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DSM History and the Diagnoses for Homosexuality and Sadomasochism

or, BDSM in the DSM

You can't spell BDSM without DSM.

A History of the DSM (Video)

A history of the DSM
National Institute on the Teaching of Psychology
Jan 1, 2021
Dr. Kenneth E. Carter

This 20 minute video provides an overview of the history of the DSM that is appropriate for both introductory psychology as well as for undergraduate psychopathology courses.

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A Brief Timeline

A Brief Timeline for the DSM
Time Event
1918 The American Medico-Psychological Association (later renamed as the American Psychological Association) published the Statistical Manual for Use of Institutions for the Insane.
1928 The American Psychiatric Association issued another edition of the Statistical Manual for Use of Institutions for the Insane. It was focused on neuroses and psychoses.

The World Health Organization (WHO) issued the International Classification of Diseases-6 (ICD-6) which contained a section on mental disorders.
1952 The APA published the DSM (DSM-I.) It was based on the WHO's ICD-6 and the military system. The DSM became the first official manual and glossary of mental disorders with a focus on clinical use. The disorders included in the manual were based on theories of abnormal psychology and psychopathology. Critics challenged its reliability and validity. But it still gained acceptance.

The manual classified Homosexualiy and “sexual sadism” (along with transvestism, pedophilia, fetishism) as “sexual deviations” within the “sociopathic personality disturbance” category of personality disorders.

It classified “Sadism” as a type of sexual deviation.

1968 The ADA published the DSM-II in 1968. In it, the ADA changed the classification of homosexuality from a “sociopathic personality disturbance” to a “sexual deviation.”

The manual defines Sexual sadism as paraphilia.
According to the English version of the "Datenschlag Chronicle of Sadomasochismus (DACHS)":

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
1973 The APA board of trustees voted to declassify homosexuality as a mental disorder.

According to the English version of the "Datenschlag Chronicle of Sadomasochismus (DACHS)":

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
1974 In the seventh printing of DSM-II, the ADA removed homosexuality as a disorder and added “sexual orientation disturbance,” a new diagnostic code for individuals distressed by their homosexuality. The latter code would remain the manual (under different names) until the release of the DSM-5 in 2013.
1980 The ADA published the DSM–III. In this version, the APA changed the category of “sexual orientation disturbance” to “ego-dystonic homosexuality.”
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.
CITE: APA Dictionary of Psychology

DSM-III includes Masochistic Personality Disorder as a condition needing further study. The disorder's diagnostic criteria were:
  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.
1994 The ADA published the DSM–IV.

The APA completely removes Masochistic Personality Disorder from the DSM.

From the Leather History Timeline:

The Diagnostic and Statistical Manual of Mental Disorders, 4th 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.

2000 The APA begins work on the DSM-V.
2000 According to the English version of the "Datenschlag Chronicle of Sadomasochismus (DACHS)":

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.

CITED by DACS: Schlagworte July 22, 2000

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.

CITE: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000.
2008 Susan Wright, MA of the National Coalition for Sexual Freedom (NCSF) starts a petition calling on the American Psychiatric Association (APA) to require that all diagnoses in DSM be based on empirical research. 3,288 supporters signed the petition out of the 4,000 goal.

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.

The petition is closed, but you can still view the petition, the signatories, and comments made to it online.

SEE ALSO: DSM Revision Petition (2008)
2013 The ADA publishes the DSM-5. For the first time, the condition of experiencing "distress over one's sexual orientation" (under whatever name) does not appear.

The manual renames sexual sadism as sexual sadism disorder.

SEE ALSO: Jillian Keenan, We’re Kinky, Not Crazy: Including “paraphilic disorders” in the DSM V is redundant, unscientific, and stigmatizing. March 08, 2013.

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