What's Crazy? Sexual Fetishes Spur Psychiatric Manual Controversy

http://www.livescience.com/28382-sexual-fetishes-kinks-dsm.html

Should a sexual fixation on shoes or a predilection for pain land you in the psychiatrist's bible of diagnoses? Plenty of kinksters say no, but psychiatrists say yes — for now.

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The exact wording of the new DSM is being kept under strict wraps until its publication. But proposed changes discussed online by the American Psychiatric Association researchers who worked on the new edition suggest that foot fetishists and bondage aficionados who hoped to get out of the book altogether won't see that wish come true.

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Instead, unusual sexual fixations, or "paraphilias," will likely get their own category as odd, but not necessarily signs of mental illness. If, however, a person is distressed by a fetish — or if that fetish harms others — he or she will likely be eligible for a diagnosis of a "paraphilic disorder."

"This was a way of saying it's OK to have a benign paraphilia," said Ray Blanchard, a psychiatrist at the University of Toronto and chair of the working group on sexual and gender identity disorders for the DSM-5. "That does not automatically give you a mental disorder." Other psychiatrists argue that even leaving benign paraphilias in the DSM goes too far. Sexual fixations that cause harm and distress can be dealt with under other diagnoses, they say, ones that don't stigmatize people who enjoy non-mainstream but harmless sexual activities.

"I've heard people at meetings talk about 'those paraphiliacs,' 'those people,'" said Alan Shindel, an urologist and specialist in sexual problems at the University of California, Davis Health System. "I think that's always a dangerous road to go down when you're talking about othering people in that way."

Some psychiatrists and paraphilics even draw parallels between their position and that of gays and lesbians, who were considered mentally ill until homosexuality was removed from the DSM in 1974.

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