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Arch Sex Behav (2010) 39:240255 DOI 10.1007/s10508-009-9535-1
ORIGINAL PAPER
The DSM Diagnostic Criteria for Female Sexual Arousal Disorder
Cynthia A. Graham
Published online: 24 September 2009 American Psychiatric Association 2009
Abstract This article reviews and critiques the DSM-IV-TR diagnosticcriteriaforFemaleSexualArousalDisorder(FSAD). An overview of how the diagnostic criteria for FSAD have evolved over previous editions of the DSM is presented and research on prevalence and etiology of FSAD is briey reviewed. Problems with the essential feature of the DSM-IV-TR diagnosisan inability to attain, or to maintainan adequate lubrication-swellingresponseofsexualexcitementareidentied. The signicant overlap between arousal and desire disorders is highlighted. Finally, specic recommendations for revision of the criteria for DSM-V are made, including use of a polythetic approachtothe diagnosisandtheadditionofduration and severity criteria.
Keywords Sexual arousal disorder DSM-V
Sexual problems Women
Introduction
diagnosticcategoriesaresimplyconcepts,justiedonly by whether they provide a useful framework for organizingandexplainingthecomplexityofclinicalexperiencein order to derive inferences about outcome and to guide decisions about treatment. (Kendell & Jablensky, 2003, p. 5)
The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association, 1980) was the rst to include the category of Psychosexual Disorders, dened as inhibitions in sexual desire or the psycho-
physiological changes that characterize the sexual response cycle (p. 261). Utilizing the human sexual response cycle (HRSC) model developed by Masters and Johnson (1966) as the framework, inhibition could occur at any one or more of the following phases: appetitive, excitement, orgasm, and resolution. The most recent edition of DSM (DSM-IV-TR) (American Psychiatric Association, 2000) preserved this basic structure, classifying sexual dysfunctions into the following categories: Sexual Desire Disorders, Sexual Arousal Disorders, Orgasmic Disorders, Sexual Pain Disorders, Sexual Dysfunction due to a General Medical Condition, Substance-Induced Sexual Dys-function, and Sexual Dysfunction Not Otherwise Specied.
The purpose of this article is to review and critique the DSM diagnosticcriteriaforFemaleSexualArousalDisorder(FSAD). An overview of how the diagnostic criteria for FSAD have evolved over the last three editions of the DSM will rst be presented. Following this, research on the prevalence and etiology of FSAD will be reviewed, and the relationship between arousal problems and distress discussed. Previous critiques of DSM and revised denitions that have been put forward will be reviewed. The specic diagnostic criteria for FSAD will be critically examined and key issues that should be considered...