Well Being

Fetish Fight: DSM-V’s Sexual “Paraphilia” List Draws Critics—And Overreaction?

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Woman in bondage collar—a "paraphliia" in the new DSM-5Oh, boy: The American Psychiatric Association is (re)-opening a can of worms re: sexual preferences and mental illness. At issue? The inclusion of certain “paraphilias“—aka sexual fetishes or fixations—in the upcoming Diagnostic and Statistical Manual of Mental Disorders, due out May 2013.

The DSM is used by psychiatric professionals (and health insurance companies) as a diagnostic bible, so the way things are defined in there really does matter. And defining sexuality-related conditions in psychiatry has always been a landmine. Homosexuality was listed in the DSM as a mental disorder until 1973; feeling distressed about one's homosexuality 'til 1986.

The hubbub now relates to what psychiatrists call “paraphilias.” The new DSM-V will define paraphilias as:

“Any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, consenting human partners between the ages of physical maturity and physical decline.”

That's a pretty loaded definition. Phenotypically more-or-less means ‘genetically and biologically' normal, so being attracted to people outside this range is considered paraphilic—as is sexual interest in older adults and any sexual activity outside “genital stimulation and preparatory fondling.”

But having a paraphilia is not, in and of itself, bad. That's the key thing to understand about the DSM's paraphilia list.

Thought the upcoming manual will still list and definite paraphilias, they are not considered mental illnesses, per se. Paraphilias are neutral. Only when one causes significant distress to the person with it or poses harm to others does it become psychiatrically problematic—at which point it gets defined as a “paraphilic disorder.”

Some people object to the DMS's list of paraphilias being so far-reaching. It includes things like fat fetishsm, Abasiophilia (attraction to the physically disabled) and Gynanadromophophilia (an attraction to trans women. [Update/Correction: While these are considered paraphilias, they are actually not included in the current DSM or the draft DSM-V paraphilia lists, as far as I can tell.]

But while those may at first seem like offensive distinctions—what, it's so weird to be attracted to fat people that it needs a psychiatric label?—remember that there are matters of degrees. Just like there's a difference between being attracted to particular Asian women and “having an Asian fetish,” there's a difference between finding different body sizes attractive or having a preference toward larger bodies and only and explicitly sexualizing the very overweight. There's a difference between falling for an amputee and only seeking out sex partners in wheelchairs.

That's not to say there's anything wrong with digging wheelchair sex or having a fat fetish—or a foot fetish, a sadist streak, cuckold fantasies, a love for latex, an abiding attraction to folks over 75 or hardcore exhibitionist tendencies. Follow your sexual bliss, y'all. Lots and lots of people engage in lots and lots of paraphilias and are none the worse (and often so much the better!) for it.

But we all know sexuality is a tricky bird, that sexual feelings can be complicated and intense, and that sexual fixations can potentially become problematic (or those fixated and the objects of their fixation). Fetishes or preferences reach the level of paraphilic disorders all the time, and it just doesn't seem that unreasonable to me that psychiatrists should like to have a handy and agreed upon list defining them.

Elizabeth Nolan Brown, Liz Nolan Brown, Elizabeth Brown, Elizabeth N Brown, sex, kink, fetish, mental health