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What the DSM-IV says once and for all

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Okay folks. I don't know why I didn't do this before...or maybe I did and can't find the thread. But in any case, here is the DSM-IV Checklist for

Hypoactive Sexual Desire Disorder

1. Persistent or recurrent deficiency of sexual fantasies and desire for sexual activity.

2. Significant distres or interpersonal difficulty.

Sexual Aversion Disorder

1. Persistent or recurrent extreme aversion to, and avoidance of, almost all genital contact with a sexual partner.

2. Significant distress or interpersonal difficulty.

Notice you have to be "significantly distressed" for it to be a "disorder." I know some of us here have had run-ins with less than sympathetic psychologists...who should really know better!

The section goes on to say:

The desire phase of the sexual response cycle consists of an urge to have sex, sexual fantasies, and sexual attraction to others (see Figure 13-2). Two dysfunctions--hypoactive sexual desire and sexual aversion--affect the desire phase. A client named Ms. Bryarton experiences both of these disorders: (Ms. Bryarton's testimonial edited out)...

Hypoactive sexual desire is a lack of interest in sex and, in turn, a low level of sexual activity (see Table 13-1). Nevertheless, when people with hypoactive sexual desire do have sex, their physical responses may be normal and they may enjoy the experience. While our culture portrays men as wanting all the sex they can get, hypoactive sexual desire may be found in as many as 16 percent of men, and the number seeking therapy has increased during the past decade (Heiman, 2002; Laumann et al., 1999) (emphasis added). It may also be found in 33 percent of women (emphasis added). It is important to recognize that a number of people experience normal sexual interest and arousal but choose, as a matter of lifestyle, not to engage in sexual relations. These individuals are not diagnosed as having hypoactive sexual desire.

DSM-IV defines hypoactive sexual desire as "deficient or absent sexual fantasies and desire for sexual activity," but it does not specify what a "deficient" level is. In fact, this criterion is difficult to define (Bach, Wineze, & Barlow, 2001; LoPiccolo, 1995). Age, number of years married, education, social class, race, and other factors may all influence the frequency of sex (see Box 13-1 on the next page). In one survey, 93 happily married couples were asked to report how often they desire sexual encounters. Almost all of them said that they desire sex at least once every two weeks, and around 85 percent reported a desire rate of several times a week or more. On the basis of this survey, sexual desire would be considered hypoactive only when a person desires sex less frequently than once every two weeks.

People with sexual aversion find sex distinctly unpleasant or repulsive (see again Table 13-1). Sexual advances may sicken, disgust, or frighten them. Some people are repelled by a particular aspect of sex, such as penetration of the vagina; others experience a general aversion to all sexual stimuli, including kissing or touching. Aversion to sex seems to be quite rare in men and somewhat more common in women (Heiman 2002) (emphasis added).

A person's sex drive is determined by a combination of biological, psychological, and sociocultural factors, and any of them may reduce sexual desire (Williams & Leiblum, 2002). Most cases of low sexual desire or sexual aversion are caused primarily by sociocultural and psychological factors, but biological conditions can also lower sex drive significantly (Kresin, 1993).

Short sections describing possible biological, psychological, and sociocultural causes (or the elusive Box 13-1) I can copy upon request.

Comer, R. J. Abnormal Psychology (5th edition). Worth Publishers: New York, 400-402.

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