The American Psychiatric Association (APA) has recently published the latest edition of the diagnostic statistical manual (DSM-5) of mental disorders.
The most significant innovations introduced in the manual as regards the changes between the nosography of sexual disorders are presented below.
Unlike the previous edition, in the DSM-5 i sexual disorders they are no longer congloble in the same category but in three distinct categories: the Genrethe Paraphilicthe Sexual dysfunctions.
In the DSM-IV, however, sexual dysfunctions concerned sexual pain or a disorder in one or more phases of the sexual response cycle.
Research suggests that the sexual response is not always a uniform linear process and that the distinction between some phases (for example, desire and excitement) can be artificial.
In the DSM-5, they were added sexual dysfunctions specifics by gender, and, for females, sexual desire disorder and sexual excitement disorder have been combined in a single disorder: Disorder of female sexual desire and sexual excitement.
Here are the criteria:
Lack, or significant reduction, of desire/sexual excitement, as manifested by at least 3 of the following problems:
• absent or reduced interest in sexual activity;
• absent or reduced sexual/erotic thoughts or fantasies;
• No initiative of sexual activity and no response to attempts by the partner;
• absent or reduced pleasure and sexual excitement during sexual activity;
• desire is not unleashed by any sexual stimulus;
• absent or reduced genital and/or non -genital changes during sexual activity.
B. The symptoms are prolonged at least for about 6 months
C. The problem causes clinically significant discomfort or impediments;
D. Sexual dysfunction is not better justified by another axis disorder and is not due exclusively to the direct physiological effects of a substance or a general medical condition.
Also the vaginism and the dispareuniawhich were often coexisting and difficult to distinguish, they were conglObed in Package-pelvic pain disorder and penetration.
The proposal to bring them together in a single disorder was dictated by the real difficulty of differentiating these two disorders in clinical practice. Here are the criteria:
A. Persistent and recurring difficulty in at least one of the following problems:
• inability to have a vaginal penetration;
• marked pelvic and vaginal pain during the relationship or attempts of vaginal penetration;
• marked fear and anxiety for vaginal penetration or for pelvic and vaginal pain first, during or as a result of vaginal penetration;
• Marked tension and hardening of the pelvic muscles during the attempts of vaginal penetration.
B. The symptoms are prolonged at least for about 6 months
C. The problem causes clinically significant discomfort or impediments;
D. Sexual dysfunction is not better explained by another axis disorder and not due exclusively to the direct physiological effects of a substance or general medical condition.
For the male gender, thedelayed ejaculation and thepremature ejaculationwhich in the DSM-IV were included in orgasm disorders, in the DSM-5 are classified into separate diagnostic categories.
In the DSM-5 the erectile disorder, the disorder of female orgasm, the disorder of male hypothetical sexual desire are maintained.
The disorder from sexual aversion It has been abolished by the main categories and relegated to “other specific sexual dysfunctions” due to the rare use of the diagnosis and the lack of support from the research data.
Clinical studies have highlighted that individuals to whom this diagnosis is attributed perfectly meet the criteria for sexual desire disorder or hypothetical sexual desire disorder.
For those individuals who show open aversion to stimuli and sexual situations, the diagnosis of Specific phobia.
To increase precision and reduce overestimation, dysfunctions must have a minimum duration of six months, with the exception of those secondary to the use of psychoactive substances. These changes provide useful thresholds to make a diagnosis and distinguish transitory sexual difficulties from more persistent dysfunctions.
To identify the debut of the difficulty, some subtypes are used: permanent/acquired and generalized/situational:
• “permanent” if a sexual problem is present from the first sexual experiences
• “acquired” if sexual disorders develop after a period of normal sexual performance
• “generalized” if sexual difficulties are not limited to certain types of stimulation, situation or partner
• “situational” if sexual difficulties occur only with some types of stimulation, situation or partner
The distinction between dysfunctions linked to biological factors or psychic factors has been abolished, convenientlyon that both these aspects often take part. Factors relating to the partner, the report, individual vulnerability, religious and cultural factors and medical factors are also examined.
Once again, however, the recommendation is to consider the sexual symptoms as mental disorders only after excluding any organic component. The collaboration between specialists is therefore further enhanced.
Bibliography
American Psychiatric Association (2013). Diagnostic and Statistic Manual of Mental Disorders, Fifth Edition.
