Sexual dysfunction and paraphilias in the DSM-5: Pathology, heterogeneity, and gender

Abstract

In the forthcoming 5 th Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5), as in previous editions, there are two overarching types of sexual problems. The first type is the ‘sexual dysfunctions’. Animating this category, we would argue, is a concern to address sexual experiences and behaviours understood as insufficiently intense in duration, magnitude or frequency. The disorders included in the category are thus predominantly those associated with a lack of arousal or pleasure, or which are physically inimical to penetration. The second type of sexual problem is labelled ‘the paraphilias’. DSM-5 distinguishes within the paraphilias as a diagnostic category between ‘paraphilias’ and ‘paraphilic disorders’: the former are understood as merely abnormal whereas the latter are pathological and require correction. Organising the category of the paraphilias, we would suggest, is a concern with forms of subjectivity with illegitimate objects of sexual attraction or pleasure. This ‘point of view’ article sets out to explore and explain, with swift brushstrokes, the gendered logic underlying the delineation of pathological desires, pleasures and acts in the proposed sexual dysfunctions and paraphilias. Our focus is on changes from previous editions of the DSM. We shall contend that the proposed sexual dysfunctions and paraphilias utilise, refract and ultimately naturalise troubling societal assumptions about gender. Kristeva (1980 [1975]: 133) has argued that ‘the notion of heterogeneity is indispensable’ as a starting point for investigations of the logic of classificatory structures, and their role in organising and occluding relations of gender power. That is to say, confronted with a taxonomic system of forms of human life, Kristeva suggests that