DSM History and the Diagnoses for Homosexuality and Sadomasochism

In the USA, the APA publishes the second edition of its diagnostic manual (DSM-II). It is even stronger aligned to psychoanalysis as the DSM-I. Homosexuality is now even officially listed as mental illness. Masochism and sadism are listed as „sexual deviations“. And for the first time, the DSM-II is combined with the 8. edition of the „International Classification of Diseases“ (ICD-8).

By connecting sexual deviations with a compendium of illnesses from the 19. century, this concept once again backs up several outdated ideas about human sexual behavior.

• American Psychiatric Association (Ed.): „Diagnostic and Statistical Manual of Mental Disorders. Second Edition (DSM-II)“. American Psychiatric Association, Washington, D.C. 1968
• Shorter, Edward: „A History of Psychiatry“. John Wiley, New York 1997, p. 299
• Noyes, John K.: „The Mastery of Submission“. Cornell University Press, Ithaca et al. 1997, p. 19

The APA work group for the creation of the new diagnostic manual (DSM-III) decides – under the pressure of gay lobbyists – to delete homosexuality from the list of mental illnesses. In a referendum, the APA members support the controversial decision. From here on, homosexuals are in principle no longer considered to be ill.

This step leads to protests, esp. among psychoanalysts.

• Baldwin, Guy: „Ties That Bind“. Daedalus, San Francisco 1993
• Shorter, Edward: „A History of Psychiatry“. John Wiley, New York 1997, p. 304
• Noyes, John K.: „The Mastery of Submission“. Cornell University Press, Ithaca et al. 1997, p. 19

ego-dystonic homosexuality

the condition of being distressed about an inability to be aroused by the opposite sex. There is a sustained pattern of same-sex arousal that the person explicitly states is unwanted and persistently distressing. The condition is frequently accompanied by feelings of loneliness, shame, anxiety, and depression.

1. A pervasive pattern of self-defeating behavior, beginning by early adulthood and present in a variety of contexts. The person may often avoid or undermine pleasurable experiences, be drawn to situations or relationships in which they will suffer, and prevent others from helping them, as indicated by at least five of the following:
   1. Chooses people and situations that lead to disappointment, failure, or mistreatment even when better options are clearly available
   2. Rejects or renders ineffective the attempts of others to help them
   3. Following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that produces pain (e.g., an accident)
   4. Incites angry or rejecting responses from others and then feels hurt, defeated, or humiliated (e.g., makes fun of spouse in public, provokes an angry retort then feels devastated)
   5. Rejects opportunities for pleasure, or is reluctant to acknowledge enjoying themselves (despite having adequate social skills and the capacity for pleasure)
   6. Fails to accomplish tasks crucial to their personal objectives despite having demonstrated the ability to do so (e.g., helps fellow students write papers, but is unable to write their own)
   7. Is uninterested in or rejects people who consistently treat them well
   8. Engages in excessive self-sacrifice that is unsolicited by the intended recipients of the sacrifice
2. The behaviors in A do not occur exclusively in response to, or in anticipation of, being physically, sexually, or psychologically abused.
3. The behaviors in A do not occur only when the person is depressed.

The Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition is issued with considerably revised definitions of Masochism and Sadism, which in essence say that it they are not illnesses unless you are bothered by your interest in them and they interfere with your normal functioning in other aspects of your life.

In the DSM-IV-TR, a revised reversion of the diagnostic handbook DSM-IV, the American Psychiatric Association alters the diagnostic criteria for „Sexual Sadism“.

In the revised version of the handbook such a diagnosis is now only allowed if the impulse or fantasies cause distress. Consensual acts are excluded as diagnostic criteria.

Diagnostic criteria for 302.84 Sexual Sadism
These criteria are obsolete.
DSM Criteria (Paragraphs)
DSM Version: DSM IV - TR
DSM Criteria
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 the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.
B. The person has acted on these urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

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.