Hypoactive Sexual Desire Disorder - Recommended Revisions

Recommended Revisions

Given criticisms of the current DSM classification, a new disorder combining the characteristics of HSDD and sexual arousal disorder has been proposed for the next version of the DSM (the DSM-V, due to be published in 2013). The name proposed for this disorder is Sexual Interest/Arousal Disorder. The criteria proposed for diagnosing this disorder in women are:

1. Lack of sexual interest/arousal of a least 6 months duration as manifest by at least four of the following indicators:

• Absent/reduced interest in sexual activity
• Absent/reduced sexual/erotic thoughts or fantasies
• No initiation of sexual activity and is not receptive to a partner’s attempts to initiate
• Absent/reduced sexual excitement/pleasure during sexual activity (on at least 75% or more of sexual encounters)
• Desire is not triggered by any sexual/erotic stimulus (e.g., written, verbal, visual, etc.)
• Absent/reduced genital and/or nongenital physical changes during sexual activity (on at least 75% or more of sexual encounters)

2. The disturbance causes clinically significant distress or impairment Specifier:

• Lifelong or acquired
• Generalized or situational
• Partner factors (partner’s sexual problems, partner’s health status)
• Relationship factors (e.g., poor communication, relationship discord, discrepancies in desire for sexual activity)
• Individual vulnerability factors (e.g., depression or anxiety, poor body image, history of abuse experience)
• Cultural/religious factors (e.g., inhibitions related to prohibitions against sexual activity)
• Medical factors (e.g., illness/medications)

3. The sexual dysfunction is not better accounted for by another Axis 1 disorder (except for another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

This classification is desirable compared to the current DSM – IV classification system because: (1) it reflects the finding that desire and arousal tend to overlap (2) it differentiates between women who lack desire before the onset of activity, but who are receptive to initiation and or initiate sexual activity for reasons other than desire, and women who never experience sexual arousal (3) it takes the variability in sexual desire into account. Furthermore, the criterion of 4/6 symptoms be present for a diagnosis helps safeguard against pathologizing adaptive decreases in desire.

The limited research in male sexual desire has revealed that it may differ from female sexual arousal in some respects (e.g., tend to have higher masturbation frequency and often continue to masturbate despite low sexual desire ), but that there are likely more within-gender than between-gender differences, there are three options under consideration for the diagnosis of low sexual desire in men:

1. The DSM-IV-TR name and criteria be preserved for men in the DSM-V
2. Proposed criteria for Sexual Interest/Arousal Disorder in women be adopted for men (one gender neutral category)
3. The proposed criteria for Sexual Interest/Arousal Disorder be adopted for men with the modification that absence or reduced genital and/or non-genital physical changes not be included as criterion