Listed under the Sexual and Gender Identity Disorders category in the Diagnostic and Statistical Manual of Mental Disorders (DSM), paraphilia is an umbrella term for sexually deviant behaviour that warrants psychiatric diagnoses by mental health professionals.
The fact that social factors like culture and environment primarily determine the human perception of paraphilias raises a new question: do new additions to the DSM really warrant psychiatric diagnoses? It can be unclear what counts as a sexual “disorder.” For example, some psychiatric diagnoses are based on a poor understanding of sexuality itself, such as the inclusion of homosexuality in the Diagnostic and Statistical Manual of Mental Disorders, until the American Psychiatric Association withdrew it from the second edition in 1973.
KIM KWAN/THE VARSITY
Of greater interest is the particular criterion that a patient must be experiencing “distress or impairment in important areas of functioning.” This mainly refers to work, school, and social relationships at the time of the diagnoses. This is essentially a catch-all criterion that eliminates bias in what should be considered normative sexual behaviour and what should be diagnosed as a disorder. While it is absolutely necessary to eliminate this problem, consider the following: if a man dresses as a woman over a period of six months and experiences both intense sexual arousal and distress or impairment, he may be considered to have Transvestic Disorder. However, it may be a matter of the environment the individual is submerged in that blurs the line between the individual’s self-expression and disorder symptoms. In an environment where crossdressing is accepted, such as in an LGBT-friendly community, a crossdressing individual may feel free to act on their desire and not experience distress. However, in an environment hostile to cross-dressing, the individual would almost certainly experience distress, which could lead to impairment in functioning. The source of the distress may be convoluted in this scenario and may mistakenly be linked back to the alleged paraphilia by a psychiatrist. The fulfillment of the “significant distress or impairment in important areas of functioning” as currently listed in the DSM may be mistaken based on external factors. And once a diagnosis is made, what is left to be treated: the sexual arousal or the distress?
Even if distress is due to the individual’s own ruminations, how can its root be separated and identified by observing a display of sexual behaviour? People experience distress over many different patterns of behaviour outside of a sexual context. Many students are attracted to wasting time when essays are due and are both distressed and impaired by their habits. Should a diagnosis for “Procrastination Disorder” be adopted if this pattern of behaviour caused distress or impairment? Why does it seem strange to attribute the act of procrastinating as the sole source of distress? While therapy may be beneficial in mitigating negative feelings that come from the behaviour, the rationale for including sexual attractions involving consenting adult partners as possible psychiatric disorders is weak.
