Day: July 18, 2017

withasmoothroundstone:

itsdeadtome:

aphobephobe:

Ok, so I’m a little bit sick of the “asexuality is no longer medicalized” attitude a lot of people have taken recently, specifically in regards to asexuality and HSDD.

So, yeah, asexuality was officially given an exception in the DSM-V. 

That’s a huge step from before, when you could be diagnosed with HSDD simply for being asexual and having interpersonal difficulties because of it.

But, there’s still a couple problems.

 1: The patient has to self identify as asexual. Combined with visibility issues, you may get people who feel “broken” and distressed because of their asexuality, people who may be okay with identifying as ace if they knew about it. That’s one of the reasons we need to keep fighting for visibility. 

2. Here’s the kicker though. The asexuality exception is not included in the diagnostic criteria, but a different part of the text. The desk reference version, which is the smaller version most psychiatrists will use because the actual DSM is a monster of a book, only contains the diagnostic criteria. So, unless a doctor is very familiar with the update DSM, you could still be diagnosed despite identifying as asexual. Obviously, that’s a big fucking problem.

Now, wait up a second. The DSM is put out by the APA, an American organization.

So….it’s probably not used internationally. The international appx. equivalent to the DSM is the ICD (International Classification of Diseases). The current version is ICD-10, although ICD-11 appears to be poised to come out in 2018.

So, let’s explore HSDD in the ICD.

F52.0 Lack or loss of sexual desire 

Loss of sexual desire is the principal problem and is not secondary to other sexual
difficulties, such as erectile failure or dyspareunia. Lack of sexual desire does not
preclude sexual enjoyment or arousal, but makes the initiation of sexual activity
less likely.

Includes: 

   frigidity

   hypoactive sexual desire disorder.

found here.

A disorder characterized by a recurrent or persistent lack of desire for sexual activity. The lack of sexual desire is not attributable to another psychiatric disorder or to the physiological effects of substance use or a general medical condition.

found here.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR)4 and the World Health Organization’s International Classifications of Disease-10 (ICD-10)5 established that the definition of hypoactive sexual desire disorder (HSDD) should include not only the lack or absence of sexual fantasies or desire for any form of sexual activity, but also the presence of personal distress and/or interpersonal difficulties.

found here.

So, I’m noticing a very distinct lack of the “asexuality exception” (yes I’m calling it that) in here. Combined with the “interpersonal difficulties” criterion, I’m not seeing much difference between this and the DSM IV. 

Ok, so if an asexual were to get diagnosed, how do they treat it?

Some women also benefit from counseling or sex therapy. Specialists can help them cope with any past sexual trauma. They can help women improve their self-esteem and understand their relationships with their partners. Women can learn how to talk about sex with confidence and express their needs and concerns to their partners. They might also introduce ways to make intimacy a bigger priority – and more interesting.

from here.

The use of testosterone appears to have a direct role in sexual desire and has been shown to increase desire, but its long-term use is limited by potential side effects, including cardiovascular and liver dysfunction. 

Antidepressants may help depression-related low desire, although many of these medications decrease sexual desire, at least initially.

Nonetheless, estrogens replacement therapy has been shown to correlate positively with sexual activity, enjoyment and fantasies.

When no causative medical disorder is found, individual or couples therapy is often recommended.

from here.

Yeah. So, my point here is not to freak anyone out (although I know I am a little bit). My point here is that while we should celebrate our victories, this is something that’s flown a little bit under the radar that we probably need to keep talking about, finding solutions for, and then campaigning about these issues.

If you’ve got more to add to this post, I’d love to see it. However, I am going to ask that we don’t discourse on this post. I know. I’m a discourse blog asking for no discourse. Just please, for once, let’s not.

Anyways. On that cheery note, I’m done. 

Another thing to note, some non-american countries also use the DSM (Hi from Canada) but will often not update as fast as it is changed. Without outing anyone I do know of people who have been diagnosed with disorders removed from the DSM several years after the new DSM had been published, this difference often depends on the medical colleges in the country and other factors including money, and how standardized psychiatric care is in a region.

A step in the right direction? Sure

Making it safe for any individual Asexual person to say they are Asexual in front of a mental health professional? Nope not at all.

Updates to the DSM don’t always make it through the USA very fast even. Often an updated concept in the DSM or in psychiatry in general can take upwards of 20 years to really catch on large-scale.  And there are always holdouts from earlier times.  I’m autistic.  In the mid-1990s I was undiagnosed with autism and rediagnosed with “psychotic since infancy schizophrenic since adolescence” by people who were very explicit I didn’t fit modern conceptions of schizophrenia.  They blamed my mother.  All of these views were quite typical of the 1970s and I found basically a description of everything they said about me and my mom in a book I think from 1971, by Frances Tustin about autism and childhood psychosis.  Autism was considered one particular form of childhood psychosis at the time, but was thought by many to never involve losses of skills and to require a minimum (yes minimum, not maximum – these were very different times) IQ, among many other things.  Anything else was described as infantile/childhood psychosis/schizophrenia.  They used the DSM-IV officially to diagnose me (in a way that nobody should ever use to diagnose anyone – they listed each criterion and made me describe myself in a way that fit it) but clearly were working from the 1971 definitions of things.  Psychosis is impossible to diagnose in an infant, and references to infantile psychosis are nearly always a coded reference to developmental disabilities like autism.  This is because, while most people think of psychosis as a loss of contact with reality such as delusions and hallucinations, there’s also a bunch of other traits that have long been associated with it that have huge overlap with autism which is why for awhile (I don’t know if still) you were not allowed to diagnose schizophrenia in an autistic person except under specific circumstances.  Because otherwise nearly all autistic people would meet the criteria.  It’s far more complicated than this, this is just the overview.  But I hope it’s an example of how not everyone changes their views at the same rate.  In France, it’s still commonplace to view autism through a psychotherapeutic lens and view it as the mother’s fault.  People who think updates to psychiatric concepts are without controversy and occur instantly haven’t been looking too closely.