Contemporary Sexuality - March 2009 - (Page 6)

Creating the DSM-V continued from page 5 “The power and impact of the DSM should not be underestimated. Psychiatric diagnoses affect child custody decisions, selfesteem, whether individuals are hired or fired, receive security clearances, or have other rights and privileges curtailed.” — Peggy Kleinplatz (pictured above) and Charles Moser should be altered or removed from the DSM-V. More than 1,700 people have signed an online petition sponsored by Susan Wright, author of Slave Trade and other fantasy novels, asking that the DSM-V be based on “empirical research and devoid of cultural bias.” The implication of the petition, which is also supported by the National Coalition for Sexual Freedom, is that some uncommon sexual practices are healthy, satisfying behaviors that shouldn’t be stigmatized through a DSM listing. “The APA specifically should not promote current social norms or values as a basis for clinical judgments,” the petition argues. Moser and Kleinplatz argue that “the power and impact of the DSM should not be underestimated. Psychiatric diagnoses affect child custody decisions, self-esteem, whether individuals are hired or fired, receive security clearances, or have other rights and privileges curtailed.” The fight against including all current paraphilias in the DSM-V is an uphill battle. Jay Paul Fink, MD, who is affiliated with Temple University School of Medicine, and Robert Spitzer, MD, a professor of psychiatry at Columbia University, wrote rebuttals to the Moser-Kleinplatz article, which were published simultaneously in the Journal of Psychology & Human Sexuality. Although Spitzer acknowledges that some people with paraphilias don’t harm others and may be victims of discrimination in child custody cases, major alterations to this section of the DSM are unlikely. “First of all, it is not going to happen because it would be a public relations disaster for psychiatry,” Spitzer writes. “There was already a little disaster when the initial DSM-IV put in the ‘clinical significance’ criterion that had the effect of requiring distress or impairment before pedophilia could be diagnosed. The APA wisely corrected that in the DSM-IV-TR.” Moser and Kleinplatz’s arguments can be summarized as a belief in “social deconstructionism,” Spitzer writes. “For them, no behavior is normal or pathological since such judgments are merely social constructs.” While that might makes sense when it comes to homosexuality, Spitzer concedes, it shouldn’t be applied to all sexuality-related disorders currently listed in the DSM. “It is true that the diagnostic criteria for the paraphilias change in minor ways from time to time and the boundary with normal sexual arousal is not always clear,” Spitzer writes. “For exam- ple, somebody finds sex a little bit more fun if they fantasize a little rough stuff or maybe being humiliated. I do not know at what point it becomes pathological. But certainly it does at some point.” The DSM Process Critics of the DSM aren’t just focusing on diagnostic definitions and whether certain conditions should be included or excluded. Some detractors are taking the APA to task for its process, saying that work group members shouldn’t have been forced to sign confidentiality agreements and that minutes from work group meetings should be published online. David Kupfer, MD, a professor at the University of Pittsburgh who is leading the DSMV Task Force, says the secrecy clause is intended to keep work group members from writing about the DSM-V before its publication in 2012. Unfortunately, it’s given some people the idea that “there is some smoke-filled room where all kinds of decisions will be made and then ‘ah-ha’, here it is,” Kupfer told the Wall Street Journal’s Health Blog. “Some of us have gotten, if you will, sick enough about playing defensive ball and being taken out of context,” he added. That’s why the APA went on the offensive in January, issuing a statement that the DSM-V is “the most inclusive and transparent process in the history of the DSM.” The organization points to 13 National Institute of Health-supported international research conferences (starting in 1999), the publication of a series of monographs containing research reviews developed in these conferences, the participation of 400 scientists and clinicians from around the world and DSM5.org, a website dedicated to the new manual. Robert Spitzer, who led the DSM-III process, asked the APA to publish the minutes of DSM-V Task Force meetings. His request was denied. “Outside review of DSM-V should be ongoing and begin early in the revision process, not after all the decisions are made,” Spitzer writes in an email. “It is clear that the confidentiality agreements are limiting critical review of the DSM-V revision — and perhaps this is the true motivation for instituting this policy. Unfettered critical review by colleagues — a foundation of science — should be encouraged, not discouraged.” The APA promises a draft version of the DSM-V criteria in 2010. “A period of comment will follow the draft, and the work groups will review submitted questions, comments and concerns,” notes the APA in a press release. — Todd Melby www.aasect.org | March 2009 Vol. 43, No. 3 6 Contemporary Sexuality http://www.DSM5.org http://www.aasect.org

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Contemporary Sexuality - March 2009 Contents Member Profile AASECT Conference Registration Form and Information Quick Hits: Sex in the News Book and Media Reviews Educational Opportunities

Contemporary Sexuality - March 2009

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