Month: July 2017
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.
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.
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.
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.
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.
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.
this girl that sits with me was complaining..about another girl. because she likes the same band as her “but doesn’t dress like it” so obviously she doesn’t really listen to them
how do you DRESS like the music you listen to???
as an imagine dragons fan i am never seen not in a full dragon costume
as an arctic monkeys fan this is me
Just a picture of me at the beach being handsome as heck!
Follow my paw prints on Instagram @hunter.thetoller for many more adventures
I always think it’s insane that Trump got elected until I read things like this. Like, how do these people slip though basic education, manage to survive the real world, and even procreate successfully?
I’m always super ambivalent about these stories, for a lot of reasons. Full disclosure: Mom’s a doctor. I am emphatically better educated about Medical Shit than the vast majority of people. Some people are really, really stupid, gods know, and so does the ER (just ask them how often they have to get things that should not be put up human anuses out of human anuses!)
However. I also know – hilariously often from my mother, as well as my own experiences – that a lot of doctors are jerks, and even those who aren’t jerks are often fucking horrible at communication, which is pretty bad, because that’s part of their job.
Further, things from these kinds of lists are often from encounters with:
1. Elderly people who are actually getting into cognitive difficulties, or who haven’t had ANY contact with the medical system in four decades until now suddenly They Have To Go To The Doctor, both of which mean that yeah: there’s shit they don’t know, or can’t understand without clear instructions
2. Immigrants and English language learners for whom this shit is not common knowledge or who are struggling with the language
3. People who are cognitively impaired
and finally,
4. Doctors who are actually fucking terrible at communicating, are authoritarian domineering dicks, and should be ashamed of themselves.
For instance, on this list:
– the guy with the allergy inhaler: if all you’ve been told is “I’m giving you this inhaler to treat your allergies with” and you have no experience with what “inhaler” means (which, AS SOMEONE WITH ASTHMA WHO HAS ONE, I can assure you that many many otherwise basically intelligent people do NOT), it is not actually unreasonable to assume that your supposed to apply it to the thing that’s causing the allergy (aka the pet). Prescribing an inhaler should in fact come along with a lesson on how to use the damn thing, either from the physician or from the pharmacist, and you should make sure the patient is aware that they need to know it.
– okay so this is the big one: the guy with the daughter who aspirated food is a case where either huge detail has been left out of the story, or that doctor is actually culpably fucking negligent. MOST PEOPLE don’t know that the reason you don’t eat before surgery is because of the risk of aspirating food and dying; it is incumbent on MOST PHYSICIANS AND ANAESTHETISTS to fucking tell them and to make sure it’s understood.
This is further exacerbated by the part where I know docs actually recommend fasts that are longer than necessary or that are completely unnecessary for non-surgical things like blood tests (NOT every blood-test needs a fast, and there is a HORRIBLE habit of demanding longer fasts than are needed, with the justification usually being “well people always knock two hours off the fast so I’ll solve this by adding two more hours” or whatever – NO. YOU ARE PART OF THE PROBLEM. MAKE THE GODDAMN EFFORT TO MAKE SURE YOUR PATIENT UNDERSTANDS WHY THEY ARE FASTING), which means that if you HAVEN’T had the aspiration/choking risk explained to you, what you are often presented with is being told that you have to deny your VERY HUNGRY, UPSET, CRYING THREE YEAR OLD DAUGHTER FOOD for no reason other than the (very possibly rude and condescending as fuck) Doctor Said So.
Further, if it was not explained in detail that food in the stomach could cause aspiration that could cause death, then the doc was FURTHER NEGLIGENT because he or she did NOT sufficiently explain the entire procedure to have gotten informed consent to the surgery in the first place. Informed consent actually does require them to sit down and tell you all the things that could go Horribly Wrong.
So unless the doc telling the story has just totally left out the part where he explained in detail and comprehensible language the REASON for the prohibition on eating (which doesn’t tend to get left out of the versions of stories where it’s actually happened, due to how it actually reinforces the OMG THESE PEOPLE), that one was the doctor’s fucking fault and I hope they are ashamed.
(The first person who says “but a doctor would never do that” will be turned over to the segment of tumblr who has experienced Horrific Doctors, and will not be expected to survive.)
–> that said, the woman faking the latex allergy makes me want to scream. Do not do this. Omg. And people DO. DON’T FAKE ALLERGIES.
Also, in the story about the aspiration thing, apparently no one asked at intake, “what time did she last eat or drink?” If they’d asked, that father might have lied OR he might have said “she said she was hungry so I gave her breakfast” and she wouldn’t have ended up in ICU. Given all the other red flags, it sounds like whoever did the intake exam didn’t ask, and that’s something I’d have thought normally gets asked multiple times to make sure since aspiration pneumonia is so serious and so preventable.
I think the one on that list that bothers me the most is the last one. The client left the hospital with their seriously ill child because of their reaction something the doctor said, something to which their response was “stop fucking patronising me and telling me how to raise my daughter just because you think you’re smarter than me.” As a result of this, the patient went into respiratory arrest. The doctor proceeds to… post about this on a Facebook thread about their “dumbest patients”. GEE I WONDER WHAT ABOUT YOUR INTERACTION WITH THIS PERSON MADE THEM THINK YOU’RE PATRONISING AND THINK YOU’RE SMARTER THAN THEM?
My older kid has had surgery twice, and both times like 85 people were VERY INTERESTED in if he had eaten and if so, when.
How crazy incompetent was that hospital? Because in order for that to happen at my local children’s hospital, I would have had to lie repeatedly about when and what my kid had eaten. They were not playing around.
(That story in particular sounds kind of fake to me? Like, lots of details sound medically wrong, like the author wrote it to sound impressive? It’s setting off my bullcrap detector.)
Oh god, all of this. Also, my doctor who said that my two months of constant vomiting was a “psych problem” because i have bipolar can go to hell.
Oh this is where I should tell the story of being in the ER with my kid who had just seriously cut her hand, and I had some PA go “does she have any diseases?” and naturally, I go, no. Then he kept asking and rephrased the question several times. Finally he used the words “developmental impairment” and I figured out he was trying to ask about the fact she’s autistic.
And then he had the audacity to say that I was avoiding the question and I’m like, no sir, screw you, because autism isn’t a fucking DISEASE and relevance? Also dude if I had wanted to deal with even more bullshit I would have been like, fucking neurotypical asshats who can’t ask a straight question. I put on my southern charm and smiled and said, “you could have just asked if she was autistic. It’s not a dirty word.”
He didn’t like me much after that.
Rose, I love you. Also wtf does being autistic have to do with having a cut hand??
Apparently they didn’t like that she was quite a bit afraid of the needle with the painkiller in it.
Which Idk seems to be more of a kid thing than a non neurotypical thing but whatever.
It worked out in the end and that dude made himself scarce. But like, ugh.
So I had this thing happen once…and at the time I did not know what to make of it at all, but I wonder now and then…
One night in college (In Georgia, idk if that’s relevant), I wound up in the ER twice having scary cardiac symptoms. (My heart was racing, my left arm had gone numb, my shoulder hurt like a bitch. I knew it was unlikely I was actually having a heart attack, and I wasn’t, it turned out to be something that is relatively benign, but…scary.)
Anyway, one ER doctor at some point very abrasively asked me “Do you have any other conditions?” and I said no. (I legitimately had no idea at the time I was autistic.) He got more abrasive and goes “Are you sure? You have no other conditions?”
Scared and in pain and confused, I was just like “No??? Can you be more specific???”
But he just dropped the question.
What was he trying to ask? Was I pregnant, was I doing drugs, or did I have an eating disorder are all things that have crossed my mind, but I have no actual idea, because apparently it wasn’t important enough for him to just ask me outright.
Urocyon's Jaunts 2.0 
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