Distress caused by mismatched sexual desire

[Olivier]

This thread was inspired by a discussion over on http://www.asexuality.org/discussion/viewtopic.php?t=28358. Rather than hijack that thread, I'm expanding my thoughts over here. In the other thread...

I see this perception of mental disorders a lot and as a psych major its annoying to see that people have this wrong perception of what a mental disorder actually is. A mental disorder is an abnormal pattern of behavior which causes a person distress or interferes in their daily life. So if you're fine having a low libido and its not causing any problems with a relationship then you can't be diagnosed with HSDD. But if it is distressing you or interfering with your life then you can be diagnosed. Those same criteria (distress and/or interference with daily life) are needed to make any mental disorder diagnosis so rest assured you'll never be treated for a mental disorder unless there's an actual problem resulting from it.

Lets say we have two people with different levels of sexual desire. One could be sexual and the other asexual, or one could be hypersexual and the other hyposexual. Let's call them "WantsItDaily" and "DoesNotWantIt". And let's assume their both perfectly happy with their levels of sexual desire.

Now at this point we have two happy people. Not a mental disorder in sight.

Moving on, lets assume that WantsItDaily and DoesNotWantIt meet, find they have much in common, love each other's company, and start a relationship in the full or partial knowledge that they have mismatched levels of sexual desire.

At first, there's plenty of sex. DoesNotWantIt wants to make WantsItDaily happy, and WantsItDaily is indeed a happy camper. But DoesNotWantIt comes to realise that it's not really working for them, to the point where they feel trapped and distressed. So now it would appear that DoesNotWantIt could be diagnosed with HSDD, as their desire for a relationship with a more sexual person is causing them distress as it conflicts with their own lower level of desire.

But what if instead of going off for treatment for HSDD, DoesNotWantIt decides to have a good talk with WantsItDaily about the distress the level of sexual activity in their relationship is causing. WantsItDaily is a considerate person, apologises for any hurt their high level of desire has cuased, and decides to mostly or entirely give up sex for the sake of a relationship the care deeply about. DoesNotWantIt is happy again.

So without changing at all, DoesNotWantIt has gone from mentally healthy, to diagnosable with the mental disorder HSDD, and back to mentally healthy. All the time they were happy with little or no sex, but for a while when they were having frequent sex they had a mental disorder. That doesn't seem credible to me, unless the mental disorder was not HSDD, but a depressive illness - and they're not usually treated with testosterone supplementation. Hmmmm....

Meanwhile, the lack of sex is driving WantsItDaily crazy. In fact it's causing real distress. Does WantsItDaily now have a mental disorder? Despite having a level of desire they are happy with, and that would be considered normal? Should they be treated with bromide? (Sure that doesn't work, but neither does testosterone supplementation for asexuals.)

WantsItDaily tells DoesNotWantIt that the lack of sex is causing distress. DoesNotWantIt is unhappy about that, but isn't keen to go back to a situation that caused them distress to the point of being diagnosable. Now maybe in this relationship a compromise is possible, and maybe it's not - that's going to depend on other factors, and is beside the point.

What I'm more interested in is that here we have two happy, mentally healthy people. But when they are in a relationship, and their sexual incompatibility is causing distress, one of the two is going to be diagnosable with a mental disorder due to the distress that causes, and it's going to be the one who has sacrificed their preferred level of sexual activity for the benefit of the other.

In my own relationship I've experienced both sides of the coin - when the compromise hasn't been perfectly balanced each of us has suffered periods of distress. But I'm also wary of HSDD as a diagnosis. Seeing it as only one person's problem, rather than a problem for the couple, seems unrealistic.

I'm not sure I have any answers, but I'd love to hear what others think of this situation, where one person's mental health may be fine when looked at in isolation, but disordered when seen through the prism of the sexual expectations of their partner. And given that it can work both ways, how do you decide who has the "disorder"?

[Lirelyn]

And this is why relationships = death.

(er... kidding there. Almost entirely.)

But you make a good point, and it's something I've wondered about every time I hear the "causes distress/does not cause distress" criterion of a disorder. It's pretty vague and leaves so much grey area. Your example just makes it evident that the current language psychology uses is inadequate.

Before too long, I imagine, seeing enough cases like these in clinical practice will force a change in the language of psychology. Instead of trying to diagnose someone with a "disorder" of sexuality, a therapist meeting with someone whose sex drive is unusual (high, low, or non-existent) will help them figure out how best to adjust so they can live a healthy life. For some people, this will involve medication or therapy aimed at increasing or decreasing their sex drive -- not because they have a "disorder" while all us happy asexuals are just "different", but because they feel their quality of life would be improved if they wanted it more, or less.

That's my vision of a psychological utopia, anyway.

[jr1]

if people can't accept us we need to "kick them to the curb" as people used to say

[andrew_w]

Lets say we have two people with different levels of sexual desire. One could be sexual and the other asexual, or one could be hypersexual and the other hyposexual. Let's call them "WantsItDaily" and "DoesNotWantIt". And let's assume their both perfectly happy with their levels of sexual desire.

Now at this point we have two happy people. Not a mental disorder in sight.

Moving on, lets assume that WantsItDaily and DoesNotWantIt meet, find they have much in common, love each other's company, and start a relationship in the full or partial knowledge that they have mismatched levels of sexual desire.

At first, there's plenty of sex. DoesNotWantIt wants to make WantsItDaily happy, and WantsItDaily is indeed a happy camper. But DoesNotWantIt comes to realise that it's not really working for them, to the point where they feel trapped and distressed. So now it would appear that DoesNotWantIt could be diagnosed with HSDD, as their desire for a relationship with a more sexual person is causing them distress as it conflicts with their own lower level of desire.

But what if instead of going off for treatment for HSDD, DoesNotWantIt decides to have a good talk with WantsItDaily about the distress the level of sexual activity in their relationship is causing. WantsItDaily is a considerate person, apologises for any hurt their high level of desire has cuased, and decides to mostly or entirely give up sex for the sake of a relationship the care deeply about. DoesNotWantIt is happy again.

So without changing at all, DoesNotWantIt has gone from mentally healthy, to diagnosable with the mental disorder HSDD, and back to mentally healthy. All the time they were happy with little or no sex, but for a while when they were having frequent sex they had a mental disorder. That doesn't seem credible to me, unless the mental disorder was not HSDD, but a depressive illness - and they're not usually treated with testosterone supplementation. Hmmmm....

Meanwhile, the lack of sex is driving WantsItDaily crazy. In fact it's causing real distress. Does WantsItDaily now have a mental disorder? Despite having a level of desire they are happy with, and that would be considered normal? Should they be treated with bromide? (Sure that doesn't work, but neither does testosterone supplementation for asexuals.)

WantsItDaily tells DoesNotWantIt that the lack of sex is causing distress. DoesNotWantIt is unhappy about that, but isn't keen to go back to a situation that caused them distress to the point of being diagnosable. Now maybe in this relationship a compromise is possible, and maybe it's not - that's going to depend on other factors, and is beside the point.

What I'm more interested in is that here we have two happy, mentally healthy people. But when they are in a relationship, and their sexual incompatibility is causing distress, one of the two is going to be diagnosable with a mental disorder due to the distress that causes, and it's going to be the one who has sacrificed their preferred level of sexual activity for the benefit of the other.

In my own relationship I've experienced both sides of the coin - when the compromise hasn't been perfectly balanced each of us has suffered periods of distress. But I'm also wary of HSDD as a diagnosis. Seeing it as only one person's problem, rather than a problem for the couple, seems unrealistic.

Exactly. That's why I said HSDD is (usually) bogus, because asexuality and hyposexuality don't (usually) cause problems in and of themselves; when there are problems, it is usually due to differing levels of drive or desire.

The only time when I would say that HSDD isn't a bogus diagnosis would be if someone who had a "normal" level of drive/desire in the past lost some or all of it due to hormonal problems or drugs, and wants it back.

[Hallucigenia]

Olivier, you hit the nail on the head.

I have actually seen differing-levels-of-sexual-desire-in-a-relationship classified as a disorder (on the Internet, though, so I'm not sure whether it was worth taking seriously). Certainly it can cause distress, but it weirded me out even so.

Perhaps we need to think of this, not as a mental disorder on the part of anyone in particular, but as a "disordered relationship". (This is not meant to be any sort of value judgement on the relationship; a disordered relationship can be worth having despite the disorder, just as people with individual mental disorders can be worth befriending and including in society.)

Maybe such terms are already in use. I don't remember enough clinical psychology right now to tell you.

Before too long, I imagine, seeing enough cases like these in clinical practice will force a change in the language of psychology. Instead of trying to diagnose someone with a "disorder" of sexuality, a therapist meeting with someone whose sex drive is unusual (high, low, or non-existent) will help them figure out how best to adjust so they can live a healthy life. For some people, this will involve medication or therapy aimed at increasing or decreasing their sex drive -- not because they have a "disorder" while all us happy asexuals are just "different", but because they feel their quality of life would be improved if they wanted it more, or less.

Wouldn't that be nice? Hear, hear!

[OwlSaint]

Mismatches there will probably mean trouble, especially if there is a very strong difference.

I support the idea that nobody is inherently "disordered" for whatever their level is, be it "wants it 3 times daily" or "don't ever", and that any and all grief caused by it is actually caused by a mismatch in the needs and abilities of the partner.

I'll bet a lot of people with that kind of mismatch directly affecting them very often wish there was something that could be done to modify the wants of one another to create a better match.