our ways; whether they be sadist, masochist, cd, asphixiation play; etc...whatever. As long as they are done with consent from all involved; then it would not present distress or harm to that person or to others involved.

And thats where the DSM needs to re-evaluate and re-write their findings. Because they are being "assuming". Which is being biased against people they don't understand.

Hope that makes sense.

 

[La_soumise]

I think, in the end, that I'm going to give up on this argument altogether. What I was initially trying to do was to help make people give the whole thing another thought.

In response to what cheerokee_dove was saying, yes, it's true that it is the same with BDSM, but (as I have been trying to say all along), BDSM proclivities, be they D or s are not considered a disorder by the DSM standards.

I have a suspicion that both sides (those being the ignorant "practitioners of BDSM are creepy and horrible people" side as well as the pro-BDSM side) do not quite grasp that what is listed in the Paraphilias is something separate.

For Gender Identity Disorder and Homosexuality, the only signs of distress are those outside of the person, namely the people who do not understand. Just like if someone was openly living the lifestyle and their relatives grew furious with them and called them names. Not a disorder, but causing distress due to outside sources.

As I understand it (from hours at different times with the DSM as well as researching for my honors thesis which dealt with mental illnesses), there are two basic types of distress:

(1) Inner distress, viz., a person cannot, in some way function because of the cognitions or behavior of the disorder. An instance of this might be a (DSM) Masochist's fantasies of being dismembered which prohibit him or her from being in a sexual relationship with his or her spouse--or even any sex at all.

(2) Outward distress, viz., what occurs in relation to others regarding that person who has the disorder. Well, for a paraphilia (DSM) Sadist, the overwhelming desire to mangle or even kill a person for sexual gratification can lead him or her to commit rather heinous murders.

If neither of these are present (among other criteria which are listed), then it is not a disorder. It's the difference between the guy from "Secretary" and Jack the Ripper. It's the difference between Sally Submissive and the man who would like to be murdered and consumed.

I can see why people would see "Sadist" or "Masochist" listed under Paraphilias and get rightly upset. However, that's not the same thing. I wish people were better educated when it came to sex, I really do. Things like this and what people have done to gay men and lesbian women would not happen. That, I think, is the problem more than anything else, because it leads to such interpretations.

I promise I'm done!

 

[Homburg]

I think, in the end, that I'm going to give up on this argument altogether. What I was initially trying to do was to help make people give the whole thing another thought.

Er, why give up on it? You're doing a good job of presenting an alternative view, and no one is screaming at you. We're trying to understand, and asking what are, to my eyes, reasonable questions.

In response to what cheerokee_dove was saying, yes, it's true that it is the same with BDSM, but (as I have been trying to say all along), BDSM proclivities, be they D or s are not considered a disorder by the DSM standards.

I have a suspicion that both sides (those being the ignorant "practitioners of BDSM are creepy and horrible people" side as well as the pro-BDSM side) do not quite grasp that what is listed in the Paraphilias is something separate.

This is why we are asking these questions. Not to attack you or your point, but to understand.

For Gender Identity Disorder and Homosexuality, the only signs of distress are those outside of the person, namely the people who do not understand. Just like if someone was openly living the lifestyle and their relatives grew furious with them and called them names. Not a disorder, but causing distress due to outside sources.

As I understand it (from hours at different times with the DSM as well as researching for my honors thesis which dealt with mental illnesses), there are two basic types of distress:

(1) Inner distress, viz., a person cannot, in some way function because of the cognitions or behavior of the disorder. An instance of this might be a (DSM) Masochist's fantasies of being dismembered which prohibit him or her from being in a sexual relationship with his or her spouse--or even any sex at all.

(2) Outward distress, viz., what occurs in relation to others regarding that person who has the disorder. Well, for a paraphilia (DSM) Sadist, the overwhelming desire to mangle or even kill a person for sexual gratification can lead him or her to commit rather heinous murders.

If neither of these are present (among other criteria which are listed), then it is not a disorder. It's the difference between the guy from "Secretary" and Jack the Ripper. It's the difference between Sally Submissive and the man who would like to be murdered and consumed.

Okay, I'm confused. Gender Identity Disorder, from what (little) I know, does seem to cause distress. I know a couple of TG people (please forgive me if I use improper terminology here), and they talk about a good bit of internal distress in the form of guilt, shame, confusion, etc.

I can see why people would see "Sadist" or "Masochist" listed under Paraphilias and get rightly upset. However, that's not the same thing. I wish people were better educated when it came to sex, I really do. Things like this and what people have done to gay men and lesbian women would not happen. That, I think, is the problem more than anything else, because it leads to such interpretations.

I completely agree. There is a pretty serious difference between a clinically diagnosed sadist and myself. It's called consent. Could that difference not be raised? The core points are still the same, as I still take pleasure from the pain I cause. The difference is that I am not enough of a sociopath to do it to people that don't want it. So why then would not the distinction be made between your friendly neighbourhood consensual sadist, and the sociopath who hurts anyone he feels like hurting?

I promise I'm done!

I hope not. Like I said, this is a disucssion, not a beating.

 

[cryptictravler]

To be clear on a couple things, the inclusion of GID is multifaceted and debated. A significant part of why it remains on the DSM (and it may not) is such that people can be treated, that insurance covers it, etc. While the DSM never alludes to treatment (it describes what is a disorder rather than what can/should be done about it) the APA consensus on the treatment for GID is hormone therapy and gender reassignment, not therapyor medication aimed at convincing people to live their lives in some other manner.

The base criteria for any disorder is "clinically significant distress or impairment in social, occupational, or other important areas of functioning". The criteria for masochism, and for most paraphilias have that phrase explicitly. Sexual sadism requires "The person has acted on these urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty".

Anything you do in the privacy of your own home and consensually, that does not bother those involved, can only clinically distress the people involved. The DSM is also makes clear that other people being bothered by your behavior because it is odd or unusual is not a social impairment.

There are many reasons to to be very critical of the DSM. Firstly, it categorizes symptoms rather than causes. It would be suspect if a medical manual classified fever, rash, bloody mucus instead of HIV, fungal infection, and broken bones. Hopefully we move closer and close to the point where the eitology of mental conditions are known, to the point where this system can describe what is not working or could be working better. Secondly, the DSM IV is probably used outside of its proper scope. It was designed as a research tool. It serves the community of researchers to share a set of definitions. That it is so heavily used by treatment professionals is perhaps unfortunate. It is useful to compress data and to have continuity between research projects, it is less useful to categorize people precisely when treating them if that precision measures something outside of the scope of treatment.

 

[Homburg]

Great post, thank you.

 

[Netzach]

However the DSM is actually used by professionals with biases and agendas in ways they're not supposed to be using it as it is. If the majority of professionals didn't see my type of sadism as clinical sadism in the making, it would be different.

I've been exposed to therapists who get it and therapists who do not want to get it.

 

[Homburg]

I've been exposed to therapists who get it and therapists who do not want to get it.

Part of the therapy MIS is in now is to help her get over the damage done by her previous anti-BDSM therapist that staged a full-on intervention.

 

[vampire28]

To be clear on a couple things, the inclusion of GID is multifaceted and debated. A significant part of why it remains on the DSM (and it may not) is such that people can be treated, that insurance covers it, etc. While the DSM never alludes to treatment (it describes what is a disorder rather than what can/should be done about it) the APA consensus on the treatment for GID is hormone therapy and gender reassignment, not therapyor medication aimed at convincing people to live their lives in some other manner.

The base criteria for any disorder is "clinically significant distress or impairment in social, occupational, or other important areas of functioning". The criteria for masochism, and for most paraphilias have that phrase explicitly. Sexual sadism requires "The person has acted on these urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty".

Anything you do in the privacy of your own home and consensually, that does not bother those involved, can only clinically distress the people involved. The DSM is also makes clear that other people being bothered by your behavior because it is odd or unusual is not a social impairment.

There are many reasons to to be very critical of the DSM. Firstly, it categorizes symptoms rather than causes. It would be suspect if a medical manual classified fever, rash, bloody mucus instead of HIV, fungal infection, and broken bones. Hopefully we move closer and close to the point where the eitology of mental conditions are known, to the point where this system can describe what is not working or could be working better. Secondly, the DSM IV is probably used outside of its proper scope. It was designed as a research tool. It serves the community of researchers to share a set of definitions. That it is so heavily used by treatment professionals is perhaps unfortunate. It is useful to compress data and to have continuity between research projects, it is less useful to categorize people precisely when treating them if that precision measures something outside of the scope of treatment.

There are certainly problems with the DSM, and that is why it's periodically reviewed and revised. It categorizes symptoms rather than causes because when you are working with individuals, there may be many causes for one type of disorder (that is, set of symptoms). By looking at symptoms, the therapist can identify a specific disorder, for example Social Phobia as opposed to Generalized Anxiety Disorder or Pervasive Developmental Disorder. Then, having made a diagnosis of the client's problem, the therapist can work with the client to determine what caused the symptoms and alieviate their distress.

It is both a research tool and a treatment tool. Ideally, people who are using the DSM would be trained in how and when to use it. On the whole, it is not the thearapeutic community who is misuing the DSM, but other groups who do not have the training to use it.

 

[vampire28]

However the DSM is actually used by professionals with biases and agendas in ways they're not supposed to be using it as it is. If the majority of professionals didn't see my type of sadism as clinical sadism in the making, it would be different.

I've been exposed to therapists who get it and therapists who do not want to get it.

Part of the therapy MIS is in now is to help her get over the damage done by her previous anti-BDSM therapist that staged a full-on intervention.

There are some really crappy people in practice who force their agenda and beliefs on clients. Personally, I think they should be forced out of the field. I have spent hours with clients who've been damaged by previous therapists, and I've filed complaints against them.

I may not agree with everything my clients do, but if it works for them it's not a problem for me.

 

[Homburg]

There are some really crappy people in practice who force their agenda and beliefs on clients. Personally, I think they should be forced out of the field. I have spent hours with clients who've been damaged by previous therapists, and I've filed complaints against them.

I may not agree with everything my clients do, but if it works for them it's not a problem for me.

I would love to see some sort of complaint/action taken against her former therapist. Unfortunately, it does not make sense for her to make a complaint for various reasons.

 

[La_soumise]

I can only say that I am glad that we are having this discussion. I think everyone has said something really thoughtful and, well, in a weird way that makes me happy.

One of the main reasons why we can't always talk about causes when it comes to mental disorders is because we still know so little about the brain. Luckily, researchers are making a lot of headway when it comes to illnesses like schizophrenia and bipolar illness. I personally would hate the notion of making a very real, suffering experience that I've been dealing with for eight years now poof out of existence (according to others) just because people don't completely understand the physiology connected to it.

(I have bipolar illness myself...another reason why I am an advocate for such things, as they have helped me immensely.)