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Between DSM and ICD: Paraphilias and the Transformation of Sexual Norms

  • Special Section: DSM-5: Classifying Sex
  • Published:
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Abstract

The simultaneous revision of the two major international classifications of disease, the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, serves as an opportunity to observe the dynamic processes through which social norms of sexuality are constructed and are subject to change in relation to social, political, and historical context. This article argues that the classifications of sexual disorders, which define pathological aspects of “sexually arousing fantasies, sexual urges or behaviors” are representations of contemporary sexual norms, gender identifications, and gender relations. It aims to demonstrate how changes in the medical treatment of sexual perversions/paraphilias passed, over the course of the 20th century, from a model of pathologization (and sometimes criminalization) of non-reproductive sexual behaviors to a model that reflects and privileges sexual well-being and responsibility, and pathologizes the absence or the limitation of consent in sexual relations.

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Notes

  1. Meeting of the American Psychiatric Association in San Francisco, CA, 2013; International Academy of Sex Research, Chicago, IL, 2013; World Association for Sexual Health, Porto Alegre, Brasil, 2013.

  2. I served as a member of the Advisory Committee of the World Association for Sexual Health and the UNESCO Chair in Sexual Health and Human Rights.

  3. With regard to this point, see Béjin, 1982; Bland and Doan, 1998; De Block and Adriaens, 2013; Hekma, 2011; Oosterhuis, 2000.

  4. Although it had been included in DSM-I and DSM-II, pedophilia was not included in the ICD-6.

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Acknowledgments

I wish to thank Gert Hekma (University of Amsterdam) and Denise Medico (Foundation Agnodice, Lausanne, Switzerland) for their comments and suggestions on a previous version of this article and the Guest Editors for their support in the clarification of the argument.

Conflict of interest

The author of this article was a special invitee of the WHO Working Group on Sexual Disorders and Sexual Health. The views expressed in this article represent the views of the author and do not represent in any way the official positions of this advisory group or of the World Health Organization. The author alone is responsible for the content and writing of the article.

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  1. Inserm, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018—Team 7: Gender, Sexuality, Health, 82 rue du Général Leclerc, 94276, Le Kremlin Bicêtre, Cedex, France

    Alain Giami

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Giami, A. Between DSM and ICD: Paraphilias and the Transformation of Sexual Norms. Arch Sex Behav 44, 1127–1138 (2015). https://doi.org/10.1007/s10508-015-0549-6

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