Sexual kinks in the DSM V: Paraphilic disorders describe unhappy kinksters.

Happy Kinksters Don’t Have a Mental Disorder—but Unhappy Ones Do?

Happy Kinksters Don’t Have a Mental Disorder—but Unhappy Ones Do?

Health and medicine explained.
March 8 2013 8:11 AM

We’re Kinky, Not Crazy

Including “paraphilic disorders” in the DSM V is redundant, unscientific, and stigmatizing.

A woman who goes by the name Sweet Meatball is restrained with large barbed hooks in a device called The Gate at the DomConLA convention
A woman is restrained in a device called "The Gate" at the DomConLA convention on May 18, 2012, in Los Angeles.

Photo by David McNew/Getty Images

The American Psychiatric Association has decided that people with kinky sexual interests (which—let’s just get this out of the way—includes me) don’t necessarily have mental disorders. That seems like good news, right? If we look up sexual masochism, fetishism, transvestism, or sadism in the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, they won’t be there! In their place, we’ll find a new list of “paraphilic disorders”: sexual masochism disorder, fetishistic disorder, transvestic disorder, and so on. The difference? To be diagnosed with one of these noncriminal sexual disorders, the person must “feel personal distress about their interest.”

Simply put, the DSM V will say that happy kinksters don’t have a mental disorder. But unhappy kinksters do.

Some sexual minorities have applauded this diagnostic compromise as a step forward. It isn’t. This is just the same routine that the psychiatric community dragged homosexuality through decades ago, and adult, consensual (in other words, noncriminal) expressions of atypical sexuality should be removed from the DSM entirely for many of the same reasons that homosexuality was.


In 1952, the DSM I officially categorized homosexuality as a mental disorder. As the gay rights movement gathered momentum in the 1960s, however, the psychiatric community introduced a diagnostic compromise by saying that people who were comfortable with their sexual orientation did not have a mental disorder. The APA triumphantly removed general homosexuality from the DSM in 1973. But for people who were "in conflict with" their homosexuality, they introduced a new condition instead: “sexual orientation disturbance” (SOD). The 1980 DSM III replaced SOD with "ego-dystonic homosexuality," but the basic principle remained the same: Happy homosexuals did not have a mental disorder, while unhappy ones did. 

The term paraphilia—which sexologist John Money defined as unusual sexual interests—first appeared in the DSM III. (Before that, the DSM II listed homosexuality, masochism, sadism, transvestism, fetishism, and other consensual minority sexualities alongside criminal pedophilia and frotteurism in the category of “sexual deviations.”) Although there were minor wording changes to the subsequent DSM IV and DSM IV-TR, psychiatric consensus continued to lump noncriminal paraphilias together with criminal paraphilias as mental disorders.

Thankfully, all forms of homosexuality (including ego-dystonic homosexuality) were finally removed from the DSM in 1987, after a long struggle and far too late. Noncriminal sexual paraphilias should also be removed for many of the same reasons that homosexuality was: People who are stigmatized and misunderstood, such as sexual minorities, might be unhappy—but the unhappiness itself is the problem that should be treated, not the person’s sexual identity or practice.

To be clear, I’m not comparing the experience of being kinky to the experience of being gay, lesbian, bisexual, or transgender. No one is trying to stop kinky people from getting married or, with a few exceptions, threaten our physical safety. The LGBTQ community has serious human rights violations to contend with; most kinksters face nothing more serious than internal turmoil, awkward conversations with new partners, and cultural mockery.