Skip to main content

Advertisement

Springer Nature Link
Log in

Between DSM and ICD: Paraphilias and the Transformation of Sexual Norms

  • Special Section: DSM-5: Classifying Sex
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

See More

The simultaneous revision of the two major international classifications of disease, the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, serves as an opportunity to observe the dynamic processes through which social norms of sexuality are constructed and are subject to change in relation to social, political, and historical context. This article argues that the classifications of sexual disorders, which define pathological aspects of “sexually arousing fantasies, sexual urges or behaviors” are representations of contemporary sexual norms, gender identifications, and gender relations. It aims to demonstrate how changes in the medical treatment of sexual perversions/paraphilias passed, over the course of the 20th century, from a model of pathologization (and sometimes criminalization) of non-reproductive sexual behaviors to a model that reflects and privileges sexual well-being and responsibility, and pathologizes the absence or the limitation of consent in sexual relations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

Notes

  1. Meeting of the American Psychiatric Association in San Francisco, CA, 2013; International Academy of Sex Research, Chicago, IL, 2013; World Association for Sexual Health, Porto Alegre, Brasil, 2013.

  2. I served as a member of the Advisory Committee of the World Association for Sexual Health and the UNESCO Chair in Sexual Health and Human Rights.

  3. With regard to this point, see Béjin, 1982; Bland and Doan, 1998; De Block and Adriaens, 2013; Hekma, 2011; Oosterhuis, 2000.

  4. Although it had been included in DSM-I and DSM-II, pedophilia was not included in the ICD-6.

References

  • Allyn, D. (2000). Make love not war. The sexual revolution: An unfettered history. Boston: Little, Brown & Company.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

    Google Scholar 

  • Angel, K. (2010). The history of ‘female sexual dysfunction’ as a mental disorder in the 20th century. Current Opinion in Psychiatry, 23, 536–541.

    Article  PubMed Central  PubMed  Google Scholar 

  • Angel, K. (2012). Contested psychiatric ontology and feminist critique: ‘Female sexual dysfunction’ and the Diagnostic and Statistical Manual. History of the Human Sciences, 25(4), 3–24.

    Article  PubMed Central  PubMed  Google Scholar 

  • Angel, K. (2013). Commentary on Spurgas’s “Interest, arousal, and shifting diagnoses of female sexual dysfunction”. Studies in Gender and Sexuality, 14, 206–216.

    Article  Google Scholar 

  • Baldwin, J. W. (1994). The language of sex: Five voices from northern France around 1200. Chicago: University of Chicago Press.

    Book  Google Scholar 

  • Bayer, R. (1981). Homosexuality and American psychiatry: The politics of diagnosis. New York: Basic Books.

    Google Scholar 

  • Béjin, A. (1982). Le pouvoir des sexologues et la démocratie sexuelle [Sexologists’ power and sexual democracy]. Communications, 35, 178–191.

    Article  Google Scholar 

  • Bland, L., & Doan, L. (Eds.). (1998). Sexology in culture: Labelling bodies and desires. Cambridge: Polity Press.

    Google Scholar 

  • Bowker, G., & Leigh Star, S. (1999). Sorting things out: Classification and its consequences. Cambridge, MA: MIT Press.

    Google Scholar 

  • Cochran, S. (2012). Sexual orientation and gender related variations in the context of the International Classification of Diseases. Paper presented at the meeting of the American Psychological Association, Orlando, FL.

  • Cochran, S. D., Drescher, J., Kismödi, E., Giami, A., García-Moreno, C., & Reed, G. M. (2014). Declassification of disease categories related to sexual orientation: Rationale and evidence from the Working Group on Sexual Disorders and Sexual Health. Bulletin of the World Health Organization, 92, 672–679.

    Article  PubMed Central  PubMed  Google Scholar 

  • Conrad, P. (2007). The medicalization of society. Baltimore, MD: The Johns Hopkins University Press.

    Google Scholar 

  • Cosgrove, L., & Wheeler, E. E. (2013). Industry’s colonization of psychiatry: Ethical and practical implications of financial conflicts of interest in the DSM-5. Feminism & Psychology, 23, 93–106.

    Article  Google Scholar 

  • Davidson, A. (1987). Sex and the emergence of sexuality. Critical Inquiry, 14, 16–48.

    Article  PubMed  Google Scholar 

  • De Block, A., & Adriaens, P. R. (2013). Pathologizing sexual deviance: A history. Journal of Sex Research, 50, 276–298.

    Article  PubMed  Google Scholar 

  • Demazeux, S. (2013). Qu’est ce que le DSM? Genèse et transformations de la bible américaine de la psychiatrie [What is DSM? Genesis and transformations of the psychiatric american bible]. Paris: Ithaque.

    Google Scholar 

  • Dreger, A. (2010). Of kinks, crimes, and kinds: The paraphilias proposal for the DSM-5. Science and Society. http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4494&blogid=140&blogid=140.

  • Drescher, J. (2014). Controversies in gender diagnoses. LGBT Health, 1, 10–14.

    Google Scholar 

  • Drescher, J., Cohen-Kettenis, P. T., & Winter, S. (2012). Minding the body: Situating gender identity diagnoses in the ICD-11. International Review of Psychiatry, 24, 568–577.

    Article  PubMed  Google Scholar 

  • Duschinsky, R., & Chachamu, N. (2013). Sexual dysfunction and paraphilias in the DSM-5: Pathology, heterogeneity, and gender. Feminism & Psychology, 23, 49–55.

    Article  Google Scholar 

  • Fink, P. J. (2005). Sexual and gender identity disorders: Discussion of questions for DSM-V. Journal of Psychology & Human Sexuality, 17, 117–123.

    Article  Google Scholar 

  • First, M. B., Pincus, H. A., Levine, J. B., Williams, J., Ustun, B., & Peele, R. (2004). Clinical utility as a criterion for revising psychiatric diagnoses. American Journal of Psychiatry, 161, 946–954.

    Article  PubMed  Google Scholar 

  • Fishman, J. R., & Mamo, L. (2001). What’s in a disorder? A cultural analysis of medical and pharmaceutical constructions of male and female sexual dysfunction. Women & Therapy, 24, 179–193.

    Article  Google Scholar 

  • Foucault, M. (1988). The history of sexuality: The will to knowledge (Vol. 1). London: Penguin.

    Google Scholar 

  • Frances, A. (2010). Opening Pandoras box: The 19 worst suggestions for DSM-5. Psychiatric Times. Retrieved from the Internet: http://www.psychiatrictimes.com/display/article/10168/1522341.

  • Franke, K. (2001). Theorizing yes: An essay on feminism, law and desire. Columbia Law Review, 101, 181–208.

    Article  Google Scholar 

  • Gagnon, J. (1975). Sex research and social change. Archives of Sexual Behavior, 4, 111–141.

    Article  PubMed  Google Scholar 

  • Giami, A. (2002). Sexual health: The emergence, development, and diversity of a concept. Annual Review of Sex Research, 13, 1–35.

    PubMed  Google Scholar 

  • Giami, A. (2007). Fonction sexuelle masculine et sexualité féminine. Permanence des représentations du genre en sexologie et en médecine sexuelle [Male sexual function and women sexuality: Permanence of gender representations in sexology and sexual medicine]. Communications, 81, 135–151.

    Article  Google Scholar 

  • Giami, A. (2013). A Sexual Health Z code section in the ICD-11? Paper presented at the meeting of the American Psychiatric Association, San Francisco, CA.

  • Graham, C. A. (2007). Medicalization of women’s sexual problems: A different story? Journal of Sexual and Marital Therapy, 33, 443–447.

    Article  Google Scholar 

  • Grosskurth, P. (1980). Havelock Ellis: A biography. New York: Knopf.

    Google Scholar 

  • Hacking, I. (1999). The social construction of what? Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Hammarberg, C. (2009). Issue Paper on Gender Identity and Human Rights. Strasbourg: Counsel of Europe.

    Google Scholar 

  • Healy, D. (2002). The creation of psychopharmacology. Cambridge, MA: Harvard University Press.

    Book  Google Scholar 

  • Hekma, G. (2011). Sexual variations. In G. Hekma (Ed.), A cultural history of sexuality in the modern age (pp. 79–104). Oxford: Berg.

    Google Scholar 

  • Hekma, G., & Giami, A. (Eds.). (2014). Sexual revolutions. Houndmills, Basingstoke: Palgrave.

    Google Scholar 

  • Herdt, G. (Ed.). (1994). Third sex, third gender: Beyond sexual dimorphism in culture and history. New York: Zone Books.

    Google Scholar 

  • Herzog, D. (2008). Sex in crisis: The new sexual revolution and the future of American politics. New York: Basic Books.

    Google Scholar 

  • Insel, T. R., & Lieberman, J. A. (2013). DSM-5 and RDoC: Shared interests [Press release]. Retrieved from http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdoc-sharedinterests.shtml?utm_source=rss_readers&utm_medium=rss&utm_campaign=rss_summary.

  • Jablensky, A. (1988). An overview of the prospects for ICD-10. In J. Mezzich & M. von Chranach (Eds.), International classification in psychiatry: Unity and diversity (pp. 343–364). Cambridge: Cambridge University Press.

    Google Scholar 

  • Kafka, M. P. (2010). The DSM diagnostic criteria for fetishism. Archives of Sexual Behavior, 39, 357–362.

    Article  PubMed  Google Scholar 

  • Krafft-Ebing, R. (1895). Psychopathia sexualis with special reference to contrary sexual instinct. A medico-legal study. London: F.A. Davis Company.

    Google Scholar 

  • Krueger, R. B. (2010a). The DSM diagnostic criteria for sexual masochism. Archives of Sexual Behavior, 39, 346–356.

    Article  PubMed  Google Scholar 

  • Krueger, R. B. (2010b). The DSM diagnostic criteria for sexual sadism. Archives of Sexual Behavior, 39, 325–345.

    Article  PubMed  Google Scholar 

  • Krueger, R. B. (2013). Sexual disorders and sexual health in the ICD-11: Parallels and contrasts with DSM-5 paraphilic disorders. Paper presented at the meeting of the American Psychiatric Association, San Francisco, CA.

  • Kruger, R. F., & South, S. C. (2009). Externalizing disorders: Cluster 5 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine, 39, 2061–2070.

    Article  Google Scholar 

  • Långström, N. (2010). The DSM diagnostic criteria for exhibitionism, voyeurism, and frotteurism. Archives of Sexual Behavior, 39, 317–324.

    Article  PubMed  Google Scholar 

  • Lanteri-Laura, G. (1979). Lecture des perversions: Histoire de leur appropriation médicale [Lecture of the perversions: A history of their medical appropriation]. Paris: Masson.

    Google Scholar 

  • Laqueur, T. (2003). Solitary sex: A cultural history of masturbation. New York: Zone Books.

    Google Scholar 

  • Latour, B. (1993). We have never been modern. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Laws, D. R., & O’Donohue, W. T. (Eds.). (2008). Sexual deviance: Theory, assessment, and treatment. New York: Guilford Press.

    Google Scholar 

  • Marcus, S. (1964). The other Victorians: A study of sexuality and pornography in mid-nineteenth-century England. New York: Basic Books.

    Google Scholar 

  • McLaren, A. (1999). Twentieth-century sexuality: A history. Oxford: Blackwell.

    Google Scholar 

  • Milner, J. S., & Dopke, C. A. (2008). Paraphilia not otherwise specified. Psychopathology and theory. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment. New York: Guilford Press.

    Google Scholar 

  • Money, J. (1990). Gay, straight, and in-between: The sexology of erotic orientation. Oxford: Oxford University Press.

    Google Scholar 

  • Money, J. (1993). Lovemaps: Clinical concepts of sexual/erotic health and pathology, paraphilia, and gender transposition in childhood, adolescence and maturity. Buffalo, NY: Prometheus Books.

    Google Scholar 

  • Moser, C. (2009). When is an unusual sexual interest a mental disorder? [Letter to the Editor]. Archives of Sexual Behavior, 38, 323–325.

    Article  PubMed  Google Scholar 

  • Moser, C., & Kleinplatz, P. (2005). DSM-IV-TR and the paraphilias: An argument for removal. Journal of Psychology and Human Sexuality, 17, 91–109.

    Article  Google Scholar 

  • Moynihan, R., & Henry, D. (2006). The fight against disease mongering: Generating knowledge for action. PLoS Med, 3(4), e191. doi:10.1371/journal.pmed.0030191.

    Article  PubMed Central  PubMed  Google Scholar 

  • Oosterhuis, H. (2000). Stepchildren of nature: Krafft-Ebing, psychiatry, and the making of sexual identity. Chicago: University of Chicago Press.

    Google Scholar 

  • Petchesky, R. (2000). Rights and needs: Rethinking the connections between in debates over reproductive and sexual rights. Health and Human Rights, 4, 17–30.

    Article  PubMed  Google Scholar 

  • Quinsey, V. L. (2010). Coercive paraphilic disorder. Archives of Sexual Behavior, 39, 405–410.

    Article  PubMed  Google Scholar 

  • Reed, G. (2010). Toward ICD-11: Improving the clinical utility of WHO’s International Classification of Mental Disorders. Professional Psychology: Research and Practice, 41, 457–464.

    Article  Google Scholar 

  • Reiersøl, O., & Skeid, S. (2006). The ICD diagnoses of fetishism and sadomasochism. Journal of Homosexuality, 50, 243–262.

    Article  PubMed  Google Scholar 

  • Robinson, P. (1976). The modernization of sex. New York: Harper & Row.

    Google Scholar 

  • Shindel, A. W., & Moser, C. A. (2011). Why are the paraphilias mental disorders? Journal of Sexual Medicine, 8, 927–929.

    Article  PubMed  Google Scholar 

  • Silverstein, C. (2008). The implications of removing homosexuality from the DSM as a mental disorder [Letter to the Editor]. Archives of Sexual Behavior, 38, 161–163.

    Article  Google Scholar 

  • Soble, A. (1987). Philosophy, medicine, and healthy sexuality. In E. Shelp (Ed.), Sexuality and medicine: Conceptual roots (Vol. 1, pp. 111–138). Boston: D. Reidel Publishing Company.

    Chapter  Google Scholar 

  • Spitzer, R. L. (1988). The revision of DSM-III: Process and change. In J. Mezzich & M. von Chranach (Eds.), International classification in psychiatry: Unity and diversity (pp. 263–283). Cambridge: Cambridge University Press.

    Google Scholar 

  • Spitzer, R. L. (2005). Sexual and gender identity disorders: Discussion of questions for DSM-5. Journal of Psychology & Human Sexuality, 17, 111–116.

    Article  Google Scholar 

  • Spurgas, A. K. (2013). Interest, arousal, and shifting diagnoses of female sexual dysfunction, or: How women learn about desire. Studies in Gender and Sexuality, 14, 187–205.

    Article  Google Scholar 

  • Stekel, W. (1930). Disorders of the instincts and the emotions. Sexual aberrations. The phenomena of fetishism in relation to sex. New York: Liveright Publishing Corporation.

    Google Scholar 

  • Stekel, W. (1951). Onanisme et homosexualité. La parapathie homosexuelle [Onanism and homosexuality. The homosexual parapathia]. Paris: Gallimard.

    Google Scholar 

  • Stoller, R. J. (1991). Pain and passion: A psychoanalyst explores the world of S&M. New York: Plenum.

    Book  Google Scholar 

  • Tiefer, L. (1996). The medicalization of sexuality: Conceptual, normative, and professional issues. Annual Review of Sex Research, 7, 252–282.

    Google Scholar 

  • Tosh, J. (2011). The medicalisation of rape: A discursive analysis of ‘paraphilic coercive disorder’ and the psychiatrisation of sexuality. Psychology of Women Section Review, 13, 2–12.

    Google Scholar 

  • Ungerer, T. (2000). S.M.. Paris: Le Cherche-Midi.

    Google Scholar 

  • World Health Organization. (1975). The ICD-9 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. Geneva: Author.

    Google Scholar 

  • World Health Organization. (1990). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. Geneva: Author.

    Google Scholar 

  • Young, A. (1995). The harmony of illusions: Inventing post-traumatic stress disorder. Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Zucker, K. J. (2002). From the Editor’s Desk: Receiving the torch in the era of sexology renaissance [Editorial]. Archives of Sexual Behavior, 31, 1–6.

    Article  PubMed  Google Scholar 

  • Zucker, K. J. (2010). Reports from the DSM-V Work Group on Sexual and Gender Identity Disorders. Archives of Sexual Behavior, 39, 217–220.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

I wish to thank Gert Hekma (University of Amsterdam) and Denise Medico (Foundation Agnodice, Lausanne, Switzerland) for their comments and suggestions on a previous version of this article and the Guest Editors for their support in the clarification of the argument.

Conflict of interest

The author of this article was a special invitee of the WHO Working Group on Sexual Disorders and Sexual Health. The views expressed in this article represent the views of the author and do not represent in any way the official positions of this advisory group or of the World Health Organization. The author alone is responsible for the content and writing of the article.

Author information

Authors and Affiliations

  1. Inserm, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018—Team 7: Gender, Sexuality, Health, 82 rue du Général Leclerc, 94276, Le Kremlin Bicêtre, Cedex, France

    Alain Giami

Authors
  1. Alain Giami
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Alain Giami.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Giami, A. Between DSM and ICD: Paraphilias and the Transformation of Sexual Norms. Arch Sex Behav 44, 1127–1138 (2015). https://doi.org/10.1007/s10508-015-0549-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-015-0549-6

Keywords