Are paraphilias mental disorders ? The case of the DSM

We are happy to welcome Prof. Pieter Adriaens from KU Leuven on Wednesday 19th of February 15h-17h for a CEFISES seminar. Pieter Adriaens works in philosophical anthropology, informed by, but at the same time critical at, the background sciences that take homo sapiens within their scope. He has published on many socially relevant issues, especially related to psychiatry.

Title: Are paraphilias mental disorders? The case of the DSM.     

Abstract: Do paraphilias, previously known as sexual deviations or perversions, belong in psychiatric handbooks? Here I attempt to answer this question by focusing specifically on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA 2013). Early on in the DSM-5 revision process, the work group devoted to revising the subclass of the paraphilias announced a consensus, already implicit in earlier editions of DSM, that paraphilias are not ‘ipso facto mental disorders’ and that by themselves they would ‘not automatically justify or require clinical intervention.’ (APA 2012; italics in original) Therefore, the work group proposed to differentiate between paraphilias and paraphilic disorders: ‘A Paraphilic Disorder is a paraphilia that is currently causing distress and impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others in the past. A paraphilia is a necessary but not a sufficient condition for having a Paraphilic Disorder.’ (APA 2012)

In this paper I argue that, even though the distinction between paraphilias and paraphilic disorders is an interesting concession to earlier and ongoing criticism of the DSM’s dealings with sexual deviance (see, e.g., Moser & Kleinplatz 2005), DSM-5 has trouble justifying its decision to consider at least some unusual sexual behaviours and desires as symptoms of a mental disorder. More particularly, I point out that the handbook’s treatment of sexual deviance is inconsistent with its own definition of the concept of mental disorder. I then consider some attempts to improve this definition, or to apply it more rigorously and consistently, only to find that such attempts are demonstrably unsuccessful. I conclude with a threefold recommendation directed at any psychiatric classification, including DSM-5.